Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Titanium”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,009 records · Page 56Linked to original sources
PubMed2000

A role for surface topography in creating and maintaining bone at titanium endosseous implants.

STATEMENT OF PROBLEM: A variety of claims are made regarding the effects of surface topography on implant osseointegration. Many in vivo and in vitro experimental observations have key limitations in their interpretations. PURPOSE: This review considers the major claims made concerning the effects of commercially pure (cp) titanium implant surface topography on osseointegration. Important findings of consensus are highlighted, and existing controversies are revealed. MATERIAL AND METHODS: This review considers many of the research publications listed in MEDLINE and presented in biomedical research publications and textbooks. RESULTS: Implant surface topography is not well defined in the marketplace or consistently reported among experimental studies. Many in vitro evaluations are not predictive of or correlated with in vivo outcomes. In some culture models, increased surface topography positively affects pro-osteogenic cellular activities. Animal models reveal modest increases in bone-to-implant contact and increases in the biomechanical interlock of the implant with bone for implants of increased surface topography. Existing information fails to define increased surface topography as a risk factor for peri-implant inflammation. CONCLUSION: Increased cp titanium implant surface topography improves the bone-to-implant contact and the mechanical properties of the enhanced interface. Growing clinical evidence for increased bone-to-implant contact at altered cp titanium implants confirms the temporally limited observations made in preclinical studies. In the absence of controlled comparative clinical trials, the aggregate experimental evidence supports the use of cp titanium implants with increased surface topography.

Biomechanical Phenomena↗
PubMed2002

Internal porosity of cast titanium removable partial dentures: Influence of sprue direction on porosity in circumferential clasps of a clinical framework design.

STATEMENT OF PROBLEM: Although internal porosity is a potential risk factor for clasp fracture, little is known about its frequency in the clasps of titanium removable partial dentures. PURPOSE: This study investigated the influence of the direction of auxiliary sprues on porosity in the circumferential clasps of a pressure-cast titanium removable partial denture. MATERIAL AND METHODS: Wax patterns of a removable partial denture framework were made on 10 identical refractory casts of a Kennedy class II, modification 1, mandibular partially edentulous arch. For the auxiliary sprues directed to the circumferential clasps, 2 designs were used: straight and curved. Casting was performed in a 1-chamber pressure casting machine. Pore number and size were assessed on radiographs of the castings. The data were analyzed with the 2-tailed Student t test (P <.05). Randomly selected specimens were sectioned for morphologic observation of the internal surface of the pores. RESULTS: The number of pores >or=0.5 mm diameter and the total number of pores were significantly lower in the molar lingual arms of the curved sprue group than in the corresponding clasp arms of the straight sprue group (P =.03 and P =.009, respectively). No significant differences between the 2 groups were found for pores of any size in other locations. The pores had smooth internal surfaces. CONCLUSION: Within the limitations of this study, the curved sprue design produced significantly less porosity in the circumferential clasp arms of a cast titanium removable partial denture than the conventional straight design. The results suggest that internal porosity in titanium castings can be controlled through sprue design.

Dental Casting Technique↗
PubMed2002

Fit of cast commercially pure titanium and Ti-6Al-4V alloy crowns before and after marginal refinement by electrical discharge machining.

STATEMENT OF PROBLEM: Titanium has been suggested as a replacement for alloys currently used in single-tooth restorations and fixed partial dentures. However, difficulties in casting have resulted in incomplete margins and discrepancies in marginal fit. PURPOSE: This study evaluated and compared the marginal fit of crowns fabricated from a commercially pure titanium (CP Ti) and from Ti-6Al-4V alloy with crowns fabricated from a Pd-Ag alloy that served as a control. Evaluations were performed before and after marginal refinement by electrical discharge machining (EDM). MATERIAL AND METHODS: Forty-five bovine teeth were prepared to receive complete cast crowns. Stone and copper-plated dies were obtained from impressions. Fifteen crowns were cast with each alloy (CP Ti, Ti-6Al-4V, and Pd-Ag). Marginal fit measurements (in micrometers) were recorded at 4 reference points on each casting with a traveling microscope. Marginal refinement with EDM was conducted on the titanium-based crowns, and measurements were repeated. Data were analyzed with the Kruskal-Wallis test, paired t test, and independent t test at a 1% probability level. RESULTS: The Kruskal-Wallis test showed significant differences among mean values of marginal fit for the as-cast CP Ti crowns (mean [SD], 83.9 [26.1] microm) and the other groups: Ti-6Al-4V (50.8 [17.2] microm) and Pd-Ag (45.2 [10.4] microm). After EDM marginal refinement, significant differences were detected among the Ti-6Al-4V crowns (24.5 [10.9] microm) and the other 2 groups: CP Ti (50.6 [20.0] microm) and Pd-Ag (not modified by EDM). Paired t test results indicated that marginal refinement with EDM effectively improved the fit of CP Ti crowns (from 83.9 to 50.6 microm) and Ti-6Al-4V crowns (from 50.8 to 24.5 microm). However, the difference in improvement between the two groups was not significant by t test. CONCLUSION: Within the limitations of this study, despite the superior results for Ti-6Al-4V, both groups of titanium-based crowns had clinically acceptable marginal fits. After EDM marginal refinement, the fit of cast CP Ti and Ti-6Al-4V crowns improved significantly.

