Showing papers on "Prosthesis published in 2014"

A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients

Abstract: Patients with transfemoral amputation (TFA) often experience problems related to the use of socket-suspended prostheses. The clinical development of osseointegrated percutaneous prostheses for patients with a TFA started in 1990, based on the long-term successful results of osseointegrated dental implants. Between1999 and 2007, 51 patients with 55 TFAs were consecutively enrolled in a prospective, single-centre non-randomised study and followed for two years. The indication for amputation was trauma in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical procedure was used to introduce a percutaneous implant to which an external amputation prosthesis was attached. The assessment of outcome included the use of two self-report questionnaires, the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Short-Form (SF)-36. The cumulative survival at two years’ follow-up was 92%. The Q-TFA showed improved prosthetic use, mobility, global situation and fewer problems (all p < 0.001). The physical function SF-36 scores were also improved (p < 0.001). Superficial infection was the most frequent complication, occurring 41 times in 28 patients (rate of infection 54.9%). Most were treated effectively with oral antibiotics. The implant was removed in four patients because of loosening (three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form of treatment for patients with TFA. The high cumulative survival rate at two years (92%) combined with enhanced prosthetic use and mobility, fewer problems and improved quality of life, supports the ‘revolutionary change’ that patients with TFA have reported following treatment with osseointegrated percutaneous prostheses. Cite this article: Bone Joint J 2014;96-B:106–13.

Three-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws.

Abstract: PURPOSE To evaluate whether 5-mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10-mm long implants in posterior atrophic jaws. MATERIALS AND METHODS Fifteen patients with bilateral atrophic mandibles (5 mm to 7 mm bone height above the mandibular canal) and 15 patients with bilateral atrophic maxillae (4 mm to 6 mm bone height below the maxillary sinus), and bone thickness of at least 8 mm, were randomised according to a split-mouth design to receive one to three 5-mm short implants or at least 10-mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after another 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures; any complication and peri-implant marginal bone level changes. RESULTS In five augmented mandibles, the planned 10-mm long implants could not be placed and shorter implants (7 mm and 8.5 mm) had to be used instead. Three years after loading, two patients, one treated in the mandible and one in the maxilla, dropped out. Three prostheses (1 mandibular and 2 maxillary) failed in the short implant group versus none in the long implant group. In mandibles, one long implant failed versus two short implants in 1 patient. In maxillae, one long implant failed versus three short implants in 2 patients. There were no statistically significant differences in the failures. Eight patients had 13 complications at short implants (1 patient accounted for 6 complications) and 11 patients had 13 complications at long implants. There were no statistically significant differences in complications (P = 0.63, difference = 0.10, 95% CI from -0.22 to 0.42). Three years after loading, patients with mandibular implants lost on average 1.44 mm at short implants and 1.63 mm at long implants of peri-implant marginal bone. This difference was not statistically significant (difference = 0.24 mm; 95% CI -0.01, 0.49 P = 0.059). In maxillae, patients lost on average 1.02 mm at short implants and 1.54 mm at long implants. This difference was statistically significant (difference = 0.41 mm; 95% CI 0.21, 0.60, P = 0.001). CONCLUSIONS Three years after loading, 5-mm short implants achieved similar results as longer implants in augmented bone. Short implants might be a preferable choice to vertical bone augmentation, especially in mandibles, since the treatment is faster and cheaper, however there are still insufficient data on the long-term prognosis of short implants.

Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial.

Abstract: Purpose To compare planning and patient rehabilitation using a 3D dental planning software and dedicated surgical guides with conventional rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading. Materials and methods Fifty-one fully or partially edentulous patients requiring at least 2 implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width, had their implant rehabilitation planned on three-dimensional (3D) cone beam computed tomography (CBCT) scans using a dedicated software. Afterwards they were randomised according to a parallel group study design into two arms: computer-guided implant placement aided with templates (computer-guided group) versus conventional implant placement without templates (conventional group) in three different centres. Implants were to be placed flapless and loaded immediately; if inserted with a torque over 35 Ncm with reinforced provisional prostheses, then replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors were: prosthesis and implant failures, complications, peri-implant bone level changes, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, treatment time, time required to solve complications, additional treatment cost, patient satisfaction. Patients were followed up to 1 year after loading. Results Twenty-six patients were randomised to the conventional treatment and 25 to computerguided rehabilitation. No patient dropped out. One provisional prosthesis failed, since one of the two supporting implants failed 11 days after implantation in the conventional group (P = 1.0). Four patients of the conventionally loaded groups experienced one complication each, versus five patients (6 complications) in the computer-guided group (P = 0.726). There were no statistically significant differences between the two groups for any of the tested outcomes with the exception of more postoperative surgical pain (P = 0.002) and swelling (P = 0.024) at conventionally treated patients. Conclusions When treatment planning was made on 3D CBTC scan using a dedicated software, no statistically significant differences were observed between computer-guided and a free-hand rehabilitations, with the exception of more postoperative pain and swelling at sites treated freehand because more frequently flaps were elevated.

Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up

Abstract: Purpose of the study The aim of this retrospective study was to analyze outcome in 23 cases of Delta III reverse ball-and-socket total shoulder prosthesis implantation for acute complex fractures of the proximal humerus in an elderly population with poor bone quality. In this type of population, this procedure could respond to the difficulties of a reliable and efficient re-fixation of the tubercles. Material and methods From 1993 to 2000, 23 Delta III prostheses were implanted by a single operator for acute injury: 18 three-part and four-part fractures and five fracture-dislocations. The study population included two men and 21 women, mean age 75 years, ten on the dominant side. Surgery was performed under general anesthesia in the semi-sitting position via the anterolateral approach without osteotomy of the acromion, with 10–20° retroversion of the humeral stem (except in one shoulder) and cement fixation in two. For five shoulders, the tubercles were re-fixed. Postoperative physiotherapy was not possible in all patients. Outcome was assessed with the Constant score and with AP and lateral Lamy radiographs. Results Seven patients died so the series included 16 cases for analysis. Complications were: reflex sympathetic dystrophy (n = 2), postoperative Acinetobacter infection (n = 1) requiring revision to clean and drain allowing preservation of the prosthesis, and early postoperative anterior dislocation (n = 1) (10° stem anteversion) with surgical revision to re-orient the stem. At a mean follow-up of 86 months, the Constant score was 60 points (contralateral shoulder, 83 points). Outcome, influenced in cases of re-fixation of the tubercles, was good for pain (14.1), activity (13.3), strength (16.1), anterior elevation (6.5), and abduction (6.5), but very poor for external (1.1) and internal (2.4) rotation. The radiographs showed aseptic glenoid loosening (n = 1) at 12 years with surgical revision in 2005; the Constant score at 6 months follow-up was 48 points, inferior scapular notching (n = 11) according the Nerot classification (six stage 1, four stage 2, one stage 3, at 2, 4.3, and 5 years follow-up), inferior spurs (n = 9) appearing at a mean 2.5 years follow-up (stable after emergence without clinical impact), proximal humeral resorption (n = 4) (medially for three at a mean 8 years follow-up and one laterally at 10 years), and a humeral radiolucent line (n = 1) at 5 years follow-up. Discussion For acute complex fractures of the proximal humerus in elderly subjects with poor bone quality, when effective and reliable re-fixation of the tubercles is difficult or impossible, the reverse ball-and-socket shoulder prosthesis is a possible alternative providing good functional outcome except for rotations, but with the risk of inferior scapular notching. Although not problematic in the medium term, these notches may contribute to glenoid loosening with bone loss in the long term. Nevertheless, this procedure seems to improve the status of patients with such fractures.

Short implants versus longer implants in vertically augmented posterior mandibles: a randomised controlled trial with 5-year after loading follow-up

Abstract: OBJECTIVES To evaluate whether 6.6-mm long implants could be a suitable alternative to longer implants placed in vertically augmented atrophic posterior mandibles. MATERIALS AND METHODS Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5 mm thickness measured on CT scans above the mandibular canal were randomised according to a parallel group design. They were either to receive 1 to 3 submerged 6.6-mm long implants or 9.6 mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with interpositional anorganic bovine bone blocks covered by resorbable barriers. Grafts were left to heal for 5 months before implant placement. Four months after provisional acrylic prostheses were delivered, they were replaced, after 4 months, by definitive metal-ceramic prostheses. Outcome measures were: prosthesis and implant failures; complications; and radiographic peri-implant marginal bone level changes. All patients were followed up to 5 years after loading. RESULTS Five years after loading, 8 patients dropped out: 3 from the short implant group and 5 from the augmented group. The augmentation procedure failed in 2 patients and only 6.6-mm long implants could be inserted. There were no statistically significant differences for prosthesis and implant failures. Five prostheses failed in 4 patients of the short implant group versus 5 prostheses in 5 patients in the augmented group (Fishers exact test P = 1.0; difference in proportions = 0.07; 95% CI -0.29 to 0.43). Five short implants failed in 3 patients versus 3 long implants in 3 patients (Fishers exact test P = 1.00 difference in proportions = 0.00; 95% CI -0.43 to 0.43). There were statistically more complications in augmented patients (25 complications in 21 augmented patients versus 6 complications in 6 patients of the short implant group) (Fishers exact test P < 0.0001; difference in proportions = 0.60; 95% CI 0.38, 0.82). Both groups gradually lost peri-implant bone in a statistically significant way. Five years after loading, short implant group patients lost an average of 1.49 mm peri-implant bone compared with 2.34 mm in the augmented group. Short implants experienced statistically significantly less bone loss (0.82 mm, 95% CI 0.48; 1.16, P < 0.0001) than long implants. CONCLUSIONS When residual bone height over the mandibular canal is between 7 to 8 mm, 6.6 mm short implants could be an interesting alternative to vertical augmentation in posterior atrophic mandibles since the treatment is faster, cheaper and associated with less morbidity. Longer follow-ups may still be needed to confirm these results, however the medium-term prognosis (5 years after loading) of short implants is at least as good as those of longer implants placed vertically in augmented mandibles.

Blocks of autogenous bone versus xenografts for the rehabilitation of atrophic jaws with dental implants: preliminary data from a pilot randomised controlled trial.

