From the editor. The Desired Sensation Level (DSL) method for fitting hearing aids.
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Algorithms↗
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Results for “Prosthesis Fitting”
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Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration.
PURPOSE: The purpose of this review is to summarize the literature related to the advances that have taken place in the management and rehabilitation care of limb amputation. RESULTS: Prostheses for the lower and upper limb amputee have changed greatly over the past several years, with advances in components, socket fabrication and fitting techniques, suspension systems and sources of power and electronic controls. Higher levels of limb amputation can now be fitted with functional prostheses, which allow more patients to achieve independent life styles. This is of particular importance for the multi-limb amputee. The rehabilitation of more traditional lower limb levels of amputation have also greatly benefited from the technological advances including energy storing feet, electronic control hydraulic knees, ankle rotators and shock absorbers to mention a few. For the upper limb amputee, myoelectric and proportional controlled terminal devices and elbow joints are now used routinely in some rehabilitation facilities. Experimental prosthetic fitting techniques and devices such as the use of osseo-implantation for suspension of the prosthesis, tension control hands or electromagnetic fluids for knee movement control will also be briefly discussed in this paper. CONCLUSION: It is possible to conclude from this review that many advances have occurred that have greatly impacted the functional outcomes of patients with limb amputation.
Adaptation, Physiological↗
[The initial findings in 50 cases of the cementless hip prosthesis].
The authors, after putting forth several biomechanical premises, discuss their experience in total hip arthroplasty (THA) using a PCA-type press fit cementless prosthesis with partial Madreporic covering. Several cases which demonstrate the versatility of this type of replacement are discussed in depth. Even though the short follow-up precludes definitive conclusions, use of cementless total hip replacements must be considered a valid option in the future, especially in cases of early onset of hip pathology.
Adult↗
A technique for fabrication of a custom tracheostomy prosthesis.
A technique is described for using an endotracheal tube to make an impression of the intratracheal anatomy for fabrication of a custom-fitted tracheostomy prosthesis.
Airway Obstruction↗
A method of verifying and improving internal fit of all-ceramic restorations.
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Crowns↗
The time course of effects on intensity discrimination following monaural fitting of hearing aids.
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Hearing Aids↗
Montreal bar: in search of the positive fit.
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Chronic Disease↗
Changes in bone density after cemented total knee arthroplasty: influence of stem design.
Total knee arthroplasty has shown excellent survivorship in short-term and intermediate-term studies. With longer follow-up, however, aseptic loosening becomes an increasing cause of failure. Dual-energy x-ray absorptiometry scanning has shown that stress shielding occurs from altered mechanical loading. The purpose of this study is to determine if tibial stem design affects bone density in the longterm. Bone densities in the proximal tibia with and without cemented stems were compared at an average of 94 months after surgery. The bone quality under the Miller-Galante I prosthesis, which has 4 0.5-cm pegs, was compared with the bone quality under a Press-Fit Condylar prosthesis with a single 4-cm stem. Each group was also compared with the unoperated contralateral tibia. Results showed that there is a significantly reduced density of bone in the tibial metaphysis in the cemented stemmed group but not in the pegged group. There were no changes distally in the diaphyseal bone. This study supports the contention that the use of a cemented stem reduces proximal stresses and may result in proximal bone resorption. Although the use of a stem provides excellent resistance to lift-off and shear, it comes at a price. The proximal resorption may contribute to the persistence of tibial component loosening as a primary threat to survivorship. This bone loss may complicate revision surgery. Consideration should be given to using shorter tibial stems, less cement, or alternative designs that avoid long-stem fixation.
Absorptiometry, Photon↗
A clinical investigation of the fit of removable partial dental prosthesis clasp assemblies.
STATEMENT OF PROBLEM: Removable partial denture frameworks are complex castings fabricated from high-shrinkage alloys. This may result in difficulty in achieving accurate fit. PURPOSE: The purpose of this study was to evaluate which component(s) of the clasp assembly contact the abutment tooth clinically. MATERIAL AND METHODS: New and existing frameworks with at least 1 conventional prepared occlusal rest were evaluated for fit. The spacing between the bottom of each of the rests of the 50 clasp assemblies and the corresponding rest seat were recorded with vinyl polysiloxane. The fit of each rest was determined with the use of a dial caliper by measuring, in micrometers, the thickness of the record between the rest and the bottom of the rest seat. The Kennedy classification was also recorded. A 2-sample t test was used to evaluate the difference in fit between tooth-tissue supported and tooth-supported designs (alpha=.05). RESULTS: The average space between the rest and prepared rest seat was 193 +/- 203 microm, with a range of 0 to 828 mum. Twenty tooth-tissue frameworks had an average space of 136 +/- 160 microm and 30 tooth-supported frameworks had an average space of 230 +/- 222 microm. The 2-sample t test showed no significant difference for fit between tooth-tissue supported and tooth-supported frameworks (P=.1081). Twenty-four percent of rests had contact in the prepared rest seat. CONCLUSION: The majority of rests evaluated did not contact the intended surfaces.
Dental Abutments↗
The significance of passive framework fit in implant prosthodontics: current status.