Alloys↗
PubMed2003

Howse II cemented titanium metal-backed acetabular cups: poor 10-year results in 107 hips.

We report a retrospective clinical and radiographic review of 107 consecutive primary total hip replacements, using the cemented Howse II prosthesis. The review concentrates on the long-term performance of the acetabular cup, which was designed with a cylindrical titanium metal backing and a polyethylene liner. In all the hips in the series, this cup was used with a modular titanium straight femoral stem and a 32-mm diameter titanium head. At a mean follow-up of 9.8 (7-11) years, 28 hips had already been revised and 10 others were recognized as clinical or radiographic failures. The indication for revision in 26 of the hips was aseptic loosening and the mean time to revision was 7.2 (3.7-10.9) years This metal-backed cup has only 42% survival at 10 years, which seems to be related to certain of its design features. These include an inadequate thickness of polyethylene sterilized by gamma irradiation in air, a lack of mechanical bonding between the liner and its metal shell, and the high wear rate from the use of a 32-mm titanium femoral head.

Acetabulum↗
PubMed2001

A comparative study of MR imaging profile of titanium pedicle screws.

OBJECTIVE: We compared the MR imaging profile of three different types of titanium pedicle screw implants in common usage in a human cadaveric model. We additionally compared the change in temperature during imaging among three constructs. MATERIAL AND METHODS: Titanium-based lumbar pedicle screw/rod constructs from three manufacturers were implanted sequentially in a human cadaveric spine. MR imaging was then performed using both conventional spin-echo sequences and advanced imaging pulse sequences. Changes in tissue temperature were also measured during imaging to assess differences among the various implants. MR images were compared in a blinded fashion by two neuroradiologists. RESULTS: No significant differences in imaging profile were noted between the three types of titanium implants with regards to their MR artifact profile. Fast spin-echo sequences led to a decrease in perceptible MR artifacts. Moreover, there were no significant differences in temperature increase among the three manufacturers (mean increase 0.5 degrees C) during imaging. CONCLUSION: Slight differences in the percentage of titanium among the three pedicle screw systems does not appear to result in artifact differences during MR imaging. Therefore, with regard to imaging profile considerations, the three systems studied should be considered interchangeable.

Artifacts↗
PubMed1998

Aneurysm clip MR artifacts. Titanium versus stainless steel and influence of imaging parameters.

PURPOSE: The aim of this study was to evaluate the extent to which titanium aneurysm clips could improve the quality of MR imaging compared with stainless steel clips, and to determine whether the clip artifacts could be reduced by controlling certain MR imaging parameters in frequently used pulse sequences. MATERIAL AND METHODS: The metal artifacts induced by 3 aneurysm clips were compared in 3 pulse sequences. The clips were: a Yasargil titanium aneurysm clip FT 752 T; a Yasargil standard aneurysm clip FE 752 K; and, for comparison, a ferromagnetic Scoville aneurysm clip En-58J. The pulse sequences were: spin echo (SE); gradient echo (GE); and fast SE. An evaluation was made of 3 imaging parameters with regard to their influence on the size of the metal artifacts. The parameters were: bandwidth; echo time (TE); and echo-train length. RESULTS: The titanium clip showed artifacts that were about 60% smaller than those from the stainless steel clip. The only parameter that influenced artifact size to any major degree was bandwidth in the SE sequences but not in the GE sequences. GE sequences induced larger artifacts than SE sequences and showed larger artifacts with longer TE. CONCLUSION: Titanium aneurysm clips reduced MR artifacts by approximately 60% compared to stainless steel clips. Artifacts were further reduced by using SE-based sequences with a high bandwidth or, if necessary, GE sequences with a low TE.

