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Surgical Protocol (surgical + protocol)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Surgical Protocol

  • one-stage surgical protocol
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    Selected Abstracts

    Fast track surgery: A clinical audit

    AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010
    Jonathan CARTER
    Background:, Fast track surgery is a concept that utilises a variety of techniques to reduce the surgical stress response, allowing a shortened length of stay, improved outcomes and decreased time to full recovery. Aims:, To evaluate a peri-operative Fast Track Surgical Protocol (FTSP) in patients referred for abdominal surgery. Methods:, All patients undergoing a laparotomy over a 12-month period were entered prospectively on a clinical database. Data were retrospectively analysed. Results:, Over the study period, 72 patients underwent a laparotomy. Average patient age was 54 years and average weight and BMI were 67.2 kg and 26 respectively. Sixty three (88%) patients had a vertical midline incision (VMI). There were no intraoperative blood transfusions. The median length of stay (LOS) was 3.0 days. Thirty eight patients (53%) were discharged on or before post op day 3, seven (10%) of whom were discharged on postoperative day 2. On stepwise regression analysis, the following were found to be independently associated with reduced LOS: able to tolerate early enteral nutrition, good performance status, use of COX inhibitor and transverse incision. In comparison with colleagues at the SGOG not undertaking FTS for their patients, the authors' LOS was lower and the RANZCOG modified Quality Indicators (QI's) did not demonstrate excess morbidity. Conclusions:, Patients undergoing fast track surgery can be discharged from hospital with a reduced LOS, without an increased readmission rate and with comparative outcomes to non-fast tracked patients. [source]

    Early healing of implants placed into fresh extraction sockets: an experimental study in the beagle dog.

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2009
    De novo bone formation
    Abstract Objectives: Describe the early phases of tissue integration in implants placed into fresh extraction sockets and test whether a new implant surface nano-topography (DCD nano-particles, NanotiteÔ) promotes early osseointegration when compared with minimally rough surface implants (DAE, Osseotite®). Material and Methods: Sixteen beagle dogs received 64 test and control implants randomly installed into the distal socket of 3P3 and 4P4. Histomorphometric analysis of bone to implant contact (BIC) and bone area was performed at 4 h, 1, 2, 4 and 8 weeks. Results: Wound healing initiated with a coagulum that was substituted by a provisional matrix at 1 week. Bone formation started concomitant to a marked bone resorption. At 2 weeks, woven bone formation was evident and gradually remodelled into lamellar bone at 4 and 8 weeks. BIC increased similarly throughout the study in both groups with a tendency to higher percentages for the test devices at 2 and 4 weeks. The influence of the DCD nano-particles was more evident at the fourth premolar site. Conclusion: Osseointegration occurred similarly at both implant groups, although the socket dimension appeared to influence bone healing. It is suggested that the enhanced nano-topography has a limited effect in the immediate implant surgical protocol. [source]

    Correlation between early perforation of cover screws and marginal bone loss: a retrospective study

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2008
    Nele Van Assche
    Abstract Aim: This retrospective study aimed to determine the consequence of early cover screw exposure on peri-implant marginal bone level. Material and Methods: Sixty Astra Tech® MicroThread implants installed in partially edentulous jaws were compared: 20 implants were placed following a two-stage procedure and were unintentionally exposed to the oral cavity (two-stage exposed), 20 implants were placed following a two-stage procedure and were surgically exposed after a subgingival healing time of 3,6 months (two-stage submerged), and 20 implants were placed following a one-stage surgical protocol (one-stage). Digital radiographs were taken at implant placement for all implants, and after abutment surgery for the two-stage exposed and two-stage submerged groups or after 3 months for the one-stage group. Bone loss mesially and distally was measured with an on-screen cursor after calibration. Results: Mean bone re-modelling was 1.96 mm (range: 0.2,3.2 mm) around the two-stage exposed implants, 0.01 mm (range: 0.0,0.3 mm) around the two-stage submerged implants and 0.14 mm (range: 0.0,1.2 mm) around the one-stage implants. Conclusion: The unintentional perforation of two-stage implants resulted in significant bone destruction, probably because the biological width was not considered. [source]

    Effects of Ethanol on Extracellular Levels of Adenosine in the Basal Forebrain: An In Vivo Microdialysis Study in Freely Behaving Rats

