Soft Tissue Quality Research Articles

A randomized controlled clinical multicenter trial comparing the clinical and histological performance of a new, modified polylactide‐co‐glycolide acid membrane to an expanded polytetrafluorethylene membrane in guided bone regeneration procedures

To compare the clinical and histological outcomes of a resorbable modified polylactide/polyglycolide acid (PLGA) test membrane and a titanium-reinforced expanded polytetrafluorethylene (ePTFE) control membrane used for guided bone regeneration (GBR) around dental implants. A total of 40 patients with peri-implant dehiscence-type defects were randomly allocated to a GBR procedure using either a modified PLGA test or an ePTFE control membrane. Soft tissue condition, implant integration, adverse events and quality of life were recorded during the 6-month healing period. At re-entry peri-implant bone defect dimensions were measured and compared with values recorded at implant/GBR surgery. A biopsy was retrieved for qualitative and quantitative histological analyses. A comparison between the groups was conducted using non-parametric statistical tests. Soft tissue complications were observed in five test patients and two control patients. Except for soft tissue complications and incomplete regeneration, no procedure- or device-related adverse events were observed. The vertical bone defect component was, in mean, reduced by-5.1 mm (95% CI -6.8, -3.3) in the test group and -6.9 mm (95% CI -8.2, -5.5 mm) in the control group. The mean residual vertical defect height measured 1.2 ± 2.4 mm in the test group and 0.3 ± 1.1 mm in the control group meaning a mean defect resolution of 81% in the test group and 96% in the control group (P = 0.161). The horizontal bone thickness at implant shoulder level decreased from a mean of 3.2 mm to 1.4 mm (-56%, mean -1.7 mm, 95% CI -2.3, -1.1) in the test group and from 3.3 mm to 2.5 mm (-24%, mean -0.8 mm, 95% CI -1.3, -0.3) in the control group (P = 0.022). Qualitative and quantitative histological analyses did not show significant differences in the tissue composition between groups. Peri-implant GBR was successfully performed using either of the membranes. The control membrane was able to better maintain the horizontal thickness of regenerated bone and revealed less soft tissue complications. No statistically valid evidence about the superiority of one membrane was found in any other parameters. Soft tissue dehiscences occur with both types of membranes and can impair the amount of regenerated bone.

Statements from the Estepona Consensus Meeting on Peri‐implantitis, February 2–4, 2012

† The great majority of well-documented oralimplants show very good long-term clinical results.† A limited amount of crestal bone loss (CBL) ormarginal bone loss may be a biologic response toimplant placement.† CBL may occur for reasons other than infection.† CBL may occur around implants and can have along-termimpactontheoutcomeof thoseimplants.† Some implants can demonstrate substantial boneloss, but a steady state may be reached and nofurther clinically significant bone loss observed.† There is an adaptive change of the crestal bone levelafter placement and restoration.† Peri-implantitis is an unsuitable term to describe allCBL.† The term peri-implantitis is here defined as aninfection with suppuration associated with clini-cally significant progressing CBL after the adaptivephase.† In contrast, peri-implant mucositis is defined asinflammation of the peri-implant mucosa withoutdiscernibly progressing CBL.† Bone remodeling including CBL is influenced byinflammation.† Implant-, clinician-, and patient-related factors aswell as foreign body reactions may contribute toCBL. Implant factors: material, surface properties,and design (e.g., ease of plaque removal); clinicianfactors: surgical and prosthodontic experience,skills, and ethics; patient factors: systemic diseaseand medication, oral disease (e.g., untreated orrefractory periodontal disease, local infections),behavior (e.g., patient compliance with oral hygieneand maintenance, smoking), and site-related factors(e.g., bone volume and density, soft tissue quality);and foreign body reactions (e.g., corrosion by-products, excess cement in soft tissues).† A radiograph does not give an absolutely accuratepicture of the bone-implant contact or the crestalbone situation. However, the periapical radiographis an important clinical tool to be used at im-plant placement, implant loading, and repeatedlythereafter.† Radiographs taken longitudinally may assist the cli-nician to monitor changes in crestal bone levels.† Peri-implant examinations that include bleedingon probing and probing depths do not by