Artifacts↗
PubMed2003

Effects of the Er:YAG laser irradiation on titanium implant materials and contaminated implant abutment surfaces.

OBJECTIVE: The purpose of this study was to examine the morphological changes and temperature increases of the titanium after Er:YAG laser irradiation, and also to investigate the effect of this laser on debridement of contaminated healing abutments. BACKGROUND DATA: Mechanical instruments have been used for the cleaning of implant abutment surfaces, however, most of them are not appropriate for the application to titanium surface. Recently, the Er:YAG laser has been expected to have a promising ability for the debridement of implant surface. MATERIALS AND METHODS: Experiments were composed of three parts. At first, ten titanium round plates were exposed to the Er:YAG laser irradiation at 30-200 mJ/pulse and the surface changes were observed by stereomicroscope and scanning electron microscope. Secondly, the surface temperature changes of 60 titanium plates during and after Er:YAG laser irradiation at 30 and 50 mJ/pulse were measured by thermographic equipment. At last, calculus on the surface of six contaminated healing abutments was removed by Er:YAG laser or ultrasonic scaler, and the treated surfaces were examined by stereomicroscope. RESULTS: Under 50 mJ/pulse, distinct morphological changes were not observed and the elevation of surface temperature was minimal, especially in the use of water-cooling. The Er:YAG laser at 30 mJ/pulse and 30 Hz with water spray was capable of effectively removing plaque and calculus on the implant abutments without injuring their surfaces. CONCLUSION: This study indicates that the Er:YAG laser can be a novel technical modality for the debridement of implant abutment surface.

Dental Abutments↗
PubMed2003

Evaluation of various seeding techniques for culturing osteogenic cells on titanium fiber mesh.

The objective of the present study was to learn more about the effect of seeding and loading techniques on the osteogenic differentiation in vitro of rat bone marrow cells into titanium fiber mesh. This material was used as received or subjected to glow discharge treatment (RFGD). The seeding methods that were used included a so-called droplet, cell suspension (high and low cell density), and rotating plate method. Osteogenic cells were cultured for 4, 8, and 16 days into titanium fiber mesh. DNA, osteocalcin, scanning electron microscopy (SEM) analysis, and calcium measurements were used to determine cellular proliferation and differentiation. DNA analysis of the differently seeded specimens showed that proliferation proceeded faster in the first versus second run for droplet and cell suspension samples. No clear and distinct additional effect was found when RFGD treatment was used. Statistical analyses revealed that high cell density and low rotational speed resulted always in a significantly higher DNA content. Calcium measurements and osteocalcin analysis showed that using high cell densities during inoculation of the scaffolds prevented the occurrence of differences between experimental runs. SEM examination showed that for droplet and cell suspension samples cells were present at only one side of the mesh. The mesh side where the cell sheet was observed depended on the additional use of glow discharge treatment. On these materials, the cells had penetrated through the meshes and formed a cell sheet at the bottom side. When rotation was used, no cell sheet was formed and cells had invaded the meshes and were growing around the titanium fibers. On the basis of our results, we conclude that (1). titanium fiber mesh is indeed suitable to support the osteogenic expression of bone marrow cells, and (2). changing the initial cell density as well as the use of dynamic seeding methods can influence the osteogenic capacity of the scaffold.

Animals↗
PubMed1998

The effect of environmental factors on elastomeric chain and nickel titanium coil springs.

It is well known that elastomers exhibit viscoelasticity and as such have their mechanical properties modified by temperature. Nickel titanium archwires are also affected by temperature and have been modified with specific temperature related properties for clinical use. What is less well known is the effect that other environmental factors, such as food, might have on the force delivery properties of both elastomeric materials and nickel titanium coil springs used for space closure. For instance gross colour change in elastomeric chain is a common clinical finding in patients who consume spiced foods. The aim of this work was to determine the effect three common environmental factors namely, water, Coke, and turmeric solution have on elastomeric chain and nickel titanium coil springs. In addition, it was decided to re-examine the effect of temperature at 10, 22, and 37 degrees C on both these space closing materials. Unlike many previous investigations, the test specimens were held at a constant stretch throughout the test period, including during their transfer to the Instron Universal Testing machine for force measurement. Six force measurements were made over the first hour, then at 24 hours and 7 days. A control group of dry specimens, maintained at 22 degrees C, had additional measurements made weekly for a 4-week period. The results indicated that elastomeric chain was affected by all the test environments while nickel titanium springs were only affected by temperature.