    ALCOHOLISM, Issue 5 2010
    Rishi Sharma
    Background:, Adenosine is implicated to play a pivotal role in mediating many neuronal responses to ethanol. While in vitro studies performed in cell culture have demonstrated that acute ethanol exposure increases extracellular adenosine levels, this effect has not been demonstrated, in vivo, in the brain. We performed an in vivo microdialysis study to examine the effects of local ethanol perfusion on extracellular levels of adenosine in the basal forebrain (BF). Methods:, Under sterile conditions and using a standard surgical protocol, adult male Sprague,Dawley rats were implanted with unilateral microdialysis guide cannula targeted toward the BF. Following postoperative recovery, the microdialysis probe was inserted. After allowing at least 12 to 16 hours for probe insertion recovery, the experiment was begun. Artificial cerebrospinal fluid (aCSF) was perfused (0.7 ,l/min) for 80 minutes, and 4 × 20-minute pre-ethanol baseline samples were collected. Subsequently, 30, 100, and 300 mM doses of ethanol were perfused. Each ethanol dose was perfused for 80 minutes, and 4 × 20-minute samples were collected. Finally, aCSF was perfused, and 4 × 20 postethanol samples were collected. Adenosine in the microdialysate was separated and measured with HPLC coupled with an UV detector. On completion, the animals were euthanized, brain removed and processed for histology. Results:, Local ethanol perfusion in the BF produced a significant increase in extracellular adenosine with the highest dose of 300 mM ethanol producing a 4-fold increase. Cresyl violet (Nissl) staining did not indicate any toxic damage in the area surrounding the probe tip. Choline acetyltransferase immunohistochemistry revealed that all microdialysis probe sites were localized in the BF. Conclusion:, Our study is the first to demonstrate that ethanol acts directly in the brain to increase extracellular adenosine. [source]

    Hypospadias surgery: when, what and by whom?

    BJU INTERNATIONAL, Issue 8 2004
    Gianantonio Manzoni
    Summary Hypospadias is repaired by paediatric surgeons, paediatric urologists, adult reconstructive urologists and plastic surgeons. This review is unique in representing all four specialities, to provide a unified policy on the management of hypospadias. The surgeon of whichever speciality should have a dedicated interest in this challenging work, ideally having an annual volume of at least 40,50 cases. The ideal time for primary repair is at 6,12 months old, although when this is not practicable there is another opportunity at 3,4 years old. A surgical protocol is presented which emphasises both functional and cosmetic refinement. Using a logical progression of a very few related procedures allows the reliable correction of almost any hypospadias deformity. A one-stage repair is used when the urethral plate does not require transection and its axial integrity can be maintained. Occasionally, when the plate is of adequate width and depth, it can be tubularized directly using the second stage of the two-stage repair. When (usually) the urethral plate is not adequately developed and requires augmentation before it can be tubularized, then that second-stage procedure is modified by adding a dorsal releasing incision ± a graft (alias Snodgrass and ,Snodgraft' procedures). The two-stage repair offers the most reliable and refined solution for those patients who require transection of the urethral plate and a full circumferential substitution urethroplasty. From available evidence this protocol combines excellent function and cosmesis with optimum reliability. Nevertheless, it would be complacent to assume that these gratifying results will be maintained into adult life. We therefore recommend that there is still a need for active follow-up through to genital maturity. [source]

    Turned, Machined Versus Double-Etched Dental Implants In Vivo

    CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2007
    B. Al-Nawas Priv.-Doz., DrMed, DrMedDent
    ABSTRACT Background:, Positive effects on the clinical outcome of moderately rough implant surfaces are described. Intercomparison of clinical data, however, is rarely found. Purpose:, The aim of this study was to compare the clinical results of two macroscopically identical implants, the one with a turned, machined and the other with an etched surface. Materials and Methods:, In a retrospective cohort study, the included implants followed the criteria: standard surgical protocol, >12 months in situ; minimally rough self-threading implants with a turned, machined surface (Mk IITM Nobel Biocare AB, Göteborg, Sweden], n=210); etched implants of the same macrodesign (3iTM Implant Innovations Inc., Palm Beach Gardens, FL, USA], n=151), length , 10 mm. Clinical data and implant success were rated. Resonance frequency analysis (RFA) and Periotest® (Siemens AG, Bensheim, Germany) were measured and related to the corresponding implant survival rate in the respective group. Results:, The total number of implants was 361, of which 264 (73%) were subject to clinical reexamination. RFA and Periotest could be recorded in 25% of the implants. Neither clinically relevant nor statistically significant differences between the surface designs were found in the RFA (64 ± 8.6 vs 63 ± 9.7), in Periotest (,2 ± 3.3 vs ,1 ± 5.1), and in mean survival periods (49 months, 95% confidence interval CI]: 46,51 months, for the turned vs 46 months, 95% CI: 43,49 months, for the double-etched implant). After osteoplastic procedures, a significantly higher rate of implant losses in the turned, machined implant group was observed (17 vs 1) with a mean survival period of 43 (40,46) months for the turned and 46 (45,48) months for the double-etched implants. Conclusion:, No difference between implants with two different minimally rough surfaces was found. A positive effect of surface roughness is observed in poor quality bone, but the pivotal proof of this effect is still lacking. [source]

