Implantation Group Research Articles

Physical well-being recovery trajectories by reconstruction modality in women undergoing mastectomy and breast reconstruction: Significant predictors and health-related quality of life outcomes.

We sought to identify trajectories of patient-reported outcomes, specifically physical well-being of the chest (PWBC), in patients who underwent postmastectomy breast reconstruction, and further assessed its significant predictors, and its relationship with health-related quality of life (HRQOL). We used data collected as part of the Mastectomy Reconstruction Outcomes Consortium study within a 2-year follow-up in 2012-2017, with 1422, 1218,1199, and 1417 repeated measures at assessment timepoints of 0,3,12, and 24 months, respectively. We performed latent class growth analysis (LCGA) in the implant group (IMPG) and autologous group (AUTOG) to identify longitudinal change trajectories, and then assessed its significant predictors, and its relationship with HRQOL by conducting multinomial logistic regression. Of the included 1424 patients, 843 were in IMPG, and 581 were in AUTOG. Both groups experienced reduced PWBC at follow-up. LCGA identified four distinct PWBC trajectories (χ2 = 1019.91, p<0.001): low vs medium high vs medium low vs high baseline PWBC that was restored vs. not-restored after 2 years. In 76.63%(n = 646) of patients in IMPG and 62.99% (n = 366) in AUTOG, PWBC was restored after two years. Patients in IMPG exhibited worse PWBC at 3 months post-surgery than that in AUTOG. Patients with low baseline PWBC that did not improve at 2-year follow up (n = 28, 4.82% for AUTOG) were characterized by radiation following reconstruction and non-white ethnicity. In IMPG, patients with medium low-restored trajectory were more likely to experience improved breast satisfaction, while patients developing high-restored trajectories were less likely to have worsened psychosocial well-being. Although more women in IMPG experienced restored PWBC after 2 years, those in AUTOG exhibited a more favorable postoperative trajectory of change in PWBC. This finding can inform clinical treatment decisions, help manage patient expectations for recovery, and develop rehabilitation interventions contributing to enhancing the postoperative quality of life for breast cancer patients.

Echo intensity and gray-level co-occurrence matrix analysis of soft tissue grafting biomaterials and dental implants: an in vitro ultrasonographic pilot study.

To characterize different allogeneic and xenogeneic soft tissue graft substitutes and to assess their echo intensity and grayscale texture-related outcomes by using high-frequency ultrasonography (HFUS). Ten samples from each of the following biomaterials were scanned using HFUS: bilayered collagen matrix (CM), cross-linked collagen matrix (CCM), multilayered cross-linked collagen matrix (MCCM), human-derived acellular dermal matrix (HADM), porcine-derived acellular dermal matrix (PADM), collagen tape dressing (C) and dental implants (IMPs). The obtained images were then imported in a commercially available software for grayscale analysis. First-order grayscale outcomes included mean echo intensity (EI), standard deviation, skewness, and kurtosis, while second-order grayscale outcomes comprised entropy, contrast, correlation, energy and homogeneity derive from the gray-level co-occurrence matrix analysis. Descriptive statistics were performed for visualization of results, and one-way analysis of variance with Bonferroni post-hoc tests were performed to relative assessments of the biomaterials. The statistical analysis revealed a statistically significant difference among the groups for EI (p < .001), with the group C showing the lowest EI, and the IMP group presenting with the greatest EI values. All groups showed significantly higher EI when compared with C (p < .001). No significant differences were observed for energy, and correlation, while a statistically significant difference among the groups was found in terms of entropy (p < 0.01), contrast (p < .001) and homogeneity (p < .001). IMP exhibited the highest contrast, that was significantly higher than C, HADM, PADM, CCM and CM. HFUS grayscale analysis can be applied to characterize the structure of different biomaterials and holds potential for translation to in-vivo assessment following soft tissue grafting-related procedures.

Comparison of Clinical Outcomes of Intraortic Balloon Pump Versus Impella in Patients with Cardiogenic Shock: A Real-World Analysis

Background Benefits of temporary mechanical circulatory support has not been demonstrated successfully in clinical trials despite their increased widespread use in the real-world management of patients with cardiogenic shock (CS). Methods Using the Nationwide Readmissions Database from Jan 2016 to Nov 2017, we identified all patients admitted with CS requiring either only intra-aortic balloon pump (IABP) or Impella device implantation (IM) with 30-day follow up. Patients with combined devices or undergoing medical management only were excluded. Propensity matched (1:1) was performed based on demographics and comorbidities to compare the survival, complications, and use of advanced heart failure therapies. Results Out of a total of 236156 patients, 32850(13.9%) had IABP and 8389(3.5%; unweighted n= 4504) patients had IM implantation. Well-matched 4411-pairs of matched IABP vs IM patients had mean similar age (65 vs 64.9 years), women (29.2% vs 28.6%), and acute myocardial infarction (75.7% vs 75.8%). In terms of therapy, no differences in use of right heart catheterization/pulmonary catheter placement or vasopressor use(p>0.05 for all). IM group had higher mortality (45.8% vs. 28.6%, p Conclusion Significant number of CS patients undergo IM implantations with widely different survival as well as candidacy for a heart transplant. The underlying patient- and physician-related differences need to further be explored prior to widespread use of this powerful technology.

