Time Of Prosthesis Placement Research Articles

Clostridial prosthetic joint infections: A series of 16 cases and literature review

ObjectivesProsthetic joint infections (PJIs) due to the Clostridium species have not been widely investigated. We aimed to characterize these uncommon infections. MethodsWe conducted a retrospective study between 2003 and 2020 in six French hospitals combined with a review of the literature. ResultsThe main conclusions obtained from the 16 patients included were reinforced by the literature analysis: (i) Clostridium perfringens was the most frequently involved species, (ii) patients presented an advanced age at the time of prosthesis placement and infection, (iii) most of the infections were early- or delayed-onset, (iv) the prognosis for these PJIs remains poor, (v) when performed (n = 5), DAIR with 12-week antimicrobial therapy led to a favorable outcome in 80% of cases. ConclusionsGiven the low incidence of this infection, our work represents the largest series of clostridial PJIs reported to date and highlights some specificities of these infections. Further prospective studies are needed to confirm these results.

Effect of advanced platelet-rich fibrin and concentrated growth factor on tissues around implants in maxillary anterior region.

To assess the effect of advanced platelet-rich fibrin (APRF) and concentrated growth factor (CGF) on tissues around implants in the maxillary anterior region. This was a prospective clinical study. Thirty subjects were divided into three groups with 10 dental implants in each group, i.e., Group 1: Control group, Group 2: Endosseous implant placement with APRF, and Group 3: Endosseous implant placement with CGF. The subjects were assessed at baseline (at the time of prosthesis placement), 2 weeks, 2 months, 6 months, and 1 year for modified sulcular bleeding index, periimplant probing depth, mucosal suppuration, bleeding on probing, crestal bone level as well as implant stability. Oneway Analysis of variance and Post hoc Bonferroni were the statistical tests used. The difference in implant stability at 2 months was significantly (P < 0.05) more among the control and CGF groups compared to APRF group. However; the crestal bone levels, periimplant probing depth, modified sulcular bleeding index, mucosal suppuration, and bleeding on probing were statistically non-significant (P > 0.05). CGF and APRF accelerated osseointegration. Furthermore, they had a positive effect on stabilization values. However, CGF showed better results and with further clinical trials may show a positive effect on implant healing period.

Marginal Bone Loss in Implants with External Connection versus Internal Conical Connection Prior to Prosthetic Loading. A Randomized Clinical Study

Introduction: The prosthetic connection of implants has been related to the loss of marginal bone. The aim of this study was to evaluate bone loss around external connection (EC) and internal conical connection (ICC) implants prior to prosthetic loading. Material and methods: A randomized clinical trial (RCT) was carried out, with a sample size of 93 implants (31 EC and 62 ICC) placed in 27 patients. Radiological controls were performed and stability was measured by resonance frequency analysis (RFA) on the day of placement, at 1 month and at 4 months after the placement. Results: Bone loss in EC implants was not statistically different than in ICC implants between the time of placement (T0) and the subsequent month (T1): (EC = 0.18 mm and ICC = 0.17 mm). Between one month (T1) and four months (T2): (EC = 0.39 mm and ICC = 0.19 mm) this difference was highly significant (p = 0.00). Bone loss between T0 and T2 was significantly lower in the ICC (EC = 0.57 mm and ICC = 0.36 mm), (p = 0.01). The overall success rate of the implants was 97.8%. The stability of the implants increased from 70.69 (T0) to 73.91 (T1) and 75.32 (T2). Conclusions: ICC showed less bone loss up to the time of prosthesis placement. Such bone loss did not have a significant impact on bone stability. Long term RCTs are needed to demonstrate whether this bone loss, which is more pronounced at the beginning in EC, tends to stabilize and equate to ICC.

A prospective cohort study of immediate implant placement into posterior compromised sockets with or without primary wound closure of reactive soft tissue.

Conventional wisdom states that reactive soft tissue consisting of granulation tissue and long junctional epithelium in compromised sites should be curetted completely, while others approve of its preservation in implant surgeries. To evaluate the presence of reactive soft tissue as wound closure for immediate implantation in posterior compromised sockets. Thirty-three implants were included in this study: (a) experimental group (EG), the reactive soft tissue was raised as the primary wound closure for the implant; (b) control group (CG), the reactive soft tissue was also elevated but failed to cover the site. Implants were inserted immediately after the tooth extraction. The bone dimensional changes were observed instantly after surgery (T1) and 6 months later (T2) by cone beam computed tomography. Soft tissue alterations were evaluated before tooth extraction (T0), at prosthesis delivery and at 1-year follow-up (T3). Measurements of marginal bone level (MBL) was obtained at the time of prosthesis placement and at T3. In all, 100% implant survival was reported during the study period. The buccal bone height and width of keratinized mucosa decreased less in the EG compared to the CG. At the 1-year follow-up, MBL and soft tissue changes were not significantly different between the two groups. Within the limitations of this study, the presence of reactive soft tissue as primary closure may contribute to hard-soft tissue augmentation during immediate implants into posterior compromised sockets.