Ultraschall im elektrophysiologischen Herzkatheterlabor

During recent years the need for intraprocedural imaging has increased. Fluoroscopy and angiography are frequently supplemented by pre-procedural magnetic resonance or computed tomography imaging as well as electroanatomic mapping techniques. However, poor real-time imaging quality of soft tissue, radiation exposure, and contrast media consumption are disadvantageous. Ultrasound techniques are characterized by high-quality imaging of soft tissue that can be obtained in real time. All relevant anatomical structures and their relationships to catheters can be evaluated at any time during the procedure. Moreover, functional analysis, e.g., flow measurements and monitoring for complications, is possible. Transesophageal and especially intracardiac echocardiography (ICE) contribute enormously to effectiveness and safety of complex procedures. ICE has been shown to be useful in transseptal procedures like atrial fibrillation ablation but also in ablation procedures for ventricular tachycardias.

Arthroscopic Posterior Shoulder Stabilization With an Iliac Bone Graft and Capsular Repair: A Novel Technique

Several surgical approaches have been described for the treatment of recurrent posterior shoulder instability. Many authors have performed posterior bone block procedures with good results not only in the presence of glenoid bone loss or dysplasia but also in the case of capsular hyperlaxity and poor soft-tissue quality. Open techniques often require an extensive approach with the disadvantage of a poor cosmetic result and possible insufficiency of the deltoid muscle. Furthermore, the treatment of concomitant pathologies and the correct placement of the bone graft are difficult. Therefore we describe an all-arthroscopic posterior shoulder stabilization technique with an iliac bone graft and capsular repair that is intended to improve the pre-existing open procedure. The key steps of the operation are the precise placement and screw fixation of the bone block at the posterior glenoid under arthroscopic control and the subsequent posterior capsular refixation and plication using 2 suture anchors to create an extra-articular graft position.

Allograft Replacement for Absent Native Tissue

Context:Structural instability due to poor soft tissue quality often requires augmentation. Allografts are important biological substitutes that are used for the symptomatic patient in the reconstruction of deficient ligaments, tendons, menisci, and osteochondral defects. Interest in the clinical application of allografts has arisen from the demand to obtain stable anatomy with restoration of function and protection against additional injury, particularly for high-demand patients who participate in sports. Traditionally, allografts were employed to reinforce weakened tissue. However, they can also be employed to substitute deficient or functionally absent tissue, particularly in the sports medicine setting.Objective:This article presents a series of 6 cases that utilized allografts to restore functionally deficient anatomic architecture, rather than just simply augmenting the degenerated or damaged native tissue. Detailed discussions are presented of the use of allografts as a successful treatment strategy to replace functionally weakened tissue, often after failed primary repairs.

Retrograde Nail for Tibiotalocalcaneal Arthrodesis as a Limb Salvage Procedure for Open Distal Tibia and Talus Fractures with Severe Bone Loss

The treatment of complex fractures of the distal tibia, ankle, and talus with soft tissue damage, bone loss, and nonreconstructable joints for which the optimal timing for reduction and fixation has been missed is challenging. In such cases primary arthrodesis might be a treatment option. We report a series of multi-injured patients with severe soft tissue damage and bone loss, who were treated with a retrograde tibiotalocalcaneal arthrodesis nail as a minimally invasive treatment option for limb salvage. After a median follow-up of 5.4 years, all patients returned to their former profession. The ankle and bone fusion was complete, with moderate functional results and quality of life. Calcaneotibial arthrodesis using a retrograde nail is a good treatment option for nonreconstructable fractures of the ankle joint with severe bone loss and poor soft tissue quality in selected patients with multiple injuries, in particular, those involving both lower extremities, as a salvage procedure.