Carbonated Beverages↗
PubMed2001

Ectopic bone formation in titanium mesh loaded with bone morphogenetic protein and coated with calcium phosphate.

The osteoinductive properties of porous titanium fiber mesh, with or without a calcium phosphate coating and loaded with recombinant human bone morphogenic protein-2 (rhBMP-2) or rhBMP-2 and native bovine BMP (S-300) were investigated in a rat ectopic assay model. A total of 112 calcium phosphate-coated and 112 noncoated porous titanium implants, either loaded with rhBMP-2 and S-300 or loaded with rhBMP-2 alone, were subcutaneously placed in 56 Wistar-King rats. The rats were killed 5, 10, 20, and 40 days postoperatively, and the implants were retrieved. Histologic analysis demonstrated that all growth factor and carrier combinations induced ectopic cartilage and bone formation at 5 and 10 days, respectively. At 20 days, bone formation increased and was characterized by trabecular bone and bone marrow-like tissue. At 40 days, more lamellar bone and hemopoietic bone marrow-like tissue were present. At both times, more bone had been formed in calcium phosphate-coated implants than in noncoated samples. Further, in rhBMP-2 and S-300-loaded specimens, bone formation was higher than in rhBMP-2 only-loaded specimens. In rhBMP-2 only-loaded specimens, bone formation was mainly localized inside the mesh material, whereas in specimens loaded with both rhBMP-2 and S-300, the bone was localized inside and surrounding the titanium mesh. The histological findings were confirmed by calcium content and alkaline phosphatase activity measurements. In addition, all specimens showed osteocalcin expression as early as 5 days postoperatively. Our results show that the combination of titanium mesh with BMPs can induce ectopic bone formation and that this bone formation seems to be similar to "enchondral" ossification. In addition, a thin calcium phosphate coating can have a beneficial effect on the bone-inducing properties of a scaffold material. Finally, rhBMP-2 and native BMP act synergistically in ectopic bone induction.

Alkaline Phosphatase↗
PubMed1996

A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis.

STUDY DESIGN: Titanium miniplates are used to secure the posterior elements in the open position after expansive open-door laminoplasty. Preoperative and postoperative spinal canal dimensions are measured to assess the effectiveness of this technique. OBJECTIVES: To develop a simple yet effective technique to stabilize the posterior elements after laminoplasty and to compare preoperative and postoperative spinal canal dimensions to accepted normal values. SUMMARY OF BACKGROUND DATA: Expansive open-door laminoplasty has been offered as a simple alternative to laminectomy, which has been associated with postoperative kyphosis. Although the technique of laminoplasty is effective, a simple and reliable method of holding the posterior elements open has not been described. METHODS: Ten myelopathic patients with multilevel cervical canal stenosis secondary to spondylosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty. The posterior elements were stabilized in the open position with titanium miniplates. Computer-assisted morphometric analysis was performed on preoperative and postoperative computed tomography scans to obtain spinal canal dimensions. Plain radiographs were used to monitor construct integrity. RESULTS: The preoperative sagittal canal diameter was 8.2 +/- 0.96 mm, and the canal area was 180.6 +/- 33.7 mm2. These dimensions increased after surgery to 16.6 +/- 1.5 mm and 321.9 +/- 29.7 mm2, respectively. The titanium miniplate constructs did not fail during the follow-up period (mean, 26.4 months), and the decompression was maintained. The single significant complication was transient C5 radiculopathy. CONCLUSIONS: Normal canal dimensions can be reestablished with open-door laminoplasty. Achieving and maintaining an increased sagittal canal diameter is probably the most important change in anatomic parameters to facilitate neurologic recovery. The use of titanium miniplates to stabilize the posterior elements after laminoplasty is a simple, durable, and effective technique to maintain the increased sagittal diameter of the spinal canal.

Adult↗
PubMed1992

Detoxification of endotoxin-contaminated titanium and hydroxyapatite-coated surfaces utilizing various chemotherapeutic and mechanical modalities.

