Smooth Surface Implants Research Articles

Evaluation of bone apposition on surface modified titanium implant in experimental animal model: A systematic review and meta-analysis.

To evaluate the response of peri-implant bone to smooth (machined) surface and surface-modified dental implants in healthy experimental animal models. Systematic electronic search was done for using PUBMED, SCOPUS, WEB OF SCIENCE, and EMBASE databases for potentially relevant records from the last 20 years. Duplicate screening and data extraction were performed to formulate the evidence tables and meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The outcome criteria were: 1. Bone Implant Contact (BIC) in percentage, 2. Removal Torque Values (RTV) in Ncm, 3. Implant stability Quotient (ISQ), Quality assessment was done using the ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines and SYRCLE RoB (Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias) tool. Results were expressed as pooled mean difference for the respective groups viz. sandblasted and acid etched, laser modified, acid etched and anodized surface. The surface modified implants revealed somewhat higher BIC over machined surface (P < 0.01). Forest plot were drawn for all the outcome variables. Within the limitations of this study, the authors found a higher degree of osseointegration pertaining to bone to implant interface, RTV, and implant stability quotient (ISQ) with surface modified procedures which seemed to promote bone formation around peri-implant tissue during the early stages of healing. After analyzing all 37 included publications for the outcome of interest (BIC%, RTV, ISQ), a positive outcome was obtained for both subtractive and additive implant surface modifying procedures over machined implant surfaces when the data were pooled together. More advanced research work on healthy animal models needs to be investigated to review the impact of surface modifications on dental implant osseointegration.

Hybrid Augmentation Mastopexy with New Generation of Smooth Surface Implants: Combining the Benefits of Fat Grafting, Inferior Muscle Support, and an L-Shaped Scar.

Augmentation mastopexy (AM) is a challenging procedure. Complications include implant displacement and visibility, which can be addressed, but the stability of the smooth implant surface and poor soft-tissue coverage may present limitations. This article describes a surgical technique for AM using a composite reverse inferior muscle sling associated with autogenous fat grafting. Forty-five patients (90 breasts; mean age, 37.7 ± 7.2 years) underwent hybrid composite reverse inferior muscular sling AM. An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive fat grafting and divided into three zones. Three-dimensional imaging was used to evaluate lower pole stretch and intermammary distance. The average implant volume was 265 cc (range, 175 to 335 cc). The average fat volumes in zones I/II and III were 80.1 (range, 61.6 to 95.2 cc) and 39.3 (range, 25.2 to 47.3 cc), respectively. Five complications were observed in three patients (6.6%)-minor dehiscence in two (4.4%) and nipple-areola asymmetry in one (2.2%). The lower pole stretched 11.51% (9.9 mm) and 9.8% (8.5 mm) on the right and left sides, respectively ( P < 0.0001), between 10 days and 1 year postoperatively. The intermammary distance was reduced, on average, 49.9% (25.1 mm) ( P < 0.001) between the preoperative value and 1 year postoperatively. Hybrid composite reverse inferior muscular sling has led to improved aesthetic results for patients with breast ptosis and poor tissue coverage. Fat grafting and recognizing cleavage zones are still important to obtain satisfactory results. This procedure offers a good alternative for AM candidates, providing an adequate smooth surface for implant stabilization.

Implant-Associated Lymphoma

Although cases have been reported in women with smooth surface implants as well, textured surface implants have seen the majority of breast implant-associated lymphoma cases. The most typical signs and symptoms are breast lumps, discomfort, and swelling. Clinical, radiographic, and pathological findings are used to make a diagnosis. The basic course of treatment is still removal of the implant and capsule, however in some circumstances stem cell transplantation, chemotherapy, and radiation therapy may be required. Patients with breast implants who exhibit symptoms should be evaluated by doctors for lymphoma. Long-term monitoring is necessary to identify illness recurrence early and guarantee effective therapy. In conclusion, lymphomas connected to breast implants provide a diagnostic and therapeutic challenge that has to be handled collaboratively and with a full understanding of the patient.

Ultrasound Criteria and Baker Scale for Breast Implant Capsular Contracture Diagnosis.