Microsurgical Skills Training With a New Tympanoplasty Model

To evaluate the microsurgical skills training on a tympanoplasty model with regard to the learning curve and the participants' motivation for a surgical specialty. Randomized controlled prospective study. Department of Otolaryngology, Head and Neck Surgery, Medical Campus Carl Gustav Carus at the Technische Universität Dresden, Germany. Thirty randomly chosen fifth-year medical students divided into 2 groups. Group 2 (n = 16) had to perform an ossicular and tympanic membrane reconstruction on a tympanoplasty model on Days 1, 7, 14, and 21 and Group 1 (n = 14) on Days 1 and 21, while observing the procedure at Days 7 and 14. Six otosurgeons served as gold standard. Attempts and time of prosthesis placement and time for tympanic membrane reconstruction were recorded. Tremor frequency and amplitude were obtained at the same time points. An adjusted study interest questionnaire was used to assess students' motivation. Students in Group 2 showed a significant improvement in all reconstruction parameters over the study period compared with both, baseline measurement on first day and Group 1. However, the obtained learning curve did not reach the experts level. Tremor indices and students' motivation showed no correlation with the reconstruction parameters, whereas the training itself had a positive impact on students' interest in the surgical specialty. Training with the tympanoplasty model is suitable to acquire first microsurgical motor skills in otolaryngology and to arouse students' interest in the surgical field and otorhinolaryngology.

A Prospective Multicenter 5‐Year Radiographic Evaluation of Crestal Bone Levels Over Time in 596 Dental Implants Placed in 192 Patients

Dental implants have been used to replace missing teeth to provide function and esthetics. One goal of such restorations is to maintain host tissue around the implants. The purpose of this prospective multicenter human clinical trial was to evaluate radiographic marginal bone levels around non-submerged hollow cylindrical and solid-screw implants for 5 years after loading. Patients older than 18 years of age with sufficient native bone to surround a dental implant without imposing on a vital structure were recruited at five sites. Solid-screw or hollow-cylinder implants with a titanium plasma-sprayed implant surface were placed in the anterior maxilla or anterior mandible and restored with fixed restorations. Baseline radiographs were taken at the time of implant placement. Subsequent radiographs were taken at the time of final prosthesis placement, at 6 months after prosthesis placement, and annually from prosthesis placement for 5 years. The results of 596 implants in 192 patients at five international sites revealed that clinically significant remodeling of the marginal bone occurred during the first 6 months after implant placement, with a mean (+/- SD) marginal bone loss of 2.44 +/- 1.20 mm. After that, clinically insignificant mean changes in the bone were observed. Overall, 0.22 +/- 0.42 mm of bone loss occurred between the time of prosthesis placement and 1-year postloading. Between 1-year postloading and the last 5-year recall, 0.18 +/- 0.88 mm bone loss occurred. Because 2.84 +/- 1.63 mm of bone loss occurred between implant placement and the 5-year postloading follow-up, 86% of the total mean bone loss over the course of 5 years was accounted for at the time of prosthesis placement. These same trends occurred if the data were analyzed with regard to implant design (solid screw and hollow cylinder), type of restoration (single and multiple), and length of implant (8 to 10, 12, and 14 to 16 mm). These data demonstrate that, in general, clinically significant marginal bone remodeling occurred between the time of implant placement and final prosthesis placement around one-stage non-submerged titanium implants with a titanium plasma-sprayed surface. Subsequent to that, bone loss observed around implants up to 5 years postloading was minimal. These results suggest that the factors that influence early healing around implants are significantly different from those that affect later marginal bone remodeling.

Rehabilitation of Edentulous Mandibles by Means of Turned Branemark SystemR Implants after One-Stage Surgery: A 1-Year Retrospective Study of 152 Patients

Rehabilitation of the edentulous mandible with oral implants is today predominantly executed with one-stage surgery and early or immediate loading. It is generally claimed that the outcome is similar to that of the classic two-stage technique. The aim of the present investigation was to retrospectively evaluate the 1-year results of one-stage surgery and early loading performed in edentulous mandibles in a large group of patients. The outcome was compared with that of a study, from the same clinic (control), that used the two-stage surgical technique in edentulous mandibles and whose data were well controlled. The study included 152 individuals with 750 turned Brånemark System implants of various designs placed in edentulous mandibles by means of one-stage surgery. The prosthetic procedure was commenced at a mean of 13 days after the surgical intervention. Intraoral apical radiography was performed at the time of prosthesis placement and at the 1-year annual checkup. Comparison of failure rates between the test and the control groups was made by means of the chi-square test. A total of 18 implants in 12 patients in the study group were found to be mobile up to and including the first annual checkup, equivalent to a 1-year implant cumulative survival rate (CSR) of 97.5%. The corresponding CSR for the control group was 99.7%. Differences between the two groups in regard to implant survival reached significant levels when analyzed with the chi-square test (p < .05). No such significant difference was seen on the patient level (p > .05). Because of implant failures one prosthesis in the study group was remade. The mean marginal bone resorption during the first year of function was 0.4 mm in both groups. The present investigation showed a high but (compared with the classic two-stage technique) somewhat lower CSR after 1 year for the one-stage technique. More prosthetic adjustments due to implant failures were observed in the study group, and the results emphasize the need for large study samples in order to statistically verify small differences between various treatment techniques.