The surgical repair of the ailing implant may be complicated by the surface effects of pathogenic bacteria and their products. This study evaluated the ability of various chemotherapeutic modalities to detoxify endotoxin-contaminated titanium alloy and hydroxyapatite-coated test strips. Grit-blasted titanium alloy and hydroxyapatite-coated test strips were contaminated with purified outer membranes of Escherichia coli labeled with radioactive 14C. The titanium alloy strips were treated with citric acid, stannous fluoride, tetracycline HCl, chlorhexidine gluconate, hydrogen peroxide, chloramine T, sterile water, a plastic sonic scaler tip, and an air-powder abrasive unit. Hydroxyapatite-coated strips were treated with chloramine T, citric acid, or burnished with sterile water on cotton pellets. Residual lipopolysaccharide levels were measured by liquid scintillation spectrometry. The air-powder abrasive unit removed significantly greater amounts of lipopolysaccharide than all other treatment modalities on titanium samples (P < 0.05). A 60-second burnish with sterile water was able to remove significant amounts of lipopolysaccharide when compared with untreated controls (P < 0.05). Citric acid was superior in the removal of lipopolysaccharide from hydroxyapatite-coated surfaces when compared with the controls or chloramine T (P < 0.01). Detoxification of an implant infected surface may be beneficial when surgical repair of the ailing implant is indicated.

Air Pressure↗
PubMed1999

Titanium foil-guided tissue regeneration in the treatment of periimplant bone defects.

Resorbable membranes are often not stable enough for complete corrections of deep periimplant bony defects. Nonresorbable polytetrafluoroethylene membranes require removal after osseous healing. In this study the use of titanium foils for reconstruction of deficient alveolar ridge structures around dental implants is described. The advantages and disadvantages of the titanium foil-guided bone regeneration technique is discussed. Forty-two patients with deep intra alveolar periimplant defects were treated by means of a titanium foil-guided bone regeneration technique. Autologous bone in combination with a demineralized freezedried bone allotransplant was used for augmentation. Clinical and radiological control was performed 3, 6, and 12 months after surgery. In 37 cases, the average 12-month postoperative increase in bone was 4.2 mm, and the decrease in augmented bone was only 4% compared with the postoperative situation. Acceptable augmentative results were achieved in 88% of patients after the first operative treatment using a titanium foil-guided bone regeneration technique for reconstruction of periimplant defects and in all patients after the second augmentation. The main problem with foil loss was denudation and infection 6 weeks after surgery.

Adult↗
PubMed2001

Effects of a modified sandblasting surface treatment on topographic and chemical properties of titanium surface.

A modified sandblasting surface treatment (a noncoating, roughening surface modification of dental implants) has been developed that will overcome the defects of conventional coating techniques. To verify the feasibility and reliability of this method at the chemical and topographic levels, scanning electron microscopy, x-ray diffraction, and a titanium ion releasing test were used; the topography of titanium surface, the embedding of sandblasting particles, nonpollution of heteroelements, and anticorrosiveness of titanium were criteria. Results showed that the rough surface created by sandblast was rather irregular, full of sharp tips and many embedded sandblast particles, and its corrosive rate was increased. These characteristics were modified by oxalic acid attack; the contour of the rough surface became more regular and round, the embedded particles and the heteroelement pollution were thoroughly removed, and the Ti corrosive rate decreased dramatically. Oxalic acid attack modification also created numerous secondary micropores (2.0-micron diameter) on the basis of sandblasted surface macrotexture. This modified sandblasting surface treatment is feasible and reliable to apply to dental implants and does not decrease the biocompatibility of titanium.

Aluminum Oxide↗
PubMed2003

Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating.

The ideal surgical treatment of multilevel cervical spondylosis remains unclear. This study analyzed the complications in using titanium cages and plating to reconstruct multilevel cervical corpectomies. This was a retrospective analysis of 21 consecutive patients who had multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. Sixteen had 2-level, one had 2.5-level, three had 3-level, and one had 3.5-level corpectomies. All had reconstruction with titanium cages and anterior plating. Thirty-three percent of the patients developed complications. Radiographs revealed bony consolidation in 95% of patients. Reconstructing multilevel cervical corpectomies with titanium cages and plating is associated with complications. Advantages include rigid immobilization and the avoidance of iliac crest bone graft harvesting. Major complications are largely the result of failures of the cage and plate construct, especially in patients with osteopenic bone. Supplemental posterior stabilization may be considered for cases with spasticity or greater than 2-level corpectomies with profound osteoporosis.

Adult↗
PubMed2003

Early results with titanium ossicular implants.