    Short Implants in the Severely Resorbed Maxilla: A 2-Year Retrospective Clinical Study

    CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2005
    Franck Renouard DDS
    ABSTRACT Background: Although the predictability of endosseous dental implants is well documented, the restoration of the posterior region of the maxilla remains a challenge. The placement of short implants is one therapeutic option that reduces the need for augmentation therapy. Purpose: The purpose of this retrospective study was to assess the survival rates of 6 to 8.5 mm-long implants in the severely resorbed maxilla following a surgical protocol for optimized initial implant stability. Materials and Methods: The study included 85 patients with 96 short (6,8.5 mm) implants (Brånemark System®, Nobel Biocare AB, Göteborg, Sweden) supporting single-tooth and partial reconstructions. The implants had a machined (54) or an oxidized (TiUniteÔ, Nobel Biocare AB) (42) surface. A one-stage surgical protocol with delayed loading was used. The patients were followed for at least 2 years after loading (average follow-up period 37.6 months). The marginal bone resorption was assessed by radiographic readings. Results: Five implants were lost during the first 9 months, and four implants were lost to follow-up. The cumulative survival rate was 94.6%. Four of the failed implants had a machined surface, and one had an oxidized surface. The mean marginal bone resorption after 2 years in function was 0.44 ± 0.52 mm. Conclusion: This study demonstrates that the use of short implants maybe considered for prosthetic rehabilitation of the severely resorbed maxilla as an alternative to more complicated surgical techniques. [source]

    One-Stage Operative Procedure Using Two Different Implant Systems: A Prospective Study on Implant Overdentures in the Edentulous Mandible

    CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2001
    Andrew Tawse-Smith DDS, Cert Perio (Göteborg)
    ABSTRACT Background: Evidence-based reports are needed to support the application of a one-stage surgical protocol for unsplinted implants supporting mandibular overdentures. Purpose: To examine the feasibility and success of using two different dental implant systems (originally designed for two-stage operative technique) using a one-stage operative procedure in patients being rehabilitated with implant mandibular overdentures. Materials and Methods: The study sample involved 24 edentulous subjects (aged 55,80 yr) randomly allocated to two different implant systems, one with a machined titanium implant surface (Steri-Oss, Nobel Biocare, Göteborg, Sweden) and the other with a roughened titanium surface (Southern Implants, Ltd., Irene, South Africa). Two unsplinted implants to support implant overdentures were placed in the anterior mandible of all patients, using a standardized one-stage surgical and prosthodontic procedure. Primary stability and bicortical anchorage of the implants was mandatory before healing abutments were connected at the time of implant placement. Implant overdentures and their respective matrices were inserted following a standard 12-week healing period. Data relating to mobility tests, radiographs, and peri-implant parameters were documented at 12, 16, and 52 weeks after surgery. Results: A success rate of 95.8% for the Steri-Oss and 100% for the Southern Implants was found, without any statistically significant differences in the marginal bone loss. Significant changes in Periotest values were observed for both types between 12 and 52 weeks (p <.001). Minor changes were observed in the peri-implant parameters evaluated. Conclusions: These preliminary findings show a successful application of this one-stage approach for unsplinted implants supporting mandibular overdentures with Steri-Oss and Southern Implant Systems. [source]

    Resilient liner vs. clip attachment effect on peri-implant tissues of bar-implant-retained mandibular overdenture: a 1-year clinical and radiographical study

    CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2010
    Moustafa Abdou Elsyad
    Abstract Purpose: The aim of this study was to compare between the effects of resilient liner and clip attachments of bar-implant-retained mandibular overdenture on peri-implant tissues. Materials and methods: In a randomized-controlled clinical trial, 30 edentulous male patients (mean age 62.5 years) were equally assigned to two groups. In each patient, two implants were inserted in the canine area of the mandible using a two-stage surgical protocol. After 3 months, the implants were connected with resilient bars. Mandibular overdentures were retained to the bars with either clips (group I) or silicone-resilient liners (group II). Peri-implant tissues were evaluated clinically (with regard to plaque scores, gingival scores and probing depths) and radiographically (with regard to peri-implant vertical and horizontal alveolar bone changes). Evaluations were performed at the time of overdenture insertion (T0), 6 months (T6) and 12 months (T12) after overdenture insertion. Results: After 12 months of using bar-implant-retained mandibular overdenture, the resilient liner attachment had significantly decreased peri-implant plaque score, gingival score, probing depth, vertical and horizontal bone loss when compared with the clip attachment. Conclusion: Within the limitations of this study, and in terms of peri-implant tissue health of bar-implant-retained mandibular overdenture, we recommend resilient liner rather than clip attachment. To cite this article: Elsyad MA, EL Shoukouki AH. Resilient liner vs. clip attachment effect on peri-implant tissues of bar-implant-retained mandibular overdenture: a 1-year clinical and radiographical study. Clin. Oral Impl. Res. 21, 2010; 473,480 doi: 10.1111/j.1600-0501.2009.01879.x [source]

    Surgical navigation for implant placement using transtomography

    CLINICAL ORAL IMPLANTS RESEARCH, Issue 7 2008
    Frederic Bousquet
    Abstract Objectives: To present a new guidance technique using transtomography in the operating room and to test the accuracy of this surgical protocol. Material: A new concept of operating room, integrating when necessary this imagery to secure flapless procedures by intraoperative control, is described. This operating room concept, including X ray protection of the operators, is explained in addition to the transport system of the panoramic machine for its transfer to the patient who remains seated on his surgical chair. Methods: Twenty-five single-tooth edentulous patients were treated by implant placement with a flapless or a minimally invasive procedure using transtomographic navigation. The surgical protocol is explained: after the first limited drill through mucosa and bone, intraoperative transtomography is performed with a custom-made titanium guide inserted into the bone. Images show the drilling axis in three dimensions. This form of navigation allows rectifying the drill axis. We explain how this protocol respects asepsis. Results: The mean angular deviation was 2.04° in the mesiodistal direction (range: 0°,4.8°, variance: 2.88) and 2.71° in the buccal or the palatolingual direction (range: 0°,5.4°; variance: 2.63). Implant tip deviation was calculated: the mean mesiodistal tip deviation was 0.42 mm, and the mean buccal or palatolingual tip deviation was 0.5 mm. The maximum tip mesiodistal deviation was 1.08 mm and the maximum vestibular or palatolingual tip deviation was 1.22 mm. Conclusion: This protocol appears to be as accurate as other guided or navigation systems. The advantages and limitations of this technique are explained, followed by future prospects with the new 3D cone beam computed tomography developed with the same panoramic machine. [source]

    Bone density and primary stability in implant therapy

    CLINICAL ORAL IMPLANTS RESEARCH, Issue S2 2006
    Liene Molly
    Abstract Introduction: To improve patient comfort, deviations from the very successful standard osseointegration protocol are being developed. To keep implant failure rates as low as possible, the most perfect treatment planning and a good patient selection are extremely important. Because bone density plays an important role in implant outcome, known relations of bone density could improve treatment planning. Material and methods: A Pubmed search revealed 66 manuscripts investigating and discussing bone density of human jawbone whether or not related to implant stability or outcome. Forty-five of these will be discussed in this review. Results and discussion: Many pre-operative methods of jawbone density assessment are available. Most of those techniques correlate well with one another. Some are more elaborate to use in clinical practice. Primary stability measurements show significant correlations with different bone densities and also with implant outcome; however, not many studies investigate both at the same time. Conclusion: To investigate the outcome of adaptation methods of the surgical protocol with regard to the jawbone density, an objective pre-surgical determination of bone density is necessary. [source]

    Single-tooth replacement by immediate implant and connective tissue graft: a 1,9-year clinical evaluation

    CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2004
    Andrea E. Bianchi
    Abstract Objectives: The aim of the present study was to evaluate the long-lasting efficacy of a combined surgical protocol, using immediate implant and subepithelial connective tissue graft for single-tooth replacement. The advantages of this single-center, longitudinal, randomized, blind examiner research were the following: preservation of both keratinized mucosa amount and bone tissue, optimal peri-implant marginal sealing, satisfactory aesthetic results, reduction in treatment time. Materials and methods: In the time period from 1990 to 1998, 116 patients were consecutively admitted for treatment with a total of 116 solid screw ITI-implants supporting single crowns. Ninety-six patients underwent the proposed combined treatment (test group), while 20 received only single immediate implants (control group). The observation time extended from 1 up to 9 years. Results: The 9-year cumulative survival rate was 100% for both test and control groups. Comparative statistical analysis of soft and hard tissue peri-implant parameters demonstrated better results in the test group than in the control during every single 3-year analysis and especially in the last observation interval. The test group also showed very good results in terms of aesthetic parameters, which estimated the keratinized mucosa width, the alignment of crown emergence profile and the patient's satisfaction. Conclusion: Single-tooth replacement by immediate solid screw ITI implants in association with connective tissue autograft was demonstrated to be a predictable procedure. Moreover, this treatment can be considered as a sure system to reach an excellent functional and harmonious aesthetic restoration. Résumé Le but de l'étude présente a été d'évaluer l'efficacitéà long terme d'un protocole chirurgical combiné utilisant l'implant placé immédiatement et un greffon tissulaire de tissu conjonctif sous-épithélial pour le remplacement d'une dent unique. Les avantages de cette recherche randomisée longitudinale dans un seul centre et en aveugle étaient les suivants : préservation de la quantité de muqueuse kératinisée et du tissu osseux, une fermeture marginale paroïmplantaire optimale, des résultats esthétiques satisfaisants et une réduction du temps de traitement. Durant les années 1990 à 1998, 116 patients ont été admis pour le traitement de 116 implants ITI en vis pleines portant des couronnes uniques. Nonante-six patients ont recu le traitement proposé (groupe test) tandis que 20 autres n'ont reçu que des implants placés immédiatement en une étape (groupe contrôle). Le temps d'observation s'échelonnait de un à neuf ans. Le taux de survie cumulatif à neuf années était de 100% dans les deux groupes. L'analyse statistique comparative des tissus mous et durs paroïmplantaires a constaté des meilleurs résultats dans le groupe test que dans le groupe contrôle durant chaque analyse de trois ans et spécialement dans la dernière période d'observation. Le groupe test montrait également de très bons résultats esthétiques concernant la largeur de la muqueuse kératinisée, l'alignement du profil de l'émergence de la couronne et la satisfaction du patient. Le remplacement de dents uniques par des implants ITI en vis pleines placées immédiatement en association avec une greffe de tissu conjonctif est un processus prévisible. De plus, ce traitement peut être considéré comme un système sûr pouvant apporter une restauration fonctionnelle harmonieuse et esthétique. Zusammenfassung Ziele: Das Ziel dieser Studie war es, den Langzeiterfolg eines chirurgischen