Early Loading of Four or Five Astra Tech Fixtures with a Fixed Cross-Arch Restoration in the Mandible

Early Loading of Four or Five Astra Tech Fixtures with a Fixed Cross-Arch Restoration in the Mandible B. Collaert, H. De Bruyn, Clin Implant Dent Rel Res, 2002;4:133–135 Reduction of the extended postoperative period before placement of a final implant-supported restoration is likely to be perceived as beneficial by most patients. With this in mind, several recently developed clinical protocols have focused on the reduction of the postoperative healing phase before definitive restoration. Many of these involved placement of a fixed, implant-supported mandibular restoration in edentulous patients on the day of implant installation. The advantage of this approach is the immediate functional restoration of edentulous patients. One potential shortcoming of the procedure is the possible detrimental effects on osseointegration. Additionally, consideration must be given to the need to extend the surgical procedure with a time intensive construction and placement of the immediate prosthodontic restoration. The present study reports on 25 patients who received four or five implants in edentulous mandibles (total of 114 implants). Impressions were made immediately following surgical implant installation. Definitive, fixed, metal-resin, mandibular restorations were placed within 1 month after implant surgery. Radiographs made at the time of prosthesis placement were compared with radiographs made at the completion of the study 7 to 24 months later. No postoperative complications were noted, and no implants were lost during the follow-up period. The mean bone loss was recorded to be 0.7 mm. Final bone levels were indirectly related to abutment heights—short abutments being associated with greater bone loss. These authors demonstrated an effective clinical protocol for expediting placement of a definitive mandibular fixed restoration in edentulous patients. This 1-month protocol provided ample time for construction of a metal-resin prosthesis and yet restored the patient sooner than would be accomplished using more conventional approaches. Based on indicators monitored in this study, long-term successful performance of these restorations is expected.

Ventral penile curvature following radical pelvic surgery: A variant of urethral manipulation syndrome

Urethral manipulation syndrome (UMS) describes ventral penile curvature and urethral stricture disease that develop following repeated episodes of urethral manipulation. We describe a variant of this syndrome, in which the presence of an indwelling catheter following radical pelvic surgery led to a marked penile curvature without clinically apparent urethral stricture disease. We identified 4 patients in whom ventral penile curvature developed following radical pelvic surgery. Three patients underwent radical retropubic prostatectomy and the fourth patient underwent radical cystoprostatectomy with creation of a neobladder to the urethra. All were treated with 3 weeks of catheter drainage postoperatively. Each patient reported straight erections prior to surgery. These patients came to prosthesis surgery between 7 months and 3 years after their pelvic procedure. Each patient was noted to have ventral penile curvature when artificial erection was induced. Curvature was secondary to scarring between the anterior corpus spongiosum and the overlying ventral tunica albuginea in the mid- to proximal penile shaft. It was necessary to mobilize the urethra off the corpora and to incise the scarred tunica to obtain a satisfactory result at the time of prosthesis placement. In 3 cases, GoreTex was needed to bridge the corporeal defect. These cases represent a variant of UMS in which catheter drainage leads to scarring of the ventral tunica albuginea, resulting in ventral penile curvature. In view of the increasing number of radical pelvic procedures being performed, this potential complication must be recognized, as aggressive corporeal reconstruction with urethral mobilization is needed if subsequent prosthesis surgery is undertaken.

Immediate breast reconstruction with tissue expansion.

Between October of 1983 and June of 1985, 31 patients underwent primary breast reconstruction with tissue expansion. Tissue expansion was utilized for breast reconstruction when the remaining muscle and skin following modified radical mastectomy was insufficient to accommodate a prosthesis that matched in size and shape the opposite breast. All expanders were placed beneath an investing muscular pocket created by elevating the pectoralis major and serratus anterior. Postoperative expansion began within 1 week, and the breast was expanded to double the volume of the opposite breast. Twenty-two patients have completed their reconstruction with a mean follow-up in 7 months. There were nine complications, including five deflations and four infections. All patients have remained Baker I or Baker II. Creating ptosis to match the breast was accomplished by placing the expander below the rectus fascia and superiorly advancing this expanded tissue at the time of prosthesis placement. Primary breast reconstruction with tissue expansion following modified radical mastectomy is safe, simple, and produces a breast with excellent shape, size, texture, and patient satisfaction.