Background:Due to the subjectivity of the Baker scale in grading capsular contracture (CC), an objective and reproducible measurement tool is necessary to estimate the presence and grade of CC in patients with breast implants. This study aimed to assess the capacity of breast ultrasonography to identify CCs using the Baker grading system.Methods:This study included patients who underwent breast augmentation with implants or implant-based breast reconstruction. Patient demographics, surgical type, and ultrasonographic variables were analyzed. The Kruskal–Wallis test was used to determine differences between means, and the Fisher exact test was used for binary variables.Results:A total of 21 patients (28 breasts) with smooth surface implants were included. In total, 39.2% of breasts had a score of Baker I, 25% had Baker II, 17.9% had Baker III, and 17.9% had Baker IV. When comparing breasts graded Baker I to IV, a mean capsule thickness of 0.6 ± 0.2, 1.0 ± 0.53, 1.68 ± 0.99, and 1.52 ± 0.46 mm, respectively, was shown (P = 0.0044). The breast implant deformity variable was significantly different between Baker grades I to IV (0.0218). Finally, Baker III and IV categories were five times more likely to have abnormal wrinkles than Baker I and II (odds ratio, 5.25; 95% confidence interval, 0.82–33.45; P = 0.0496).Conclusion:Ultrasound is a useful tool for evaluating the presence of augmented thickness, implant shape deformity, and abnormal wrinkles of the implant shell in correlation with the severity of CC.

Impact on capsule formation for three different types of implant surface tomography

Although capsular contracture remains one of the major problems following silicone breast implantation, the associated mechanism has yet to be determined. This study thus aimed to investigate capsule formation and capsular contracture using three types of implants with different surface topographies in vivo. Three types of implants (i.e., smooth, macrotexture, and nanotexture) with different surface topographies were inserted in a total of 48 Wistar rats. After 4 and 12 weeks, the samples were analyzed via histological, immunohistochemical, and Western blot examination. To identify implant movement, the degree to which implant position changed was measured. And the surface topography was characterized using scanning electron microscopy. Hematoxylin–eosin staining showed that the nanotexture type implant promoted significant decreases in capsule thickness at 12 weeks (P < 0.05), while Masson trichrome staining showed decreased collagen fiber density with the same implant type. Immunohistochemical and Western blot examination revealed reduced fibrosis markers (myofibroblast, and transforming growth factor beta-1) in the nanotexture surface implant. Meanwhile, implant location evaluation found that the nanotexture and smooth surface implants had significantly increased movement (P < 0.05). The nanotexture surface implant had been found to reduce capsule formation given that it minimizes the effects of factors related to foreign body reaction.

Osseointegration in Zirconia Implants Stumbling into Evidence

Osseointegration is a critical factor for the clinical success of any oral implants. The unique characteristics of zirconia as a material for dental implants being high toughness and strength, aesthetic factor, excellent osseointegration behaviour and biocompatibility. Implants with rough surface favour bone anchoring, biomechanical stability, increased bone implant contact and removal torque or push in strength values compared to smooth surface implants. Greyish discoloration of peri-implant mucosa is a challenge especially in anterior titanium implant restoration. Zirconia abutments customized for single crown showed excellent survival for 5 years. Restoring single tooth and up to 3 adjacent missing teeth with zirconia implants are compatible to titanium implants. Evidence exists on improved osseointegration on surface modification of zirconia implants with enhanced cell response. Zirconia implants with modified surface displays features of osseointegration similar to titanium implants. Results are promising for dental application in future.

In Vivo and In Vitro Fibroblasts' Behavior and Capsular Formation in Correlation with Smooth and Textured Silicone Surfaces