Primary, secondary, and quality-of-life endpoint results from the phase III AFFIRM study of MDV3100, an androgen receptor signaling inhibitor.

4519^ Background: MDV3100, a novel androgen receptor signaling inhibitor (ARSI), inhibits: 1) binding of androgens to AR, 2) AR nuclear translocation, and 3) association of AR with DNA. MDV3100 was active in a phase I-II trial enrolling pre- and post-docetaxel castration-resistant prostate cancer (CRPC) patients. The AFFIRM trial evaluated whether MDV3100 could provide benefit to men with post-docetaxel CRPC. Methods: In this double-blind, multinational phase III study, patients who had received docetaxel-based chemotherapy were randomized 2:1 to MDV3100 160 mg/day or placebo. Treatment with corticosteroids was allowed but not required. Patients were stratified by baseline ECOG and mean brief pain inventory score. The primary endpoint was overall survival (OS). Other efficacy endpoints included radiographic progression-free survival (rPFS), time to PSA progression (TTPP), soft tissue objective response (PR+CR), PSA response, and quality of life (QoL) response (FACT-P). Results: 800 patients were randomized to MDV3100 and 399 to placebo with respective median treatment durations of 8.3 and 3.0 months.Based on a planned interim analysis at 520 deaths, the Independent Data Monitoring Committee recommended the study be unblinded and placebo patients offered MDV3100. Efficacy results are presented (Table). The most common MDV3100 events with an incidence higher than placebo were fatigue (34% vs 29%), diarrhea (21% vs 18%), and hot flush (20% vs 10%). Grade >3 events of interest were cardiac disorders (0.9% MDV3100 vs 2% placebo), fatigue (6% MDV3100 vs 7% placebo), seizure (0.6% MDV3100 vs. 0% placebo), and LFT abnormalities (0.4% MDV3100 vs 0.8% placebo). Conclusions: MDV3100, a novel ARSI, is well-tolerated and significantly prolongs OS, slows disease progression, and improves QoL in men with post-docetaxel CRPC. [Table: see text]

Flat-Panel CT Arthrography

To show the feasibility of flat-panel computed tomography (FPCT) arthrography and quantitatively and qualitatively compare different FPCT protocols with standard multidetector computed tomography (MDCT). First, a phantom simulating joint space with increasing iodine concentrations was scanned using a standard MDCT and 3 different FPCT protocols. Quantitative analyses were performed by measuring CT numbers of iodine dilutions, radiation dose, and image noise as well as signal-to-noise ratio and contrast-to-noise ratio. Second, FPCT arthrographies of 4 animal joint specimens were performed and analyzed qualitatively by 2 independent readers who evaluated image artifacts, image noise, overall image quality and anatomic depiction of bone, cartilage, and soft tissue. Kappa values were calculated for inter-reader agreement. Pearson's correlation coefficient (r) and Wilcoxon signed-ranks test with Bonferroni corrections for multiple comparisons were used to compare MDCT and FPCT. In phantoms, all CT scans showed a linear correlation between increasing iodine concentrations and mean HU values of contrast media and radiation dose, respectively (r = 0.98-0.99, P < 0.01). Dose-length product remained constant for MDCT scans. Signal-to-noise ratio for phantom water linearly decreased in all FPCT scans with increasing iodine concentrations. Contrast-to-noise ratio curves showed reduced slope at iodine concentrations higher than 75 mg/mL. FPCT arthrography after intra-articular administration of 5 to 6 mL of a 25% dilution of iopromide (Ultravist 300 mg/mL, Bayer HealthCare, Berlin, Germany) was successfully performed in all 4 animal joint specimens. Kappa values for inter-reader agreement of qualitative image analyses were 0.62 to 0.91. Image and depiction quality of 20-s FPCT scans were similar or superior compared with standard MDCT (P < 0.005). FPCT arthrography is feasible and may allow similar image quality compared with standard MDCT arthrography.