Post-abortion long-acting reversible contraception in a sample of Italian women: intrauterine device versus subdermal implant

Long-acting reversible contraceptives (LARC) represent an especially effective kind of post-abortion contraception. We aimed at assessing satisfaction, discontinuation, efficacy, and tolerability associated with either levonorgestrel intrauterine device (L-IUCD), the copper intrauterine device (C-IUCD) and implant (IMP) after termination of pregnancy (TOP). We recorded baseline data about the patients and performed phone surveys at 3, 6 and 12 months after insertion to assess the bleeding profile. Furthermore, women were inquired about possible adverse events, satisfaction, and discontinuation at 12 months after insertion. LARC continuers (>12 months after TOP) were divided into three groups: L-IUCD (n = 47), C-IUCD (n = 6) and IMP (n = 36). Satisfaction rates among L-IUCD users were higher than among IMP users (100% vs. 72.2%, p < .05). A higher, yet not significant, share of patients decided to withdraw contraception in IMP group (3.6% in IUCD group and 12.2% in IMP group). The bleeding profile was significantly more favorable among L-IUCD users than among IMP users. Finally, the reported rate of treatment-associated adverse events did not differ significantly among the groups. L-IUCD insertion after TOP is associated with higher satisfaction and lower discontinuation rates than IMP. Such pattern could be attributed to a more favorable bleeding profile.

Pain from Dental Implant Placement, Inflammatory Pulpitis Pain, and Neuropathic Pain Present Different Somatosensory Profiles.

To address the two following questions: (1) What kind of somatosensory abnormalities may be characterized in patients receiving dental implants (IMP), in ongoing inflammatory dental pulpitis (IP) patients, and in neuropathic pain (atypical odontalgia [AO]) patients? and (2) What sort of sensory and neural changes may result from dental implant placement surgery and pulpectomy? A total of 60 subjects were divided into three groups: the IMP (n = 20), IP (n = 20), and AO groups (n = 20). Quantitative sensory testing (QST) was performed preoperatively (baseline) for all three groups and postoperatively at 1 month and 3 months after dental implant placement or pulpectomy (in the IMP group and IP group, respectively). Statistical analyses were completed with one-way and two-way analysis of variance and z score transformations (α = 5%). The main findings of this study indicated that: (1) Elevations in mechanical detection threshold (MDT) and in current perception threshold (CPT) related to C-fiber activation, indicating a loss of function, were found at baseline in IP patients; (2) Somatosensory abnormalities such as allodynia, reduced MDT and mechanical pain threshold (MPT), and impaired pain modulation were found in AO patients; (3) No somatosensory alterations after implant placement were found in the IMP group; and (4) Somatosensory alterations in the form of reduction in the CPT related to C-fiber activation were reported 3 months after pulpectomy in the IP group. This study showed that somatosensory abnormalities were evident in AO and IP patients, and somatosensory alterations were seen in IP patients even 3 months after pulpectomy. However, no somatosensory alterations were seen after implant placement.

The Effects of Steroid Implant and Dietary Soybean Hulls on Estrogenic Activity of Sera of Steers Grazing Toxic Endophyte-Infected Tall Fescue Pasture.

Soybean hulls (SBHs) have been fed to cattle pasturing on endophyte-infected tall fescue in attempts to increase rate of gain. Literature reports indicated some symptoms associated with fescue toxicosis were ameliorated by the use of steroidal implants containing estradiol (E2) and progesterone [implantation (IMP)], feeding SBHs, or the combination of the two. While the mechanism for amelioration was unclear, the SBHs were postulated as acting as a diluent of the toxic factors of the fescue. Alternatively, estradiol and phytoestrogens of SBHs might be acting through relaxation of the persistent vasoconstriction found in animals ingesting ergot alkaloids of endophyte-infected fescue. If so, estrogenic activity of serum of steers receiving SBHs, IMP, or a combination of the two should be elevated. Using the cellular proliferation assay of estrogenicity (E-Screen), estradiol equivalents (E2Eqs) were determined on both SBHs and the serum of steers from a previously reported study. Range of SBHs was 5.0–8.5 ng Eqs g−1 DM (mean 6.5, n = 4 from different commercial sources of SBHs). At the rate fed, theoretically calculated blood E2Eq could be physiologically relevant (~80 pg mL−1, based on 2.3 kg SBHs d−1, 300 kg steer, 5.7% blood volume, and 10% absorption). Serum E2Eqs did increase in steers (P ≤ 0.05) with steroidal implants or fed SBHs by 56 and 151% over control, respectively, and treatments were additive (211% increase). Serum prolactin was also greatest for the SBH + IMP group (188 ng mL−1, P < 0.05), concentrations comparable to values reported for steers grazing endophyte-free fescue. Prolactin in the SBH group was higher than IMP or control groups (146 versus 76 and 60 ng mL−1, respectively). Still unknown is if additional E2Eqs from dietary phytoestrogens or exogenous sources of estradiol can further reduce symptoms of fescue toxicosis. The E-Screen assay was an effective tool in monitoring serum for estrogenic effects of dietary supplementation with SBHs or estrogenic implants.