Abstract: OBJECTIVES To compare the effectiveness of onlay bone blocks of equine origin (test or XB group) with autogenous bone blocks (control or AB group) harvested from the ramus or the iliac crest for the rehabilitation of partially or fully edentulous atrophic jaws with implant supported prostheses. MATERIALS AND METHODS Forty patients with partially or fully edentulous atrophic jaws having less than 5 mm of residual crestal bone height and/or less than 3 mm of bone thickness, as measured on computerised tomography (CT) scans, were randomised into two groups according to a parallel group design, either to be augmented with autogenous onlay bone blocks (20 patients; AB group) from the mandibular ramus or the iliac crest, or with onlays blocks of spongious bone of equine origin (20 patients; XB group). Two centres treated 20 patients each. Six XB blocks were modelled on lithographic models of the jaws before grafting. The blocks were fixed with screws and osteosynthesis plates and were covered with resorbable barriers made of equine cortical bone and fixed with tacks. The autogenous bone grafts were left to heal for 4 months and the xenografts for 7 months before placing implants, which were submerged. After 4 months, either bar-retained overdentures or provisional reinforced acrylic prostheses were delivered. Provisional prostheses were replaced, after 4 months, by definitive fixed prostheses. Outcome measures were: prosthesis and implant failures; complications; patient satisfaction; pain recorded 3 and 10 days post-augmentation; number of days of hospitalisation, total and partial infirmity days. All patients were followed for 4 months after loading. RESULTS All patients could be rehabilitated with implant-supported prostheses and none dropped out. Twenty-eight patients were augmented in the maxilla (15 with AB and 13 with XB) and 12 in the mandible (5 with AB and 7 with XB). No AB graft failed totally versus 10 XB grafts (difference = 0.5; 95% CI 0.23 to 0.68; P = 0.0004). In particular, all 7 XB mandibular grafts and 5 out of 6 XB blocks (3 in mandibles and 2 in maxillas), which were previously modelled on lithographic models of the jaws failed. One implant failed in one AB patient versus 11 implants in 4 XB patients (P = 0.3416). All but 1 prostheses were loaded in time in the AB patients, versus 4 prostheses which were loaded with delays in XB patients because of graft and implant failures (P = 0.3416). Four complications occurred in 4 AB patients versus 15 complications in 12 XB patients (difference = 0.4; 95% CI 0.09 to 0.63; P = 0.0225). Fourteen AB patients reported moderate pain 3 days postoperatively versus 6 XB patients (P = 0.0562); at 10 days, 10 AB patients reported moderate pain versus 1 XB patient (difference = -0.45; 95% CI -0.65 to -0.17; P = 0.0033). The 14 patients harvested from the iliac crest were hospitalised for an average of 3.1 nights, whereas 7 patients treated with XB were hospitalised on average for 1.4 nights (P <0.0001). The number of total and partial infirmity days was 126 for theAB group and 43 for the XB group, and 220 for the AB group and 93 for the XB group, respectively (mean day difference = -4.15; 95% CI -7.35 to -0.95; P = 0.0134 and mean day difference = -5.7; 95% CI -10.01 to -1.39; P = 0.0116, respectively). Seventeen AB patients versus 19 XB patients were fully satisfied with function of their prostheses (P = 0.6050), 18 AB patients versus 12 XB patients were fully satisfied with aesthetics of their prostheses (P = 0.0648), and 5 and 3 patients, respectively would not undergo the same procedure again (P = 0.6948). There were no differences between the outcomes of the two centres with exception of prosthesis failures and complications in the maxilla. CONCLUSIONS Autogenous onlay bone blocks are superior to equine onlay bone blocks, especially in mandibles, where all equine blocks failed, therefore we strongly discourage the use of onlay bone blocks of equine origin in mandibles.

Total alloplastic temporomandibular joint reconstruction using Biomet stock prostheses: the University

Abstract: The purpose of this study was to report the subjective and objective outcomes of temporomandibular joint (TMJ) replacement with Biomet stock prostheses at a single institution in Florida. In this retrospective study, patients who underwent TMJ replacement using a Biomet stock prosthesis from 2005 to 2012 were analyzed. Subjective (pain, diet) and objective (maximal incisal opening) information was obtained. In addition, a quality of life measure was obtained pre- and postoperatively. Significance was set at <0.01. Thirty-six patients (26 bilateral, 6 left, and 4 right) who underwent TMJ replacement using a Biomet stock prosthesis were eligible for the study. Maximal incisal opening improved from 26.1 mm preoperatively to a mean of 34.4 mm postoperatively. The pain score decreased from 7.9 preoperatively to a mean of 3.8 postoperatively. Diet restriction decreased from 6.8 preoperatively to a mean of 3.5 postoperatively. Quality of life improved from a median of 4 preoperatively to a postoperative median of 2. Four implants were removed/replaced because of heterotopic bone formation, infection, and/or loose hardware. Follow-up ranged from 6 to 83 months. Overall, TMJ reconstruction using the Biomet stock joint is effective and safe in this patient population.

The fate of marginal bone around axial vs. tilted implants: a systematic review.

Abstract: Aims The use of tilted implants has recently gained popularity as a feasible option for the treatment of edentulous jaws by means of implant-supported rehabilitations without recurring to grafting procedures. The aim of this review was to compare the crestal bone level change around axially placed vs. tilted implants supporting fixed prosthetic reconstructions for the rehabilitation of partially and fully edentulous jaws, after at least 1 year of function. Materials and methods An electronic search of databases plus a hand search on the most relevant journals up to January 2014 was performed. The articles were selected using specific inclusion criteria, independent of the study design. Data on marginal bone loss and implant survival were extracted from included articles and statistically analysed to investigate the effect of implant tilting, location, prosthesis type, loading mode and study design. The difference in crestal bone level change around axial vs. tilted implants was analysed using meta-analysis. Results The literature search yielded 758 articles. A first screening based on titles and abstracts identified 62 eligible studies. After a full-text review, 19 articles (14 prospective and five retrospective studies) were selected for analysis. A total of 670 patients have been rehabilitated with 716 prostheses (415 in the maxilla, 301 in the mandible), supported by a total of 1494 axial and 1338 tilted implants. Periimplant crestal bone loss after 1 year of function ranged from 0.43 to 1.13 mm for axial implants and from 0.34 to 1.14 mm for tilted implants. In spite of a trend for a lower bone loss around axial implants with respect to tilted ones at 12 months, as well as after 3 or more years of function, no significant difference could be found (P = 0.09 and P = 0.30, respectively). The location (maxilla vs. mandible), the loading mode (immediate vs. delayed), the restoration type (full vs. partial prosthesis) and the study design (prospective vs. retrospective) had no significant effect on marginal bone loss. Forty-six implants (18 axial and 28 tilted) failed in 38 patients within the first year of function. All failures except five occurred in the maxilla. After 12 months of loading, the survival rate of implants placed in the maxilla (97.4%) was significantly lower as compared to the mandible (99.6%). No prosthesis failure was reported. Conclusions Tilting of the implants does not induce significant alteration in crestal bone level change as compared to conventional axial placement after 1 year of function. The trend seems to be unchanged over time even though the amount of long-term data is still scarce. The use of tilted implants to support fixed partial and full-arch prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short and mid-term. Further long-term trials, possibly randomised, are needed to determine the efficacy of this surgical approach and the remodelling pattern of marginal bone in the long term.