As the most principal complication following breast augmentation with silicone breast implants, capsular contracture is greatly influenced by surface texture. However, there have long been widespread debates on the function of smooth or textured surface implants in reducing capsular contracture. Three commercially available silicone breast implants with smooth and textured surfaces were subjected to surface characterization, and in vitro and in vivo assessments were then implemented to investigate the effect of these different surfaces on the biological behaviors of fibroblasts and capsular formation in rat models. Surface characterization demonstrated that all three samples were hydrophobic with distinct roughness values. Comparing the interactions of fibroblasts or tissues with different surfaces, we observed that as surface roughness increased, the adhesion and cell spreading of fibroblasts, the level of echogenicity, the density of collagen and α-SMA-positive immunoreactivity decreased, while the proliferation of fibroblasts and capsule thickness increased. Our findings elucidated that the effect of silicone implant surface texture on fibroblasts' behaviors and capsular formation was associated with variations in surface roughness, and the number of myofibroblasts may have a more significant influence on the process of contracture than capsule thickness in the early stage of capsular formation. These results highlight that targeting myofibroblasts may be wielded in the prevention and treatment strategies of capsular contracture clinically. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of Breast Silicone Implant Topography on Bacterial Attachment and Growth: An In Vitro Study.

The mechanisms underlying capsular contracture remain unclear. Emerging evidence supports the inflammation hypothesis, according to which bacteria from an adherent biofilm cause chronic inflammation and collagen deposition on the implant and trigger capsular contracture. Our goal was to evaluate the effect of different types of breast implants on the growth of Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa, which are commonly found in biofilms in infection. Bacteria were grown in tryptic soy broth at 37°C for 2, 6, and 24 h and subsequently incubated for 24 h on 12 shell sections of smooth, nano-, and macrotextured breast implants. After incubation, the solutions were ultrasonicated and bacterial numbers were determined by serial dilution. S. aureus were fixed, washed with phosphate-buffered saline, dehydrated in ethanol, and coated with a platinum film to visualize the presence of biofilms by scanning electron microscopy. The numbers of S. aureus and S. epidermidis attached to the smooth and nanotextured surface implants were significantly lower than those on the macrotextured surface for all incubation times, whereas the number of P. aeruginosa was non-significantly lowest on the nanotextured surface after 24h incubation. Biofilms on smooth and nanotextured implant surfaces showed patchy patterns on scanning electron microscopy in contrast to the continuous pattern detected on macrotextured implants. Nanotextured breast implants may limit bacterial growth and thus prevent capsular contracture.

Nanoscale hybrid implant surfaces and Osterix-mediated osseointegration.

Endosseous implant surface topography directly affects adherent cell responses following implantation. The aim of this study was to examine the impact of nanoscale topographic modification of titanium implants on Osterix gene expression since this gene has been reported as key factor for bone formation. Titanium implants with smooth and nanoscale topographies were implanted in the femurs of Osterix-Cherry mice for 1-21 days. Implant integration was evaluated using scanning electron microscopy (SEM) to evaluate cell adhesion on implant surfaces, histology, and nanotomography (NanoCT) to observe and quantify the formed bone-to-implant interface, flow cytometry to quantify of Osterix expressing cells in adjacent tissues, and real-time PCR (qPCR) to quantify the osteoinductive and osteogenic gene expression of the implant-adherent cells. SEM revealed topography-dependent adhesion of cells at early timepoints. NanoCT demonstrated greater bone formation at nanoscale implants and interfacial osteogenesis was confirmed histologically at 7 and 14 days for both smooth and nanosurface implants. Flow cytometry revealed greater numbers of Osterix positive cells in femurs implanted with nanoscale versus smooth implants. Compared to smooth surface implants, nanoscale surface adherent cells expressed higher levels of Osterix (Osx), Alkaline phosphatase (Alp), Paired related homeobox (Prx1), Dentin matrix protein 1 (Dmp1), Bone sialoprotein (Bsp), and Osteocalcin (Ocn). In conclusion, nanoscale surface implants demonstrated greater bone formation associated with higher levels of Osterix expression over the 21-day healing period with direct evidence of surface-associated gene regulation involving a nanoscale-mediated osteoinductive pathway that utilizes Osterix to direct adherent cell osteoinduction.

In search for the ‘perfect’ breast implant: are textured implants still indicated in today’s breast augmentation practice?