The use of porcine acellular dermal matrix in silicone implant-based breast reconstruction

The most frequently occurring long-term complication in implant-based breast reconstruction is fibrotic capsule formation at the recipient site, with concurrent dysesthesia and poor aesthetic results. Using porcine acellular dermal matrix (PADM) as a connective tissue graft material is supposed to improve the quality and quantity of soft tissue in implant-based breast reconstruction. This study investigates the indications for and the results and the costs of using PADM for the correction or prevention of implant-associated breast deformities. This study reviewed a single surgeon's experience in the correction or prevention of implant-associated breast deformities with PADM in breast cancer-related breast reconstruction from 2009 to 2011. A total of 23 patients (27 breasts) were included in the study. The aesthetic outcome, the incidence and the type of complication were analysed. Twenty-three women underwent breast cancer-related breast reconstruction: 19 women underwent single-breast reconstruction and four women underwent bilateral reconstruction. Of the 23 patients who underwent breast reconstruction, 18 (78%) were "satisfied" with the aesthetic and haptic outcome after implant-based reconstruction with PADM. One patient (one breast) required another breast operation because of ipsilateral breast cancer recurrence during the follow-up period. PADM-assisted implant-based breast reconstruction has a satisfactory safety profile. The use of PADM as an interface matrix for implant-based breast reconstruction yielded predictable and acceptable aesthetic and haptic results by preventing capsular contracture, rippling, implant malposition, soft-tissue thinning and failure of the silicone implant-based breast augmentation.

Low Kilovoltage CT of the Neck with 70 kVp: Comparison with a Standard Protocol

CT protocols should aim for radiation doses being as low as reasonably achievable. The purpose of our study was to assess the image quality and radiation dose of neck CT at a tube potential of 70 kVp. Twenty patients (7 female, mean age 51.4 years, age range 19-81 years) underwent contrast-enhanced 64-section CT of the neck at 70 kVp (ATCM, effective tube current-time product 614 eff.mAs, range 467-713 eff.mAs). All 20 patients had a previous neck CT at 120 kVp on the same scanner. Two radiologists assessed image quality and artifacts in the upper, middle, and lower neck. Image noise and attenuation were measured, and the CNR was calculated. Effective radiation dose was calculated. Interobserver agreement regarding image quality of soft tissue for 70-kVp and 120-kVp scans was good to excellent. At 70 kVp, soft tissues were of diagnostic image quality in all scans, whereas the lower cervical spine was not of diagnostic quality in 3 and 4 scans per both readers. No difference was found among 70-kVp and 120-kVp scans for soft tissue image quality in the upper neck, while image quality was significantly better in the middle at 70 kVp (P < .05) and better in the lower third at 120 kVp (P < .05). CNR was significantly higher at 70 kVp in all levels for both readers (P < .001). Effective radiation dose at 70 kVp was significantly lower (0.88 ± 0.2 mSv) than at 120 kVp (1.33 ± 0.2 mSv, P < .001). CT of the cervical soft tissues at 70 kVp is feasible, provides diagnostic image quality with improved CNR, and reduces radiation dose by approximately 34% compared with a standard protocol at 120 kVp. In contrast, low kVp CT of the lower cervical spine suffers from compromised image quality.

The Use of Free Fat Tissue Transfer from the Buccal Fat Pad to Obtain and Maintain Primary Closure and to Improve Soft Tissue Thickness at Bone-Augmented Sites: Technique Presentation and Report of Case Series