Megaprosthesis in post-traumatic and periprosthetic large bone defects: Issues to consider

Abstract: Introduction The recent evolution of prosthesis technology has enabled the surgeon to replace entire limbs. These special prostheses, or megaprostheses, were developed for the treatment of severe oncological bone loss; however, the indications and applications of these devices have expanded to other orthopaedic and trauma situations. For some years, surgeons have been implanting megaprostheses in non-oncological conditions, such as acute trauma in severe bone loss and poor bone quality; post-traumatic failures, both aseptic and septic (represented by complex non-unions and critical size bone defects); major bone loss in prosthetic revision, both aseptic and septic; periprosthetic fractures with component mobilisation and poor bone stock condition. The purpose of this study was to evaluate retrospectively the complications during and after the implantation of megaprosthesis of the lower limb in post-traumatic and prosthetic bone loss, and to propose tips about how to avoid and manage such complications. Materials and methods All the complications and difficulties we have encountered during or after the implantation of megaprosthesis in non-oncology patients were evaluated retrospectively. A total of 72 patients were treated with large resection mono-and bi-articular prostheses between January 2008 and January 2014. Results The main critical problems found in the study were: restoration of the correct length and rotation of the limb; reconstruction of the knee extensor mechanism; trochanteric reconstruction; stability/dislocation of the implant; mobility/range of motion (ROM) of the implant; skin cover; sepsis, and bone quality. Conclusion Megaprosthesis in severe bone loss can be considered as an available solution for the orthopaedic surgeon in extreme, appropriately selected cases. This type of complex surgery must be performed in specialised centres where knowledge and technologies are present. Patients with severe bone loss should not be treated in the same way as oncology patients because life expectancy is definitely longer; therefore, the surgical technique and the system implantation must be extremely rigorous to ensure longevity of the prosthesis. The characteristics of the bone and soft tissue conditions in these patients are very different from those presented by oncology patients, which creates critical problems that the surgeon should be able to manage to avoid serious complications.

The Talar Body Prosthesis: Results at Ten to Thirty-six Years of Follow-up.

Abstract: Background: Satisfactory results of implantation of the talar body prosthesis were reported in 1997, although some complications associated with the initial design were noted. The present study evaluated outcomes of treatment with a modified talar body prosthesis. Methods: Of the thirty-six talar body prostheses implanted with use of a transmalleolar surgical approach from 1974 to 2011, thirty-three were available for follow-up at ten to thirty-six years or had failed prior to that time. The indication for implantation had been osteonecrosis in twenty-three patients, a comminuted talar fracture in eight, and a talar body tumor in two. Results: Twenty-eight of the thirty-three prostheses were still in place at the time of final follow-up and five had failed prior to five years. The duration of follow-up was ten to twenty years in eight patients, twenty to thirty years in eleven, and thirty to thirty-six years in nine. The AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot score did not differ significantly among these three groups. Patients over sixty-five years of age with underlying disease that impeded walking ability had lower AOFAS scores. Early prosthesis failure occurred as a result of size mismatch in two patients, tumor recurrence in one, infection in one, and osteonecrosis of the talar head and neck in one. These failures, which occurred at eight to fifty-seven months, were treated with tibiotalar arthrodesis in three patients, prosthesis revision in one, and below-the-knee amputation in one. Conclusions: Although early prosthesis failure may occur, survival of the talar body prosthesis can provide satisfactory ankle and foot function. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Three-year post-loading results of a randomised, controlled, split-mouth trial comparing implants with different prosthetic interfaces and design in partially posterior edentulous mandibles.

Abstract: Author(s): Pozzi, Alessandro; Tallarico, Marco; Moy, Peter K | Abstract: PurposeTo compare the clinical and radiological outcomes of two implant designs with different prosthetic interfaces and neck configurations.Materials and methodsThirty-four partially edentate patients randomly received at least one NobelActive implant (Nobel Biocare, Goteborg, Sweden) with back-tapered collar, internal conical connection and platform shifting design, and one NobelSpeedy implant (Nobel Biocare) with external hexagon and flat-to-flat implant-abutment interface according to a split-mouth design. Follow-up continued to 3 years post-loading. The primary outcome measures were the success rates of the implants and prostheses, and the occurrence of any surgical and prosthetic complications during the entire follow-up. Secondary outcome measures were: horizontal and vertical peri-implant marginal bone level (MBL) changes, resonance frequency analysis values at implant placement and loading (4 months), sulcus bleeding index (SBI) and plaque score (PS).ResultsNo drop-out occurred. No implants and prostheses failures were observed to the 3-year follow-up. MBL changes were statistically significant different with better results for the NobelActive implants for both horizontal and vertical measurements (P = 0.000). After 3 years post-loading, the NobelActive implants underwent a mean vertical bone resorption of 0.66 mm, compared with 1.25 mm for the NobelSpeedy Groovy implants (P = 0.000); the mean horizontal bone resorption was 0.19 mm for the NobelActive implants and 0.60 mm for the NobelSpeedy Groovy implants (P = 0.000). A high ISQ value was found for both implants, and no statistically significant difference was found for ISQ mean values between interventions (P = 0.941 at baseline; P = 0.454 at implantabutment connection; P = 0.120 at prosthesis delivery). All implants showed good periodontal health at the 3-year-in-function visit, with no significant differences between groups.ConclusionThe results of this research suggest that in well-maintained patients, the MBL changes could be affected by the different implant design. After 4 months of unloaded healing, as well as after 3 years in function, both implants provided good results, however vertical and horizontal bone loss had statistically significant differences between the two groups (difference of 0.58 ± 0.10 mm for the vertical MBL, and 0.4 ± 0.05 mm for the horizontal MBL), with lower values in the Nobel Active implants, compared to the NobelSpeedy Groovy implants.