The popularity of breast augmentation procedure has driven research and debate as to whether any given implant characteristic offers a functional advantage. One such debate exists about the role of surface texturing. In the aftermath of the recent withdrawal of aggressively textured surfaces we would like to summarize the first author’s experience of nearly 1500 primary aesthetic breast augmentations with different surfaces and offer our thoughts on this topic. All consecutive primary breast augmentations operated by the first author from January 2010 to June 2019 were included. All patients had silicone implants inserted via inframammary incision. Of all the operated cases, 1029 consecutive female patients had at least 6 months’ follow-up (mean 15.1 months). Their mean age was 31.2 years, mean BMI 20.8 kg/m2 and mean implant volume was 311 cc. 997(96.9%) patients had dual plane and 32(3.1%) had sub-glandular implant placement. In total 113 patients (11.0%) developed a complication. This represented 15.1% of those with round and 10.0% of anatomical shape (or 10.6% of textured and 14.5% of smooth surface implants). As clinicians, we like patients to receive all the advantages of an implant but not be exposed to any risks. However, in reality, such a ‘perfect implant’ still does not exist. New literature continues to shed light on this trade-off between an implant’s perceived utility and its complications profile. We hope that the search for an alternative technology, with more beneficial surface characteristics and less drawbacks, continues.

Weighing Polyurethane-Covered Implant Benefits and the Risk of BIA-ALCL

Sir: There is an increasing concern regarding breast implants causing breast implant–associated anaplastic large cell lymphoma (BIA-ALCL).1,2 There is immunological and histological evidence relating breast implants to ALCL, but the epidemiological evidence is weak. Early in 2019, an Australian study1 reported different rates of BIA-ALCL according to implant surface area and roughness. The authors estimated a higher incidence rate of BIA-ALCL in the polyurethane (PU) group at nearly 6.5 cases for every 10,000 implants sold after 9 years of exposure. This finding is relevant as it is a result of an effort to bring some light to a field where there is lot to clarify. There are several challenges in estimating such rates, mostly involving how to achieve accurate data.3 Besides, other elements may play a role as contributing causes of BIA-ALCL, such as genetic profile (JAK/STAT3) or genetic background, immunological profile, subsequent events leading to implant biofilm, environmental exposure, ethnicity, and so on.3 Ignoring other causes and not adjusting for their potential effect may lead to bias due to confounding.4 The logistic regression approach, used in the report, may only estimate risk up to a time limit, defined at the study design.4 Therefore, it is not clear how the authors incorporated the time issue for the risk estimation over time. For instance, was each year considered a different cohort, or were rates estimated considering all sales up to the event? In addition, the authors state that there was a difference in time of exposure to the different surfaces/trademarks, but there was no further discussion of how this might impose limitations on rate interpretation. In this context, a usual epidemiological approach of incidence density rate estimation (events/implant-year) over time would probably suffice, as it gives an idea of risk, it allows dynamic population context, it is possible to decompose the rates over the periods of interest, and it allows you to explore cohort and period/generation effects.4 The authors state that there were cluster patterns in the data,1 which was suspected to be related to certain surgeons and hospitals, raising a concern about implant infection as a cause. Surgical site infection is a preventable condition, and it was not clear if in these clusters the infection rates were above or below an acceptable limit at the time of implantation. There is a matter of clinical relevance. Polyurethane implants are easier to manipulate, they have higher adherence, and there is less free displacement throughout the capsular space compared with smooth surface implants.5 The BIA-ALCL rate may be relatively higher in the polyurethane group, but it has lower rates than other conditions that also require implant removal, such capsule contracture, rupture, and malposition. In addition, in its early stages, when most of patients are diagnosed, the lymphoproliferative condition has a very good prognosis, requiring no additional treatment.1 The physician must inform the patient of all risks, particularly the risks of all events that may require implant removal or jeopardize the aesthetic result, including the risk of BIA-ALCL. Together, the patient and the surgeon should decide what is best. DISCLOSURE Drs. Cintra, Massiere Y Correa, and Brasil are scientific consultants for Silimed. The remaining authors have no financial interests to disclose. No funding was received for this communication. Henrique P. L. Cintra, Dr.Universidade Estadual do Rio de JaneiroHospital Universitário Pedro Ernesto Wanda Elizabeth Massiere Y Correa, Dr.Pontifícia Universidade Católica Amanda T. BaptistaRoberta C. MillnaSergio Carlos A. J. JuniorSilimed Indústria de Implantes LTDA Pedro Emmanuel A. A. do Brasil, Ph.D.Fundação Oswaldo CruzInstituto Nacional de Infectologia Evandro ChagasRio de Janeiro, Brasil

Peri-implant alveolar bone resorption in an innovative peri-implantitis murine model: Effect of implant surface and onset of infection.