Protokolls zu untersuchen, das den Einzelzahnersatz mit einem Sofortimplantat in Kombination mit einem subepithelialen Bindegewebstransplantat vorsah. Die Vorteile dieser an einem Zentrum durchgeführten randomisierten, longitudinalen Blindstudie waren die folgenden: Erhaltung sowohl der gesamten keratinisierten Mukosa wie auch des Knochengewebes, der optimale perimplantäre marginale Abschluss, die befriedigenden ästhetischen Resultate und die Verkürzung der Behandlungszeit. Material und Methoden: In der Zeit von 1990 bis 1998 bekamen in der Folge 116 Patienten insgesamt 116 ITI-Vollschraubenimplantate, die mit Einzelkronen versorgt wurden. 96 Patienten wurden nach der vorgestellten kombinierten Methode behandelt (Testgruppe), währenddem die übrigen 20 Patienten einzig das Sofortimplantat erhielten (Kontrollgruppe). Die Beobachtungszeit reichte von 1 bis zu 9 Jahren. Resultate: Die kumulative Überlebensrate nach 9 Jahren betrug für Test- und Kontrollgruppe 100%. Eine statistische Vergleichsanalyse der Parameter von Weich- und Hartgeweben zeigte während jeder der dreijährigen Beobachtungsphasen (insbesondere in der letzten) in der Testgruppe bessere Resultate als in der Kontrollgruppe. Die Testgruppe zeigte auch bezüglich ästhetischen Parametern (Breite der keratinisierten Gingiva, Lokalisation der Durchtrittsstelle der Krone, Zufriedenheit des Patienten) sehr schöne Resultate. Zusammenfassung: Der Einzelzahnersatz mittels Sofortimplantation einer ITI-Vollschraube in Verbindung mit einem freien Bindegewebetransplantat erwies sich als gut beherrschbare Methode. Man kann diese Behandlung sogar als sicher für den Erhalt einer hervorragenden funktionellen, harmonischen und ästhetischen Rekonstruktion empfehlen. Resumen Objetivos: La intención del presente estudio fue evaluar la eficacia a largo plazo de un protocolo quirúrgico combinado, usando implantes inmediatos e injertos de tejido conectivo subepitelial para reemplazar dientes unitarios. Las ventajas de esta investigación unicentro, longitudinal, aleatoria, examinador ciego fueron las siguientes: preservación de tanto de la cantidad de mucosa queratinizada como del tejido óseo, sellado marginal periimplantario óptimo, resultados estéticos satisfactorios, reducción del tiempo del tratamiento. Material y métodos: En el periodo de tiempo desde 1990 a 1998, se admitieron 116 pacientes consecutivos para tratamiento con un total de 116 implantes macizos roscados ITI soportando coronas unitarias. Noventa y seis pacientes se sometieron al tratamiento propuesto (grupo de prueba), mientras 20 recibieron solo implantes inmediatos unitarios (grupo de control). El tiempo de observación se extendió de 1 9 años. Resultados: El índice acumulado de supervivencia a los 9 años fue del 100% tanto para el grupo de prueba como el de control. El análisis estadístico comparativo de los parámetros de los tejidos blandos y duros periimplantarios demostró mejores resultados en el grupo de prueba que en el de control, durante cada análisis de 3 años y especialmente en el último intervalo de observación. El grupo de prueba también mostró muy buenos resultados en términos de parámetros estéticos, que estimaron la anchura de la mucosa queratinizada, la alineación del perfil de emergencia de la corona y la satisfacción del paciente. Conclusión: La sustitución de un diente unitario por implantes macizos roscados inmediatos ITI en asociación con autoinjertos de tejido conectivo demostró ser un procedimiento predecible. Más aun, este tratamiento puede ser considerado como un sistema seguro para alcanzar una excelente restauración estética funcional y armónica. [source]