Double-crown–retained removable dental prostheses: A retrospective study of survival and complications

Abstract: Statement of problem Research data are scarce on double-crown–retained removable dental prostheses. In double-crown–retained removable dental prostheses, crown-like copings are definitively cemented to the abutment teeth and serve as prosthesis attachments. Purpose The purpose of this study was to evaluate the survival of double-crown–retained removable dental prostheses in use for 7 years and to determine their most common complications. Material and methods A retrospective analysis was conducted to investigate the clinical outcome of 117 prostheses in 86 patients with 385 abutment teeth. Thirty-two telescopic-crown–retained removable dental prostheses, 51 conical-crown–retained removable dental prostheses, and 34 resilient telescopic-crown–retained overdentures were clinically reexamined by 1 investigator. Prosthesis success was defined as survival without severe complications (abutment tooth extraction). Statistical analyses were performed with Kaplan-Meier modeling and Cox regression (α=.05). Results Minor complications, for example, the decementation of primary crowns (34.2%), failure of the veneer of secondary crowns (11.1%), fracture of the denture base (17.1%), and the need for relining (12%), were common. Cumulative prosthesis survival for all types of prostheses was 93.8% after 7 years. After the same period, prosthesis success was 90% for telescopic-crown–retained removable dental prostheses and 78.5% for conical-crown–retained removable dental prostheses and resilient telescopic-crown–retained overdentures. Conclusions The medium-term double-crown–retained removable dental prosthesis survival found in this retrospective investigation appears acceptable. When bearing in mind the limits of this study, this kind of prosthesis might be a viable treatment option for patients with a reduced dentition. However, more laboratory and clinical research is necessary to reduce the incidence of minor complications and confirm the present in vivo results in larger patient groups.

Implant retention and support for distal extension partial removable dental prostheses: satisfaction outcomes

Abstract: Statement of problem The rotational movements of the distal extension denture base of partial removable dental prostheses frequently harm the prosthesis stability, leading to discomfort during function. Purpose This study evaluated the use of distal implants to retain and support partial removable dental prostheses and assessed the outcomes with respect to specific aspects of patient satisfaction. Material and methods Twelve participants (mean age, 62.6 ±7.8 years) received new conventional mandibular partial removable dental prostheses and complete maxillary dentures. After 2 months of conventional prosthesis use, the participants completed a questionnaire assessing their satisfaction. Implants were then inserted bilaterally in the mandibular posterior region and, after 4 months, ball attachments were placed on the implants and on the partial removable dental prosthesis acrylic resin base. The implants and remaining teeth were followed up with clinical and image examinations. After 2 months, satisfaction was reevaluated, and the data were analyzed by the paired Student t test and the Bonferroni correction (α=.05). Results Clinical evaluation found stable periodontal conditions around the implants, no intrusions or mobility of teeth, and no radiographic changes in bone level. Participants reported significant improvements ( P Conclusions Implant-retained and -supported removable prostheses improve retention and stability, minimize rotational movements, and significantly increase participant satisfaction.

Outcomes of bipolar radial head prosthesis to treat complex radial head fractures in 22 patients with a mean follow-up of 50 months

Abstract: Background Radial head replacement is indicated to treat complex proximal radial fractures that are not amenable to internal fixation. Hypothesis Implantation of a bipolar radial head prosthesis after radial head excision ensures stability of the elbow and forearm, thereby promoting ligament healing and restoring elbow function. Material and methods Twenty-two patients managed with implantation of a bipolar radial head prosthesis (Guepar ® ) were evaluated after a mean follow-up of 50 months. The procedure was performed in the acute setting in 16 patients, including 13 with associated injuries; and at the stage of sequelae in 6 patients. Results Prosthesis removal was required in 4 patients. Of the remaining 18 patients, 14 (77%) had satisfactory Mayo Elbow Performance Score values, 14 (77%) little or no functional impairment, and 11 (61%) little or no pain. Mean motion arcs were 100° in flexion-extension and 143° in pronation-supination. Mean elbow strength in flexion and mean wrist strength were 67% and 86%, respectively, of those on the contralateral normal side. Radio-lucent lines were visible around the prosthesis in 5 patients, radial neck osteolysis in 10 patients, and capitellar erosion in 7 patients. Seven patients each experienced a complication. Early revision surgery to treat elbow instability was required in 6 patients. Discussion Outcomes after Guepar ® bipolar radial head prosthesis implantation were disappointing in patients with complex radial head fractures seen in the acute or chronic setting. The associated injuries to bones and ligaments and the measures taken to repair them influence the prognosis. The complication rate is non-negligible and seems to increase over time. Level of evidence IV, retrospective study.