To compare the difference in alveolar bone resorption around implants after immediate placement in a bacterial induced experimental periimplantitis murine model. The various conditions that were examined were: Effect of implant surface characteristics and the onset of the induced infection. Screw-shaped titanium implants, smooth-surface or sand-blasted large-grit acid-etched (SLA) coated, were inserted immediately after extraction of the first upper left molar, in 90 5-6-week-old BALB/c mice. The mice were infected with Porphyromonas gingivalis and Fusobacterium nucleatum 21 (early infection) or 42 days (delayed infection) after implantation. Six weeks post infection, bone volume around inserted implants was measured using micro-CT, and was compared to alveolar bone level around teeth. Histological analysis was also performed. The level of bone loss was significantly higher around the implants compared to the teeth, for smooth surface implants the bone loss was higher than of the SLA surface in both control and infected groups with no statistical significance. The survival rate of the implants in immediate infection was 75% compared of the 100% survival of the delayed infection and control mice. There is no significant difference between the early and the delayed infection in alveolar bone loss level around the implants. This model can assist in studying the differences in alveolar bone resorption in different implants and their effect on the development of the disease.

Risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3,546 women prospectively followed after receiving textured breast implants.

1565 Background: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare subtype of T-cell lymphoma, developing in in the fluid or capsule surrounding breast implants, primarily or exclusively in those with textured surfaces. Several prior series have estimated the risk of BIA- ALCL at 1/6920 - 1/3800 women in retrospectively defined cohorts (from diagnosed cases within national or pathology databases), approximating the population at risk from sales records or other estimates (Sirinvasa 2017; Loch-Wilkinson 2017; de Boer 2018). Methods: A prospective cohort study was conducted in the population that underwent breast reconstruction by a single surgeon at Memorial Sloan Kettering Cancer Center (MSKCC) from April 1993 to December 2017. Patients had long-term follow-up, and events related to implants were prospectively recorded. We identified all cases of BIA-ALCL by cross-checking data from internal clinical records, pathology records, and outside reports. Incidence rate per person-years and cumulative incidence when accounting for competing risk were calculated. 134 women who received smooth-surface implants were excluded from the analysis, since these implants have not been associated with BIA-ALCL. Results: From 1993 to 2017, 3546 patients underwent 6023 breast reconstructions using textured surface implants. All reconstructions were performed by a single surgeon (PGC) on patients enrolled in this study. To identify BIA-ALCL occurrence, clinical and pathological data were assessed from a prospective database. Median follow-up was 7 years (range, 3 days - 24.7 years). Eight women developed ALCL after a median exposure of 11.2 years (range, 8.3-15.8 years). Overall risk of BIA-ALCL in this cohort was 0.294 cases per 1000 person-years (1/443 women). Conclusions: This study, evaluating the risk of women with textured breast implants from a prospective database with long-term follow-up, demonstrated that the incidence rate of BIA-ALCL may be higher than previously reported. These results can help inform implant choice for women undergoing breast reconstruction.

Diagnosis and Treatment of Peri-implantitis among Dentists in Saudi Arabia

Aim: The aim of this study was to detect the knowledge and awareness of dentists practicing dentalimplantology in Saudi Arabia regarding the diagnosis and treatment of peri-implantitis.Materials and Methods: 100 dentists practicing dental implantology in Saudi Arabia were randomlyselected and asked to answer a systematized questionnaire about the diagnosis and treatment of periimplantitis that comprised of six parts as the following: The dentist’s demographic data, bacteria, implantsurface, antimicrobials and antibiotics, diagnosis, management and treatment modalities of peri-implantitis.The sample of the study consisted of dentists who hadn’t received any specialty or training degree other thanimplantology and dentists who had received other specialty degree in addition to implantology. The validityand the reliability of the questionnaire were tested. The data obtained were tabulated, and the statisticalparameter was estimated.Results: The majority of the dentists agreed that treated-surface implants have better osseointegration andhigher long-term success rate in comparison to smooth-surface implants. Also, roughly half or more thanhalf the dentists used the diagnostic parameters bleeding on probing, probing depth, suppuration, and boneloss ≥2 mm for the detection of peri-implantitis. In addition, the most preferable surgical treatment modalityemployed by the dentists for implants with peri-implantitis was bone grafting combined with a membrane.Furthermore, the most preferable delayed loading protocol chosen by the dentists for definitive prosthesisinstallation after implant placement was 3-6 months.Conclusion: There is need for randomized clinical trials on the pathogenesis, etiology, diagnosticparameters, and treatment modalities of peri-implantitis with large sample sizes. Workshops and symposiaare recommended.