Food choices of edentulous adults with implant-supported overdentures and conventional dentures

A randomised controlled trial (RCT) was carried out involving dental hospital patients. The implant group (IG) were provided with conventional maxillary dentures and implant-retained mandibular overdentures and the denture group (DG) were provided with conventional dentures. Patients consumed seven test foods. Pre- and post-treatment questionnaires were completed relating to food choices and chewing difficulty. IG subjects reported increased consumption of carrots, apples and nuts post-treatment (P<0.05) and decreased post-treatment difficulty in chewing apples and nuts. DG subjects reported decreased post-treatment difficulty in chewing carrots, bacon and nuts (P<0.05). Between-group differences for chewing difficulty were detected for nuts, which DG subjects found easier to chew than did IG subjects (P=0.002). Food selection and perceived chewing difficulty improved in both groups, with no significant differences between groups. Successful rehabilitation may not result in different food selection, which may require concurrent tailored dietary interventions, but may increase available food choices.

A randomized‐controlled trial of food choices made by edentulous adults

The aim of this study was to conduct a randomized-controlled trial to compare food choices of edentulous adults provided with implant-supported mandibular overdentures and conventional dentures. Edentulous patients were randomly allocated to an implant group (IG) or a denture group (DG). IG subjects (n=49) were provided with conventional maxillary dentures and implant-retained mandibular overdentures. Subjects in this group refusing implants were retained using the 'intention-to-treat principle' and provided with conventional dentures. DG subjects (n=48) were provided with conventional dentures. Subjects indicated whether they consumed any of seven test foods and the level of chewing difficulty experienced. Data were collected pre-treatment and 3 months post treatment. IG subjects reported increased consumption of carrots, apples and nuts post-treatment (P<0.05) and decreased post-treatment difficulty in chewing apples and nuts. DG subjects reported decreased post-treatment difficulty in chewing carrots, bacon and nuts (P<0.05). Between group differences for chewing difficulty were detected for nuts that DG subjects found easier to chew than IG subjects (P=0.002). Food selection and perceived chewing difficulty improved in both groups, with no significant differences between groups. Successful rehabilitation may not result in different food selection, which may require concurrent tailored dietary interventions, but may increase available food choices.

Soft Tissue Esthetics in Implant Dentistry

Dental implants have been considered to be a successful treatment modality. Recently, achieving a good osseointegration is not the ultimate goal for the restorative dentist. Successful implant treatment demands the best gingival esthetic success along with stability and function of the implant. This study was performed to obtain answers to some controversial points pertaining to esthetics and function of implants in maxilla. Immediate flapless implantation into the extraction sockets in maxillary anterior zone is an emerging treatment option in dentistry--the esthetic success of which was in debate for long. The proposed study compared the esthetic success of immediate flapless implants (ILA), to immediate implants with the need for flap (ILB) and, delayed implants (DSL) in single tooth restorations, in the anterior region of the maxilla. The other aim of the study was to find out if any relation exists between the interproximal crestal bone height and papilla height. Analysis was done irrespective of treatment procedure in the same study group using periodontal sounding and radiographs to find out the relation. From the study involving 106 participants, including 21 ILA, 22 ILB and 63 DSL cases, we received highest papillary index score of 2.6 average from group ILA, followed by ILB and DSL, after 3 months of prosthetic loading. From the periodontal sounding and radiographic study it was evident that, when the distance between the base of the contact point of crowns and height of interproximal bone was less than 5, the papilla was present 100% of the time, but when the distance increased to 6 and more than 7 mm, the papilla was present only 46.5 and 24 percentage of the time respectively.

Implant retained or conventional dentures, which give more patients satisfaction?

This was a randomised controlled trial (RCT) set in a dental hospital. The implant group (IG) had two implants placed in the interforaminal region of the lower jaw followed (after healing) by a denture fixed to the implants by a ball attachment mechanism. In the conventional dentures group (CG), dentures were constructed using conventional replacement denture techniques. Patients in the IG had conventional upper dentures made in the same fashion. The performance of the dentures was evaluated using an oral health impact profile (OHIP) and a denture satisfaction scale before treatment and 3 months post-treatment. Analysis was conducted on an intention-to-treat basis. Substantial improvements in oral-health-related quality of life and denture satisfaction were reported by both groups. There were, however, no significant differences post-treatment between the groups. Patients randomised to the IG who declined implants had significantly lower pretreatment OHIP scores and there were significantly greater pre-/ post-treatment change-scores for individuals who had implants compared with the change-scores of people who declined. There were no significant post-treatment differences between the groups, but a treatment effect may be masked by the intention-to-treat analysis. The pre-/ post-treatment OHIP change-scores were significantly greater for people receiving implants than for those who refused.