Short stem shoulder replacement

Abstract: Context: It is agreed that it is important to anatomically reproduce the proximal humeral anatomy when performing a prosthetic shoulder replacement. This can be difficult with a long stemmed prosthesis, in particular if there is little relationship of the metaphysis to the humeral shaft. The 'short stem' prosthesis can deal with this problem. Aims: A prospective study assessed the results of total shoulder arthroplasty using a short stem humeral prosthesis, a ceramic humeral head, and a pegged cemented polyethylene glenoid. Materials and methods: Patients with primary shoulder osteoarthritis were recruited into this prospective trial and pre-operatively had the ASES, Constant, SPADI, and DASH scores recorded. The patients were clinically reviewed at the two weeks, eight weeks, one year, and two year mark with completion of a data form. Radiological evaluation was at the eight week, one year and two year follow-up. At the one and two year follow-up the satisfaction rating, the range of passive and active motion, Constant, ASES, SPADI, DASH and pain results were recorded and analysed with SPPS 20. Results: During the study period 97 short stem, ceramic head total shoulder replacements were carried out. At the time of follow-up 12 were two years from operation and 38 one year from operation. Active elevation was overall mean 160 degrees. Constant scores were 76 at 1 year, and 86 at 2 years, ASES 88 and 93, and satisfaction 96% and 98% respectively at one and 2 year follow up. There were no problems during insertion of the humeral prosthesis, or any radiolucent lines or movement of the prosthesis on later radiographs. Conclusion: The short stem prosthesis had no complications, and on follow up radiographs good bone fixation. These fairly short term clinical results were overall good.

Ten years' experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up.

Abstract: We prospectively assessed the subjective, objective, and radiographic results at 1, 2, and 5 years in 65 patients who had pyrocarbon proximal interphalangeal prostheses inserted between 2001 and 2010. Further operations were done on 10 of the 89 joints (four for prosthetic extraction and arthrodesis, two for component changes, and four for soft tissue procedures). At 1 year, the visual analogue scale score for pain at rest had improved to 0 cm from a pre-operative 4 cm, pain at activity from 6 to 1.8 cm, and Disability of the Arm, Shoulder and Hand score from 40 to 25. Range of movement and grip strength were unchanged. At 5 years, 31 joints (21 patients) had a complete radiographic follow-up. Seven proximal and 12 distal components showing zones of osteolysis at 1 year had stabilized and were inert or integrated at 5 years. Three proximal and three distal components had osteolytic zones at 5 years. Forty-seven of 59 patients were pain-free at rest at 1 year, and 19 of 21 at 5 years. No late revisions or loosening occurred.

Five-year outcome of a retrospective cohort study on the rehabilitation of completely edentulous atrophic maxillae with immediately loaded zygomatic implants placed extra-maxillary.

Abstract: Purpose To report retrospectively on the 5-year follow-up results of the rehabilitation of complete edentulous atrophied maxillae, using extra-maxillary zygomatic implants alone or in combination with conventional implants Materials and methods This retrospective report includes an initial cohort of 39 patients (30 women and 9 men), with a mean age of 53 years, followed for 5 years The patients were rehabilitated with 39 fixed prostheses and 169 implants (92 zygomatic implants inserted extra-maxillary and 77 conventional dental implants) A provisional prosthesis was manufactured and attached via multiunit abutments secured to the implants on the same day as implant placement According to patient desires and each clinical situation, either an acrylic resin, a metal-acrylic or metal-ceramic final prosthesis was inserted approximately 6 months after implant placement Outcome measures were: prosthesis success; implant success; complications; probing pocket depths; marginal bleeding; and marginal bone levels (only for conventional implants) Data were analysed with descriptive statistics Results Two patients died after 8 and 30 months of follow-up due to causes unrelated to their oral rehabilitations, and 5 patients dropped out of the study No prosthesis was lost; one zygomatic implant was removed after 46 months of follow-up, giving cumulative success rates of 97% and 988% (patient and implant related, respectively) Twelve complications occurred in 12 patients: 5 sinus infections in 5 patients, all with a previous history of sinusitis and whose sinus membrane was disrupted during surgery; one oroantral communication (leading to removal of the implant), 2 all acrylic resin prostheses fractures, 1 ceramic crown fracture (on a metal-ceramic prosthesis); and 3 screw loosenings Bleeding on probing was recorded in 6 patients (13 implants) Probing pocket depths >4 mm were present in 13 patients (23 implants) at 5 years of follow-up The average (standard deviation) marginal bone loss on conventional implants was 116 mm (077 mm) in those 9 patients having the intraoral radiographs Conclusions The long term outcome (5 years) of rehabilitations performed on patients with completely edentulous, severely atrophic maxillae supported by immediately loaded zygomatic implants alone, or in combination with conventional implants, is satisfactory

Clinical and radiological results of femoral head structural allograft for severe bone defects in revision TKA--a minimum 8-year follow-up.