Immediately Loaded Bicortical Implants Inserted in Fresh Extraction and Healed Sites in Patients with and Without a History of Periodontal Disease.

Background:Bicortical screw implants may be used in both healed bone and fresh extraction sockets and loaded immediately. To date, there have not been too many studies reporting clinical results of such screws used in periodontally involved sites. This study aimed to assess many aspects of bicortical screw implants used to retain full-arch and segmental cemented prostheses in the rehabilitation of the mandible and maxilla in patients with or without a history of periodontal disease.Materials and Methods:This retrospective review involved 87 patients, of whom 77 had a history of periodontitis diagnosed before implant placement and 10 did not. They were treated following the same surgical procedure and received a total of 1019 implants which were immediately loaded with fixed prosthetic works.Results:A total of 1019 polished surface, one-piece, bicortical screw implants were used in 87 patients who underwent the same surgical treatment, i.e., tooth extraction and immediate implant placement were investigated, of which 526 were placed in the healed bone and 493 in fresh extraction sockets with the mean follow-up time of 22.2 ± 7.3 months. Results were analyzed using log-rank test, the Kaplan–Meier method, Chi-square test, and t-test. Cumulative survival at 12, 24, and 35 months after placement was 99.3%, 98.6%, and 97.0%, respectively.Conclusion:Bicortical smooth surface implant concept with immediate loading protocol provided predictable outcomes and survival rate of 99% in patients with and without a history of periodontitis. More studies are needed to further support the clinical advantages of bicortical anchoraged smooth surface implants.

Accelerated and enhanced osteointegration of MAO-treated implants: histological and histomorphometric evaluation in a rabbit model

Microarc oxidation (MAO) has become a promising technique for the surface modification of implants. Therefore, the aims of this study were to further quantitatively and qualitatively evaluate the osteointegration abilities of MAO-treated and smooth surface (SF) implants in vivo and to investigate the areas in which the superiority of MAO-treated implants are displayed. In a rabbit model, a comprehensive histomorphological, osteogenic, mineralizational, and integrative assessment was performed using light microscopy, fluorescence microscopy, confocal laser scanning microscopy, and radiographic analyses. Compared with the SF groups, the MAO-treated groups exhibited more active contact osteogenesis, as well as distant osteogenesis, under fluorescence examination, the mineral apposition rate was found to be greater for all of the MAO-treated implants, and the osteointegration index (OI) value was greater in the MAO-treated groups at different times. In conclusion, the calcium-rich amorphous layer created by MAO provided a better environment for osteointegration, with more active contact osteogenesis, a more rapid mineral apposition rate and greater OI values.

Natrelle Silicone Breast Implant Follow-up Study: Demographics, Lifestyle, and Surgical Characteristics of More Than 5000 Reconstruction Subjects.

Background:A large, multicenter, 10-year observational study is comparing the long-term safety and effectiveness of Natrelle silicone breast implants versus saline implants or national norms.Methods:Women who underwent primary augmentation, revision-augmentation, primary reconstruction, or revision-reconstruction were invited to participate. Enrolled subjects had completed surgery and received one implant or matching implants. Baseline demographics, health, lifestyle, and surgical characteristics are presented here for adult subjects who underwent primary reconstruction or revision-reconstruction.Results:Of 5637 subjects who underwent reconstruction surgery (86.7% primary reconstruction; 13.3% revision-reconstruction), 5407 received silicone implants and 230 received saline implants; 72.9% received bilateral implants. Silicone implants were used in 96.2% who underwent primary reconstruction and in 94.1% who underwent revision-reconstruction. Median age was about 3 years lower in those who underwent primary reconstruction versus revision-reconstruction. Most subjects were white nonsmokers and had attended college. Hispanic subjects were more likely to receive saline implants for primary reconstruction. Across groups, the most common characteristics by implant type or procedure included smooth-surface implants (90.8%), mastectomy scar site (69.7%), and partial (59.2%) or complete (33.9%) submuscular placement. Implant size was larger for revision-reconstruction versus primary reconstruction, and incision size was larger for silicone versus saline implants in subjects undergoing primary reconstruction.Conclusions:This study provides an unprecedented look at a large subject sample. The data offer surgeons an opportunity to make informed decisions regarding the most appropriate implant attributes and surgical approaches for women who desire breast implants for primary or revisionary breast reconstruction.