Purpose Atrophic ridges usually have both hard and soft tissue shortages, and bone augmentation can make soft tissue closure difficult. The aim of this case series is to present a new method utilizing transfer of free fat tissue grafts (FFG) from the buccal fat bad (BFP) during bone augmentation to enhance immediate primary soft tissue closure and improve long-term soft tissue thickness and quality at the recipient site. Materials and methods Patients with moderate to severe ridge atrophy in different regions of the jaws were treated over a 4-year period with bone augmentation and FFG. The BFP was the donor site for the FFG. Patients were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the soft tissue, obtain specimens for histologic examination, and insert implants. Results Twenty patients (18 women, 2 men; mean age 43 years) were followed for 4 to 42 months and received 92 implants in the augmented sites. The healing process was uneventful, with minimal morbidity. Bone volume increased by 4 to 8 mm horizontally and 3 to 6 mm vertically. Thick soft tissue was obtained at the recipient sites and around the dental implants, and histologic specimens showed that the FFG was replaced by fibrous tissue. Conclusions Harvesting of the FFG from the BFP is a simple procedure with minor complications, and manipulation and handling of the graft are easy. The FFG enhances primary soft tissue closure of augmented bone, prevents dehiscences, improves long-term soft tissue thickness, and mimics the attached gingiva in its fibrous healing.

Effect of Interimplant Distance (2 and 3 mm) on the Height of Interimplant Bone Crest: A Histomorphometric Evaluation

Implants restored according to a platform-switching concept (implant abutment interface with a reduced diameter relative to the implant platform diameter) present less crestal bone loss than implants restored with a standard protocol. When implants are placed adjacent to one another, this bone loss may combine through overlapping, thereby causing loss of the interproximal height of bone and papilla. The present study compares the effects of two interimplant distances (2 and 3 mm) on bone maintenance when bone-level implants with platform-switching are used. This study evaluates marginal bone level preservation and soft tissue quality around a bone-level implant after 2 months of healing in minipig mandibles. The primary objective is to evaluate histologically and histomorphometrically the affect that an implant design with a horizontally displaced implant-abutment junction has on the height of the crest of bone, between adjacent implants separated by two different distances. Results show that the interproximal bone loss measured from the edge of the implant platform to the bone crest was not different for interimplant distances of 2 or 3 mm. The horizontal position of the bone relative to the microgap on platform level (horizontal component of crestal bone loss) was 0.31 ± 0.3 mm for the 2-mm interimplant distance and 0.57 ± 0.51 mm above the platform 8 weeks after implantation for the 3-mm interimplant distance. This study shows that interimplant bone levels can be maintained at similar levels for 2- and 3-mm distances. The horizontally displaced implant-abutment junction provided for a more coronal position of the first point of bone-implant contact. The study reveals a smaller horizontal component at the crest of bone than has been reported for non-horizontally displaced implant-abutment junctions.

Atypical pulmonary carcinoid tumour in a 28-year-old nonsmoker with Prader-Willi syndrome

To the Editors: In recent years, the life expectancy of patients with Prader–Willi syndrome (PWS) has increased, unveiling several cases of early-onset cancer and raising the question whether the condition predisposes to tumourigenesis. We encountered a unique occurrence of pulmonary atypical carcinoid in a young never-smoker with PWS. A 28-yr-old, morbidly obese male with PWS was admitted as a candidate for gastric bypass. He was a lifetime nonsmoker, and his height, weight and body mass index were 1.78 m, 175 kg, and 55.2 kg·m−2, respectively. Polyphagia, obesity and a failure to achieve psychosocial milestones became apparent at the age of 5 yrs, when PWS was diagnosed based on clinical findings and a de novo deletion of the proximal region of chromosome 15 (del(15)(q11–q13)). Type II diabetes mellitus was diagnosed at the age of 17 yrs, and dietary control along with administration of sulfonylurea was initiated. The remainder of the anamnesis included low levels of testosterone, which were treated with monthly intramuscular depot injections of testosterone enanthate (250 mg). On admission, the patient reported mild shortness of breath, nonproductive cough and malaise of indeterminate origin. A physical exam revealed markedly increased subcutaneous fat, picking scars, hypoplastic external genitalia and a polyphonic wheeze over the right hemithorax. Pulse was regular and of normal rate, diastolic blood pressure was elevated (98 mmHg) and haemoglobin oxygen saturation was 96% in room air. Electrocardiography was normal. Laboratory data, including blood cell counts, routine serum biochemistry and coagulation times, were within normal limits, except for fasting plasma glucose (178 mg·dL−1) and lipids (total cholesterol 233 mg·dL−1; high-density lipoprotein cholesterol 32 mg·dL−1; triglycerides 322 mg·dL−1). A pre-operative chest radiograph, performed routinely but also prompted by the patient’s wheeze, showed a round, regular-shaped opacity of soft-tissue quality measuring …

Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

The surgical management of soft tissue sarcoma has changed over the past years, resulting in an interdisciplinary multimodal approach and limb-preserving treatment modalities. From 464 consecutive patients with a soft tissue sarcoma (STS) of an extremity, a compartmental resection was performed in 82 patients, usually for primary subfascial large tumors. Postoperative quality of life was evaluated using the EORTC Score C30. In our study population, 52% of STS was poorly differentiated, 32% moderately, and 16% well differentiated. Survival proved to be dependent on tumor grade and tumor biology, but not on tumor size. The overall survival rate was 81.5%, 71.9%, and 58.3% after 2, 3, and 5 years, respectively. Leiomyosarcoma (39%) and malignant fibrous histiocytoma (42%) are associated with poor 5-year survival rate compared to liposarcoma (82%). Metastases were observed in 33% of T1 and 43% of T2 tumors corresponding to 51% with G3 tumors, 52% with G2 and 23% with G1 tumors. We found a decreased quality of life score in our patients in all dimensions compared to a normal population. Despite the elevated risk of a functional deficit, compartmental resection reduces the risk of local recurrence comparable to the recurrence rates after the most radical surgery limb amputation.

Schulterendoprothetik bei primären Synovialkrankheiten

Shoulder arthroplasty has become an essential component of the standard surgical repertoire for the treatment of severe primary and secondary glenohumeral arthritis and has been shown to provide reliable long-term pain relief with satisfactory functional results. In most cases, in particular in patients with rheumatoid arthritis (RA), the indications for arthroplasty are primarily based on pain, which often includes severe pain at rest. Despite poor bone stock and impaired soft tissue quality in RA which frequently results in massive, irreparable rotator cuff tears, shoulder arthroplasty has been shown to be an effective means of improving shoulder function. Several different types of prostheses are now available for different indications determined by age, functional demand, etiology and structural deficits. For optimal outcome, the most suitable type of prosthesis needs to be selected by an experienced shoulder surgeon who is familiar with the entire spectrum of treatment options.

Anterolateral Thigh Flap–Based Reconstruction for Oncologic Vulvar Defects

Vulvar defects after tumor extirpation always require immediate reconstruction. Transferring a skin flap from a distant region may be required for large defects. Although the anterolateral thigh flap has gained popularity in other types of oncoplastic surgery, it has rarely been reported for vulvar reconstruction. The aims of this retrospective study were to evaluate the outcome of anterolateral thigh flap-based vulvar reconstruction and to develop an operative strategy. Eleven patients with vulvar carcinoma underwent resection and immediate reconstruction with the anterolateral thigh flap between 2005 and 2009. Based on defect type and local soft-tissue quality, four types of anterolateral thigh flap-based reconstructions were performed: unilateral anterolateral thigh flap, ipsilateral anterolateral thigh flap combined with contralateral advancement flap or local flap, fenestrated anterolateral thigh flap, and split anterolateral thigh flap. Postoperative complications were recorded and clinical outcomes were evaluated. Partial flap necrosis occurred in one patient with a fenestrated anterolateral thigh flap for bilateral reconstruction. One wound dehiscence occurred in the contralateral local flap. Two patients had prolonged serous drainage. Mean follow-up was 8 months. One patient developed stricture of the urethral meatus and another had regional metastasis. With careful design, the anterolateral thigh flap may provide reliable and durable soft-tissue coverage for various vulvar defects with good outcomes and minimal donor-site morbidity.