Abstract: Background Proper treatment of bone loss is essential for the long term durability of revision TKA. However, the method of choice in managing large bone defects is still under debate. We therefore assessed the mid to long term clinical and radiographic results of revision TKA using a fresh frozen femoral head allograft and a standard condylar implant or varus–valgus constrained prosthesis with a diaphyseal-engaging stem. Methods We retrospectively reviewed the records of 27 patients who had undergone revision TKA between August 1997 and March 2003 using a fresh frozen femoral head allograft and a standard condylar implant or varus–valgus constrained prosthesis with a diaphyseal-engaging stem. The median follow-up period was 107 months (range, 96–157 months). Results Clinical evaluation revealed that the mean range of motion had increased from 71° to 113° and the mean Hospital for Special Surgery knee score had improved from 46 to 83 points. The overall tibio-femoral angle improved from varus 7.3° to valgus 6.l°. In 26 out of 27 knees, union was demonstrated at an average of seven months postoperatively, and there were no cases of collapse, disease transmission or stress fractures. In one knee, an infection recurred. Conclusions Our results demonstrate that femoral head allografts in treatment of severe bone defects are reliable and durable. If possible, less constrained prostheses with diaphyseal-engaging stems should be chosen for increased durability. Level of evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Arthroscopic debridement for acutely infected prosthetic knee: any role for infection control and prosthesis salvage?

Abstract: Purpose The purpose of this study was to assess the success rate of arthroscopic debridement guided by C-reactive protein (CRP) levels for acutely infected total knee prostheses. Methods From January 2002 to December 2009, 16 consecutive eligible patients met the following inclusion criteria: duration of symptoms less than 72 hours, previously well-functioning prostheses, and no radiographic signs of loosening. Each patient underwent arthroscopy with thorough debridement and synovectomy and copious irrigation. In addition to the standard anterior portals, a posterior portal was used, and a drain was placed through this portal. The need for subsequent open debridement was determined by the postarthroscopy trends of CRP levels. Treatment success was defined as continuing freedom from infection based on clinical and laboratory results, salvage of the prosthesis, and no evidence of infection for at least 2 years. Results Arthroscopic debridement eradicated the infection in 10 (62.5%) of the 16 cases. The other 6 knees (37.5%) underwent subsequent open debridement with polyethylene insert exchange, which resulted in successful infection control with prosthetic salvage. Conclusions Patients who had undergone total knee arthroplasty (TKA) and had acute joint infection for less than 72 hours with no evidence of a loosening prosthesis were treated by arthroscopic debridement guided by the CRP level and had a 62.5% success rate with arthroscopic treatment alone but a 100% success rate when initial failures were treated with open debridement and polyethylene exchange. Level of Evidence Level IV, case series.

Six-mm versus 10-mm long implants in the rehabilitation of posterior edentulous jaws: a 5-year follow-up of a randomised controlled trial.

Abstract: Purpose To compare the clinical outcome of 6-mm and 10-mm long implants in partially edentulous posterior areas. Materials and methods Twenty-four patients, with a partially edentulous area in the jaws with a height and width allowing the positioning of 2 to 3 adjacent 10 × 4.1 mm implants without any augmentation procedure, were randomly allocated according to a parallel group design to receive 6-mm long or 10-mm long implants. A total of 54 implants were placed (26 × 6 mm and 28 × 10 mm implants). Patients were restored 8 weeks after surgery and were followed for 5 years. Outcome measures were prosthesis and implant survival, as well as marginal bone level changes and complications. Results After 5 years, 18 patients were available. One 6 mm implant failed during the healing period and its related prosthesis could not be placed. No implants were lost after loading. The 6 mm group registered 5 complications (1 mucositis, 3 prosthesis decementations and 1 chipping), while only 3 were registered in the 10 mm group (2 decementations and 1 chipping). The difference in complications between the two groups was not statistically significant (P = 0.39). Marginal bone loss at 5 years was 0.43 and 0.24 mm with the 6 mm and 10 mm groups, respectively (not statistically significant; difference between the two groups 0.19 mm; SD 0.23 mm; 95% CI -0.34;0.73; t test P = 0.42). Conclusions Implant and prosthetic survival and success rates were similar between prostheses supported by 6-mm or 10-mm long implants.

Practice-based evidence from 29-year outcome analysis of management of the edentulous jaw using osseointegrated dental implants.

Abstract: Purpose The aim of this retrospective study was to summarize practice-based evidence associated with long-term outcomes (>20 years) in the management of edentulous patients. The patient population was managed with implant-supported prostheses, following the original osseointegration protocol, provided over the period from 1983 to 1991 in the group prosthodontics practice at the Mayo Clinic. The data are an example of practice quality assurance monitoring and are used to refine care delivery when needed and to provide information regarding expected outcomes in a shared decision-making interaction with prospective patients. Materials and Methods Two hundred and sixty four patients with at least one edentulous jaw were identified. Of these, 255 completed their care and follow-up at the Mayo Clinic (209 mandible only, 35 maxilla only, 11 mandible and maxilla). Prosthodontic outcomes categorized as anticipated or unanticipated prosthetic and biologic events and the respective interventions required for each were recorded to assess follow-up event dynamics for this care modality. Results The mean duration of follow-up for 190 of the 255 patients (65 died at a mean follow-up of 12.6 years) was 13.0 years (median 13.6; range 0.3 to 28). At least one prosthetic event was experienced by 148 patients (58%), and 81 (32%) experienced at least one biologic event. Overall, patients experienced 3.8 times more prosthetic events than biologic events. Twenty-four (9%) patients experienced 35 implant failures. Overall survival rates at 20 years were 86% for prostheses, 15% survived free of any event, and 92% experienced survival free of implant failure (95% confidence interval). Conclusion Anticipated and unanticipated prosthetic events occur throughout the life of the hybrid prosthesis. Prosthetic events significantly surpass (four times more) biologic events and occur significantly later in the follow-up. For this patient group, 8.6% (22/255) had implant-supported prostheses remade during follow-up in this patient population. These findings support the recommendation that prosthodontic care for missing teeth be thought of in a “chronic condition” context, recognizing that long-term outcome monitoring to provide realistic care expectations is important for demonstrating care value in oral health promotion.