    Early loading (2 or 6 weeks) of sandblasted and acid-etched (SLA) ITI® implants in the posterior mandible

    CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2004
    A 1-year randomized controlled clinical trial
    Abstract: The aim of this 1-year prospective controlled clinical trial was to evaluate the effect of early loading of ITI® solid screw titanium implants with a sandblasted and acid-etched (SLA) surface on clinical and radiographic parameters. Material and methods: Twenty-seven consecutively admitted patients presenting bilateral edentulous posterior mandibular areas and in need of prosthetic reconstruction were recruited. Sixty-seven ITI® standard solid screw implants with an SLA surface, a diameter of 4.1 mm and a length of 8, 10 or 12 mm were installed bilaterally in molar and premolar areas according to a one-stage surgical protocol. One week (test) and 5 weeks (control) after implant placement, solid ITI® prosthetic abutments were connected using a torque of 35 N cm. No provisional restoration was fabricated. Two weeks (test) and 6 weeks (control) after implant placement, porcelain-fused-to-metal single-tooth crowns were cemented. Clinical measurements were obtained at day 0 and 2, 6, 12, 24 and 52 weeks thereafter. Periapical radiographs were taken immediately after implant placement, after 6 weeks and at the 1-year examination. Results: After 1 year, implant survival was 100%. Two test and one control implants rotated at the time of abutment connection and were left unloaded for 12 additional weeks. At the 1-year examination, no statistically significant differences were found between the test and control sites with respect to pocket probing depths (2.6 mm±0.5 vs. 2.7 mm±0.5), mean clinical attachment levels (3.1 mm±0.4 vs. 3.2 mm±0.5), mean percentages of sites bleeding on probing (9.7% vs. 8.3%), mean widths of keratinized mucosa (1.8 mm±0.4 vs. 1.9 mm±0.5), mean PerioTest® values (,1.4 PTV±0.9 vs. ,1.6 PTV±0.8) or mean crestal bone loss measurements (0.57 mm±0.49 vs. 0.72 mm±0.50). Conclusion: Based on these results, loading of titanium implants with an SLA surface as early as 2 weeks did not appear to jeopardize the osseointegration healing process in the posterior mandible. Furthermore, implants rotating at 35 N cm, if left unloaded for additional 12 weeks, did not negatively affect clinical and radiographic outcomes. Résumé Le but de cet essai clinique contrôlé prospectif d'une année a été d'évaluer l'effet de la mise en charge précoce d'implants en titane vis solide ITI® avec une surface sablée et mordancée (SLA) sur des paramètres cliniques et radiographiques. Vingt-sept patients présentant des aires bilatérales mandibulaires postérieures édentées et nécessitant donc une reconstruction prothétique ont été recrutés. Soixante-sept implants ITI® d'un diamètre de 4,1 mm et d'une longueur de 8, 10 ou 12 mm ont été placés bilatéralement dans les zones molaires et prémolaires suivant le processus chirurgical en une étape. Une semaine (test) et cinq semaines (contrôle) après leur placement des piliers prothétiques ITI® ont été serrés avec une force de 35 Ncm. Aucune restauration provisoire n'a été fabriquée. Deux semaines (test) et six semaines (contrôle) après le placement des implants des couronnes céramo-métalliques indépendantes ont été cimentées. Des mesures cliniques ont été obtenues aux jours 0 et deux, et aux semaines 6, 12, 24 et 52. Des radiographies périapicales ont été prises immédiatement après le placement des implants, après six semaines et une année. Après une année, le taux de survie implantaire était de 100%. Deux implants tests et un contrôle pivotaient au moment de la connexion du pilier et ont été laissés non-chargés pour 12 semaines supplémentaires. Après une année, aucune différence statistique n'a été trouvée entre les sites tests et contrôles en ce qui concerne les profondeurs de poches au sondage (2,6 ±0,5 mm vs 2,7± 0,5 mm), les niveaux d'attache clinique moyens (3,1±0,4 vs 3,2±0,5 mm,) les pourcentages moyens de sites saignant au sondage (9,7% vs 8,3%), les largeurs moyennes de muqueuse attachée (1,8±0,4 mm vs 1,9±0,5 mm), les valeurs Periotest moyennes (,1,4±0,9 PTV vs ,1,6 ±0,8 PTV) ou les mesures de perte osseuse crestale moyennes (0,57 ± 0,49 mm vs 0,72±0,52 mm). La charge d'implants en titane avec surface SLA aussitôt que deux semaines après leur placement ne semblait pas mettre en danger le processus d'ostéoïntégration dans la partie postérieure de la mandibule. De plus, les implants pivotant à 35 Ncm, si laissés non-chargés pour douze semaines supplémentaires, n'affectaient pas de manière négative les mesures cliniques et radiographiques. Zusammenfassung Material und Methoden: Es wurden siebenundzwanzig Patienten mit beidseits zahnlosem Seitenzahnbereich im Unterkiefer, welche eine prothetische