The clinical and laboratory procedures employed for framework fabrication are inadequate to provide an absolute passive fit for implant-supported fixed superstructures. Although some prosthetic complications are attributed to the lack of passive fit, its effect on implant success is questionable. Nevertheless, the clinical results of increasing applications of advanced technology to improve framework fit seem promising. This article reviews the clinical significance of passive fit and the factors that affect the final fit of implant-supported frameworks.
Dental Prosthesis Design↗
We apoligize. Factors affecting consistent audibility in pediatric hearing aid fitting.
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Adult↗
Factors affecting consistent audibility in pediatric hearing aid fitting.
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Adult↗
Poorly fitting soft lenses affect ocular integrity.
PURPOSE: The purpose of this study was to determine whether borderline fitting soft lenses have a greater effect on ocular physiology than well fitting lenses. METHOD: The study was a retrospective analysis of data from seven soft lens clinical studies. The results of 63 eyes wearing borderline fitting lenses (31 tight and 32 loose fittings) were evaluated and compared with control eyes wearing optimally fitting lenses. Tight and loose lens fittings were defined as those showing tightness on push-up of > or =65% and < or =35%, respectively. An optimally fitting lens was defined as one showing tightness on push-up in the range 45-50% and decentration less than 0.7 mm. Slit lamp findings at the 1-month follow-up visit were compared. RESULTS: There was a significantly greater level of corneal staining among the tight lens wearing group than the controls (P=0.001); 68% of eyes wearing tight lenses showed staining as compared with 42% of eyes wearing well fitting lenses. There was also a greater level of conjunctival staining among tight lens wearing eyes but no significant difference in bulbar or limbal hyperemia. The loose lens wearing eyes showed a higher level of corneal staining: 69% vs 39% (P=0.04). In addition, the loose lens wearing eyes showed a higher level of bulbar (P=0.03) and limbal hyperemia (P=0.006). From supplementary analysis of 408 lens fittings, the incidence of corneal staining was found to increase with increasing tightness or looseness of fit. CONCLUSION: The results show that corneal staining and other physiological effects of soft lens wear vary with the quality of lens fit suggesting that practitioners should be less tolerant of sub-optimal fitting soft lenses.
Conjunctiva↗
Rigid bifocal contact lenses.
Rigid bifocal contact lens options continue to improve, with several new designs available in both the simultaneous and alternating vision categories. This paper reviews the selection of bifocal lens patients, describes basic lens designs, and provides guidelines for the successful fitting of rigid bifocal lenses.
Contact Lenses↗
Hydroxyapatite clay for gap filling and adequate bone ingrowth.
In uncemented total hip arthroplasty, a complete filling of the gap between femoral prosthesis and the host bone is difficult and defects would remain, because the anatomy of the reamed intramedullary canal cannot fit the prosthesis. Therefore, it seems practical to fill the gap with a clay containing hydroxyapatite (HA), which has an osteoconductive character. The clay (HA clay) is made by mixing HA granules (size 0.1 mm or more) having a homogeneous pore distribution and a porosity of 35-48 vol%, and a viscous substance such as a saline solution of sodium alginate (SSSA). In the first experiment, the ratio of HA granules and sodium alginate in SSSA is set for the same handling properties of HA clay and polymethylmethacrylate bone cement (standard viscosity) before hardening. As a result, the ratio is set for 55 wt% of HA in the clay and 12.5 wt% of sodium alginate in SSSA (i.e., HA:sodium alginate:saline solution = 9.8:1:7). In the second study, the gap between the femoral stem and bone model is completely filled with HA clay. However, the gap is not filled only with HA granules or HA granules mixed with saline solution. In the third animal experiment, using an unloaded model, histology shows that HA clay has an osteoconductive property bridging the gap between the implant and the cortical bone without any adverse reaction. HA clay is considered a useful biomaterial to fill the gap with adequate bone ingrowth.
Animals↗
Design of a non-constrained, non-cemented, modular, metacarpophalangeal prosthesis.
A non-constrained, non-cemented, modular prosthesis for replacement of the metacarpophalangeal joints of the fingers has been developed. The prosthesis is of a surface design which is modular in construction and is implanted into the bones with a press fit. The prosthesis is designed to be implanted into patients with traumatic injuries, post-traumatic osteoarthritis and into patients with rheumatoid arthritis at an early stage in the disease where the muscles and ligaments that surround the joint are still functional and can provide joint stability.
Arthritis, Rheumatoid↗
Contact lens fitting following corneal graft surgery.
Contact lens fitting may be required following keratoplasty for either optical or therapeutic reasons. Optical indications for contact lens fitting include the correction of irregular astigmatism, high regular astigmatism, anisometropia and secondary aniseikonia, as well as simple ametropia, where the patient desires to wear contact lenses in preference to spectacles. Therapeutic lenses are not routinely fitted following keratoplasty, although this management is advised in certain cases, such as when there are protruding sutures or epithelial healing is impaired. Designing a contact lens for a patient who has undergone keratoplasty will require the practitioner to carefully assess all the relevant features of the corneal graft. In this regard, there are many factors that need to be considered including the diameter of the graft zone, the topographical relationship between the host cornea and donor cornea, the corneal (graft) toricity and the location of the graft. Special designs, such as reverse geometry lenses, or more complex contact lens modalities, such as piggyback contact lens systems, may be required to achieve success in fitting.
Contact Lenses↗