Radial head prosthesis in complex elbow dislocations: effect of oversizing and comparison with ORIF

Abstract: Elbow dislocations with complex elbow instability (CEI) and unstable radial head fractures require reconstruction by open reduction and internal fixation (ORIF) if possible or alternatively by a radial head prosthesis. The aim of this study was to determine the differential outcome of both strategies and to investigate the contribution of prosthesis-related radiographic factors such as oversizing on clinical outcome. A total of 53 patients underwent ligament and coronoid refixation, and radial head reconstruction by ORIF (n = 18; group 1) or by monopolar modular prosthesis (n = 35; group 2). Patients were followed by the Mayo Elbow Performance Score (MEPS) and a radiological score including prosthesis oversizing, joint subluxation, ossifications, capitellar erosions, implant loosening and ulno-humeral osteoarthritis. To investigate the effect of oversizing, group 2 was subdivided by prosthesis overlenghtening ≥ 2 mm. A total of 42 patients (79.2 %) could be followed for 3.0 ± 1.3 years with an average MEPS of 76.8 ± 17.2. Patients with ORIF had slightly better MEPS (82.1 ± 9.9) as compared with group 2 (74.7 ± 19.1) though three ORIF patients required an early conversion to prosthesis. In group 2, oversizing occurred frequently and 50 % showed an overlenghtening ≥ 2 mm. Oversizing significantly decreased MEPS (63.2 ± 21.3 vs 84.7 ± 9.0; p = 0.001) and elbow range of motion and increased the occurrence of other radiological abnormalities and the risk for surgical revisions. The radiological score and prosthesis overlenghtening but not prosthesis diameter showed an inverse correlation with MEPS. In CEI a radial head reconstruction with a prosthesis demonstrates similarly good clinical results as compared to ORIF in anatomically sized prosthesis, but prosthesis oversizing could induce other radiographic abnormalities with then deteriorated outcome.

Prevalence of peri-implantitis in patients with implant-supported fixed prostheses.

Abstract: OBJECTIVE The purpose of this study was to evaluate periimplantitis prevalence in patients using implant-supported fixed prostheses that did not have any routine maintenance care. METHOD AND MATERIALS A total of 161 implants (27 patients) were evaluated in patients using implant-supported fixed prostheses. Collected data included information related to patient general health and local factors such as characteristics of implants, time in function, type of loading, positioning, Modified Bleeding Index, bacterial plaque, bleeding on probing (BOP), marginal recession, probing depth (PD), keratinized mucosa, and radiographic bone loss (BL). Factors related to the prostheses were also evaluated. The exclusion criteria were patients that have had any follow-up visit for plaque control of the prosthesis and/or the implants. RESULTS From a total of 161 implants, 116 (72%) presented without peri-implantitis (PD > 4 mm + BOP + BL > 2 mm) while 45 (28%) had some sign of the disease. Implants placed in the maxilla were 2.98 times more likely to develop the disease (P < .05). Moreover, patients aged ≤ 60 years old were 3.24 times more likely to develop peri-implantitis (P < .05). Another analysis with statistical relevance (P < .05) was that implants with less than 3 mm interimplant distance were three times more likely to have peri-implantitis. There was no statistical relevance considering other analyses. CONCLUSION It can be concluded that patients aged ≤ 60 years have a greater chance of presenting periimplantitis, as well as for implants positioned in the maxilla and those placed with an interimplant distance < 3 mm.

Long-term clinical outcomes and survivorship of press-fit condylar sigma fixed-bearing and mobile-bearing total knee prostheses in the same patients.

Abstract: Background: We are aware of no study that has compared press-fit condylar Sigma fixed-bearing and mobile-bearing total knee prostheses in the same patients after more than ten years of follow-up. The purpose of the current study was to compare these two implants with respect to the functional and radiographic results, prevalence of osteolysis, and overall revision rates at a mean of 12.1 years of follow-up. Methods: The study consisted of a consecutive series of 444 patients (mean age [and standard deviation], 66.5 ± 7.4 years) who underwent simultaneous bilateral total knee arthroplasty, with one side treated immediately after the other. All of the patients received a press-fit condylar Sigma mobile-bearing prosthesis on one side and a press-fit condylar Sigma fixed-bearing prosthesis on the contralateral side. The minimum duration of follow-up was ten years (mean, 12.1 years; range, ten to thirteen years). At the time of each follow-up visit, the patients were assessed clinically and radiographically. Results: Postoperative total knee scores (95 and 94 points), Western Ontario and McMaster Universities Osteoarthritis Index (19 and 18 points), University of California, Los Angeles activity score (both prostheses, 5 points), range of motion (129° ± 6.3° and 127° ± 6.8°), and radiographic findings did not differ significantly between the press-fit condylar Sigma mobile and fixed-bearing designs at the final follow-up. The prevalence of aseptic loosening (1.4% and 1.8%) did not differ significantly between the mobile and fixed-bearing implant designs. No knee in either group had osteolysis. The estimated survival rate with revision as the end point was 98.2% (95% confidence interval, 91% to 99%) and 97.5% (95% confidence interval, 91% to 99%) at 12.1 years for the mobile and fixed-bearing implant groups, respectively. Conclusions: The results of the present long-term clinical study suggest that excellent clinical and radiographic results were achieved with both the press-fit condylar Sigma mobile and fixed-bearing cruciate-retaining total knee designs. We found no significant clinical advantage for a mobile-bearing over a fixed-bearing total knee prosthesis. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty.

Abstract: Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauve procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median followup time of 60 months (range: 2 to 102 months). Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.