The Austrian breast implant register: recent trends in implant-based breast surgery.

Due to the fact that the number of breast implant surgeries for cosmetic and medical purposes is rising yearly, a discussion about the quality of service for both patients and physicians is more important than ever. To this end, we reviewed the Austrian Breast Implant Register with one specific question in mind: What are the trends? In the statistical analysis of the Austrian Breast Implant Register, we were able to identify 13,112 registered breast implants between 2004 and 2012. The whole dataset was then divided into medical and cosmetic groups. We focused on device size, surface characteristics, filling material, device placement and incision site. All factors were considered for all examined years. In summary, the most used device had a textured surface (97 %) and silicone gel as the filling material (93 %). The mean size of implants for the cosmetic group was 240 cc, placement was submuscular (58 %) and the incision site was inframammary (67 %). In the medical group, the mean size was 250 cc. Yearly registrations had their peak in 2008 (1,898 registered devices); from this year on, registrations decreased annually. A slight trend away from subglandular placement in the cosmetic group was noted. Also, the usage of implants with polyurethane surface characteristics has increased since 2008. The smooth surface implants had a peak usage in 2006 and their usage decreased steadily from then on whereas the textured surface was steady over the years. Keeping the problems related to the quality of breast implants in mind, we could recommend an obligatory national register. Organisations of surgeons and governments should develop and establish these registers. Furthermore, an all-encompassing international register should be established by the European Union and the American FDA (Food and Drug Administration); this might be useful in comparing the individual country registers and also would help in delivering "evidence based" medicine in cosmetic and medical procedures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Transaxillary endoscopic breast augmentation.

The axillary technique is the most popular approach to breast augmentation among Korean women. Transaxillary breast augmentation is now conducted with sharp electrocautery dissection under direct endoscopic vision throughout the entire process. The aims of this method are clear: both a bloodless pocket and a sharp non-traumatic dissection. Round textured or anatomical cohesive gel implants have been used to make predictable well-defined inframammary creases because textured surface implants demonstrated a better stability attributable to tissue adherence compared with smooth surface implants. The axillary endoscopic technique has greatly evolved, and now the surgical results are comparable to those with the inframammary approach. The author feels that this technique is an excellent choice for young patients with an indistinct or absent inframammary fold, who do not want a scar in the aesthetic unit of their chest.

Clinical Outcomes of Using Lasers for Peri‐Implantitis Surface Detoxification: A Systematic Review and Meta‐Analysis

The aim of this systematic review is to compare the clinical outcomes of lasers with other commonly applied detoxification methods for treating peri-implantitis. An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles were conducted. Comparative human clinical trials and case series with ≥ 6 months of follow-up in ≥ 10 patients with peri-implantitis treated with lasers were included. Additionally, animal studies applying lasers for treating peri-implantitis were also included. The included studies had to report probing depth (PD) reduction after the therapy. Seven human prospective clinical trials and two animal studies were included. In four and three human studies, lasers were accompanied with surgical and non-surgical treatments, respectively. The meta-analyses showed an overall weighted mean difference of 0.00 mm (95% confidence interval = -0.18 to 0.19 mm) PD reduction between the laser and conventional treatment groups (P = 0.98) for non-surgical intervention. In animal studies, laser-treated rough-surface implants had a higher percentage of bone-to-implant contact than smooth-surface implants. In a short-term follow-up, lasers resulted in similar PD reduction when compared with conventional implant surface decontamination methods.