Versorgung benötigten, in die Studie aufgenommen. Es wurden 67 ITI® Standard Vollschraubenimplantate mit einem Durchmesser von 4.1 mm und einer Länge von 8, 10 oder 12 mm beidseits in der Molaren- und Prämolarenregion transmukosal eingesetzt. Eine Woche (Test) und 5 Wochen (Kontrolle) nach Implantation wurden ITI® Massivsekundärteile mit einem Drehmoment von 35 Ncm eingesetzt. Es wurde keine provisorische Versorgung angefertigt. Zwei Wochen (Test) und 6 Wochen (Kontrolle) nach Implantation wurden Gold-Porzellan Einzelkronen einzementiert. Klinische Messungen wurden am Tag 0 und nach 2, 6, 12, 24, und 52 Wochen aufgenommen. Periapikale Röntgenaufnahmen wurden sofort nach der Implantation, nach 6 Wochen und anlässlich der 1 Jahreskontrolle angefertigt. Resultate: Nach einem Jahr betrug die Implanta-tüberlebensrate 100%. Zwei Test- und ein Kontrollimplantat drehten sich beim Einschrauben der Sekundärteile und wurden für zusätzliche 12 Wochen unbelastet belassen. Bei der 1 Jahresuntersuchung konnten zwischen Test- und Kontrolli-mplantaten keine statistisch signifikanten Unterschiede bezüglich Sondierungswerten (2.6mm+/,0.5 gegenüber 2.7mm +/,0.5), mittlerem klinischem Attachmentniveau (3.1mm +/,0.4 gegenüber 3.2mm +/,0.5), mittlerem Prozentanteil beim Bluten auf Sondieren (9.7% gegenüber 8.3%), mittlerer Breite der keratinisierten Mukosa (1.8mm +/,0.4 gegenüber 1.9mm +/,0.5), mittleren Periotest® Werten (,1.4 PTV +/,0.9 gegenüber ,1.6 PTV +/,0.8) oder mittlerem marginalem Knochenverlust (0.57mm +/,0.49 gegenüber 0.72mm +/,0.50) gefunden werden. Schlussfolgerung: Gemäss dieser Resultate schien die Belastung von Titanimplantaten mit SLA Oberfäche bereits nach 2 Wochen den Heilungsprozess der Osseointegration im posterioren Unterkiefer nicht zu beeinträchtigen. Implantate, die bei 35Ncm rotierten und daraufhin für weitere 12 Wochen unbelastet blieben, beeinflussten die klinischen und radiologischen Resultate nicht negativ. Resumen La intención de este ensayo clínico prospectivo controlado fue evaluar el efecto de una carga temprana sobre implantes macizos roscados de titanio con una superficie pulverizada con arena y gravada con ácido (SLA) sobre parámetros clínicos y radiográficos. Material y Métodos: Se reclutaron veintisiete pacientes consecutivamente admitidos que presentaron áreas edéntulas bilaterales en la mandíbula posterior y necesitando reconstrucción protésica. Se instalaron bilateralmente en las áreas molar y premolar sesenta y siete implantes ITI® estándar macizos roscados de titanio con una superficie SLA, un diámetro de 4.1 mm y una longitud de 8, 10 o 12 mm de acuerdo con un protocolo quirúrgico de una sola fase. Una semana (prueba) y 5 semanas (control) tras la colocación del implante, se conectaron pilares prostéticos macizos ITI usando un torque de 35 Ncm. No se fabricaron restauraciones provisionales. Dos semanas (prueba) y 6 semanas (control) tras la colocación de los implantes, se cementaron coronas unitarias metalocerámicas. Se obtuvieron medidas clínicas en el día 0 y tras 2, 6, 12, 24 y 52 semanas. Se tomaron radiografías periapicales inmediatamente tras la colocación del implante, a las 6 semanas y en el examen de 1 año. Resultados: Tras 1 año, la supervivencia de los implantes fue del 100%. Dos implantes de prueba y uno de control rotaron en el momento de la conexión del pilar y se dejaron sin carga durante 12 semanas más. En el examen de 1 año, no se encontraron diferencias significativas entre los lugares de prueba y los de control respecto a las profundidades de sondaje (2.6 mm±0.5 vs. 2.7 mm±0.5), niveles medios de inserción clínica (3.1±mm±0.4 vs. 3.2 mm±0.5), porcentaje medio de lugares con sangrado al sondaje (9.7% vs. 8.3%), anchura media de mucosa queratinizada (1.8 mm±0.4 vs. 1.9 mm±0.5), valores medios de Perio Test® (,1.4 PTV±0.9 vs. ,1.6 PTV±0.8) o a las medidas medias de perdida de hueso crestal (0.57 mm±0.49 vs. 0.72 mm±0.50). Conclusiones: Basándose en estos resultados, la carga de implantes de titanio con superficie SLA tan pronto como a las 2 semanas no pareció comprometer el proceso de cicatrización de la osteointegración en la mandíbula posterior. Mas aun, los implantes que rotaron a 35 Ncm, si se dejan sin carga durante 12 semanas más, no afectaron negativamente los resultados clínicos y radiográficos. [source]

    Cancer Pain: Progress Since the WHO Guidelines

    PAIN PRACTICE, Issue 3 2001
    Allen W. Burton MD
    Abstract: In has been 15 years since the WHO Guidelines for the management of cancer pain were developed. This article reviews the guideline development and its effectiveness. Current trends in cancer care utilizing aggressive chemotherapeutic and surgical protocols lead to many patients living longer with advanced cancer and an attendant increase in pain. Future trends in cancer pain care are outlined. [source]