Macroscopic and microscopic process of long bone fracture healing

The growth of each type of callus (cortical, medullary and periosteal) depends on the mechanical condition of fracture fixation (elastic fixation and instability or rigid immobilization), the type of treatment (non-operative, close or open surgical procedure, intra-medullary nailing, external fixation, plate...) and the high or poor quality of soft tissue and the specific characteristics of the local vascularisation.

Syndrome de Poland chez la femme : indications thérapeutiques en fonction du stade. À propos de 11 cas et revue de la littérature

Correction of chest and breast abnormalities in Poland's syndrome differs among authors. The aim of this study is to discuss surgical protocols according to the grade of Poland's syndrome in women. The authors present a series of 11 women with Poland's syndrome among which nine were operated. Several surgical techniques were used. Cosmetic results were analysed according to the treatment and grade. Median follow up is 9 years. In grade I, a round breast implant seems to be the best choice. In grade II, a latissimus dorsi flap combined with a breast implant gives better results than a breast implant alone. In grade III, breast and chest reconstruction are linked. The authors present a case of costal reconstruction followed by an expansion without a latissimus flap. Many authors recommend a latissimus flap combined with a breast implant in severe grades of Poland's syndrome. Using this flap is not always possible nor mandatory. According to soft tissue quality, expansion may be an alternative way or a temporary solution during growth.

Clinician- and patient-reported long-term evaluation of screw- and cement-retained implant restorations: a 5-year prospective study

The purpose of this study was to evaluate the survival and success of screw- versus cement-retained implant crowns over a 5-year period. This was a multi-center prospective cohort study, consisting of patients who had ≥1 dental implant placed and restored in the anterior maxilla over a 5-year period. The primary predictor variable was the type of restoration (screw- versus cement-retained). The outcome variables were clinician- or patient-reported measures related to soft tissue and restoration quality. Descriptive and bivariate statistics were computed to compare the screw- versus cement-retained groups. Kaplan-Meier statistics were computed for implant survival. Information was collected for 102 patients who had 214 implants placed during the study period. Complete data, amenable to analysis, were available for 99 (97.1%) patients and 193 (90.2%) implants. The restorations were approximately evenly divided between screw- (53.4%) and cement-retained (46.6%). Approximately 49% of patients in the sample were female; the sample's mean age was 47.3 ± 13.9years; each patient had an average of 2.0 ± 1.0 implants placed and restored. The mean time from prosthesis placement (definitive) to study endpoint was 61.9 ± 10.6months. The overall implant survival rate was 96.4%, with no statistically significant difference in survival between the screw- and cement-retained groups (p = 0.45). The majority of clinician- and patient-assessed outcomes were similar. The results of this study indicate that for the majority of clinician- and patient-assessed success parameters screw- and cement-retained restorations are equivalent in the anterior maxilla.

Wrist arthrodesis as a salvage procedure for failed implant arthroplasty

Salvage of failed total wrist arthroplasty by arthrodesis may be difficult because of bone loss and poor quality of bone and soft tissues. We examined the outcomes of wrist arthrodesis for failed total wrist arthroplasty in a retrospective study of 21 wrists in 17 patients. Clinical data, radiographs, patient-reported outcomes and DASH questionnaires were used. Thirteen women and four men had undergone total wrist arthroplasty at an average age of 55 years. The mode of failure was aseptic loosening in 13 wrists. The average time from the index arthroplasty to wrist arthrodesis was 7.6 years. Autograft and/or allograft bone graft was used in all of the wrists. Arthrodesis was achieved in 11 wrists and ten had a nonunion. Six arthrodeses underwent eight revisions for nonunion, with two achieving union. The mean DASH score was 29 in wrists that fused and 36 in those that did not fuse. Pain scores averaged 2.1 in the wrists that fused and 3.3 in the nonunion group. Most patients had clinical improvement.