OBJECTIVE: To report the efficacy of titanium middle ear prosthesis for ossicular reconstruction. STUDY DESIGN: Retrospective chart reviews were performed for 25 patients who had undergone titanium ossicular implants between January 1, 1999, and June 1, 20001. SETTING: Tertiary otology referral center. PATIENTS: All patients had a minimum of 6 months of postoperative follow-up and no evidence of recurrent otologic disease. INTERVENTION: All patients had undergone ossiculoplasty using titanium middle ear implants. MAIN OUTCOME MEASURES: Comparisons of preoperative and postoperative pure tone averages were performed. Air-bone gap closures and implant extrusion rates were measured. RESULTS Overall mean pure tone averages improved 22.2 dB with air-bone gap improvement at 20.9 dB. Fifty-six percent of patients achieved air-bone gap less than 20 dB postoperatively. The overall extrusion rate was 4%. However, with the placement of cartilage graft interposed between the prosthesis and the tympanic membrane, no extrusion was observed. CONCLUSION: Titanium implants provide comparable hearing improvement compared with other materials. The extrusion rate seems quite low if cartilage interposition graft is inserted. Its ease of handling, biocompatible properties, and sound conducting properties improve its efficacy as an ossicular implant.

Adolescent↗
PubMed2004

Gold and titanium in the oval window: a comparison of two metal stapes prostheses.

OBJECTIVE: The objective of this study was to evaluate the hearing results of stapes surgery with 2 different full metal stapes prostheses. STUDY DESIGN: Retrospective analyses were carried out on the pre- and postoperative hearing results obtained after primary stapedotomy with 2 different prostheses. PATIENTS: We studied 106 patients with otosclerosis treated by stapes surgery. INTERVENTION: Fifty-three patients had a stapedotomy with a gold piston and 53 patients received a titanium piston after stapedotomy. MAIN OUTCOME MEASURES: The results were compared according to mean audiometric parameters. Furthermore, the individual audiologic results were demonstrated with the Amsterdam Hearing Evaluations Plot (AHEP). This method is a visual presentation of the hearing result for each operated ear. RESULTS: These AHEPs showed that the heavier gold piston (shaft Ø 0.4 mm and weight 10192.0 microg) gives more overclosure gain (28.3%) than the lightweight (shaft Ø 0.4 mm and weight 2541.0 microg) titanium piston (9.4% cases of overclosure). CONCLUSIONS: Because of the different properties of the 2 pistons (gold very malleable, titanium rather stiff), a choice can be made for different anatomic or pathologic situations in the operated middle ear. The "overclosure effect" of the gold piston is higher compared with the titanium piston.

Adult↗
PubMed2004

A new L-shaped titanium prosthesis for total reconstruction of the ossicular chain.

OBJECTIVE: To describe the technique used for total ossiculoplasty with the Fisch titanium total prosthesis and evaluate the 1-year postoperative functional results in patients presenting with the stapes (or footplate) without the malleus handle. STUDY DESIGN: Prospective trial with preoperative and postoperative comparison. SETTING: Academic and private practice tertiary care center for otologic surgery. PATIENTS: Forty-nine consecutive patients operated on from September 1996 to December 2000. SURGERY: : Staged ossicular reconstruction with a Fisch titanium total prosthesis placed between the footplate and the tympanic membrane without regard to the presence or absence of the stapes arch. Coupling of the prosthesis to the footplate was achieved by various techniques, including perforation, foot and spike on the footplate without perforation, and shaft alone (without foot) with tragal cartilage fixation (disc or small wedges). There was no interposition of cartilage between the prosthesis head and the tympanic membrane. MAIN OUTCOME MEASURES: Pre- and postoperative air and bone-conduction thresholds and air-bone gaps for pure-tone averages of three and four frequencies and for single frequencies. RESULTS: Postoperative air-bone gap closures within 20 dB distributed equally (50%) between 0.5, 1, and 4 kHz and reached the highest rate (89%) at 2 kHz (p < 0.05). The postoperative air-bone gaps for pure-tone averages reached 0 to 20 dB in 57% and 0 to 30 dB in 87% of the cases. There were no dead ears and no partial or total extrusions of prostheses. The best functional results were achieved through perforation coupling of the spiked foot to the footplate in large oval windows and after fixation of the shaft (without foot) with tragal cartilage disc in narrow oval windows. CONCLUSION: The functional results of the L-shaped Fisch titanium total prosthesis implanted in ears with the stapes but no malleus handle are best at 2 kHz and better than those of comparable columellar titanium prostheses over the remaining tested frequencies.

Adult↗