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PubMed2005

A 16-year study of the microgap between 272 human titanium implants and their abutments.

A microgap has been described at the level of the implant-abutment connection. This microgap can be colonized by bacteria, and this fact could have relevance on the remodeling of the peri-implant crestal bone and on the long-term health of the peri-implant tissues. The authors report on 272 implants with screw- or cement-retained abutments retrieved from humans for different causes during a 16-year period. In the implants with screw-retained abutments, a 60-microm microgap was present at the level of implant-abutment connection. In some areas the titanium had sheared off from the surface and from the internal threads. The contact between the threads of the implant and those of the abutment was limited to a few areas. Bacteria were often present in the microgaps between implant and abutment and in the internal portion of the implants. In implants with cement-retained abutments, a 40-microm microgap was found at the level of the implant-abutment connection. No mechanical damage was observed at the level of the implant or of the abutment. All the internal voids were always completely filled by the cement. No bacteria were observed in the internal portion of the implants or at the level of the microgap. The differences in the size of the microgap between the two groups were statistically significant (P < .05). In conclusion, in screw-retained abutments the microgap can be a critical factor for colonization of bacteria, whereas in cement-retained abutments all the internal spaces were filled by cement. In these retrieved implants, the size of the microgap was markedly variable and much larger than that observed in vitro.

Bacteria↗
PubMed1998

Hollow implants retrieved for fracture: a light and scanning electron microscope analysis of 4 cases.

One of the possible complications of implant treatment is the occurrence of an implant fracture. Metal fatigue and biomechanical overload seem to be the most common causes of fractured implants. This study evaluated 4 implants (3 hollow cylinders and 1 hollow screw) which fractured after a mean loading period of 2.8 years. All implants had a 4 mm diameter and had been inserted in a posterior location. In 3 cases parafunctional habits were present. In all cases a vertical resorption of the peri-implant bone was present. The endosseous portion of the implant presented always a very high bone-implant contact percentage. Scanning electron microscopic examination showed that at least one of the implant holes was involved in the fracture line; no porosities or material defects were observed on the fractured surface of the implant. In hollow implants the holes could represent a site of less resistance.

Alveolar Bone Loss↗
PubMed2001

Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man.

BACKGROUND: Early implantation may preserve the alveolar anatomy, and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest. Although a number of clinical studies exist, no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone. METHODS: Forty-eight healthy patients, receiving at least 4 fixtures in each of 2 symmetrical quadrants, underwent placement of 1 experimental fixture placed in a fresh extraction socket (TI) and 1 contralateral fixture in mature bone (CI). TI were placed after atraumatical tooth extraction, with a surgical site at the apex of the socket and a tight contact between the fixture and the socket's walls, but without the use of filling materials or membranes. The flap was coronally repositioned to obtain primary wound closure. Immediately after surgical intervention, a standardized periapical radiograph was taken. Second-stage surgery was done after 6 months. Six months after the second surgery, a second standardized periapical radiograph was taken and clinical parameters (bleeding and plaque index) recorded. Marginal bone loss (MBL) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs. TI and CI were then removed by a hollow drill to obtain histological specimens. Non-demineralized sections were stained by acid fuchsin and toluidine blue, and by von Kossa to evaluate the degree of bone mineralization. The percentage of direct implant-bone contact (DBC) was calculated by a computerized microscopic digitizer. RESULTS: No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories. There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the mandible. No connective or fibrous tissues were present around TI or CI. Bone resorption was not present in any of the histological sections. CONCLUSIONS: The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone-to-implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone.

Adult↗
PubMedDate not supplied

A posterior composite case utilizing the incremental and stratified layering technique.

Composite restorations should bring out the artist in the dentist. Today's composites are made to produce highly aesthetic, functioning restorations. There are several systems from which practitioners can choose, and the techniques for each system can be daunting. Composite restorations are conservative and a viable alternative, if proper protocol is followed. Each manufacturer has its own steps for applying its composites; however, by following the sound basic principles for bonded restorations, the practitioner can apply these procedures to every composite system. Thus, by utilizing proper techniques and understanding the material, one can both achieve a predictable outcome and desired aesthetics. The case study presented here illustrates the necessary steps required to achieve an anatomical, functional and aesthetic restoration.

Acid Etching, Dental↗
PubMed2000

Shade selection. Communicating with the laboratory technician.

Shade selection for anterior crowns has always set up a communications problem between the dentist and laboratory technician. Over the years, many different techniques have been formulated to help overcome the problem. These techniques include picture taking, drawing diagrams and using multiple porcelain shade guides. However, they have not completely erased the difficulty of communicating the choice of the proper shade of an anterior crown. This was especially true in the 1990's when all-ceramic crowns were introduced. Popular techniques dentists use for communicating shade selections will be reviewed, along with guidelines for making the proper selection. Many dentists are familiar only with the techniques they were taught in dental school and/or residency program and are unaware of the superior methods that can be used. This type of review can be extremely helpful to restorative dentists.

Ceramics↗
PubMedDate not supplied

Bonded resin composite strip crowns for primary incisors: clinical tips for a successful outcome.

The bonded resin composite strip crown is perhaps the most esthetic of all the restorations available to the clinician for the treatment of severely decayed primary incisors. However, strip crowns are also the most technique-sensitive and may be difficult to place. The purpose of this step-by-step technique article is to present some simple clinical tips to assist the clinician in achieving an esthetic and superior outcome.

Color↗
PubMed2002

Reconstructive surgery for congenitally malformed mitral valve.

BACKGROUND AND AIMS OF THE STUDY: The study aims were to evaluate early and mid-term survival and freedom from reoperation in patients with isolated mitral valve (MV) congenital malformation (MVCM) or in association with other cardiac defects, and to identify predictors for poor early and late outcome. METHODS: Between January 1990 and February 2001, 58 children with MVCM underwent MV-conserving surgery; patients were allocated to group I (n = 21) with isolated MVCM, and group II (n = 37) with MVCM and associated congenital heart defects (ACHD). MV stenosis was identified in 10 (48%) group I patients, and 11 (30%) group II patients (p = NS); MV insufficiency was present in 11 (52%) patients in group I, and in 26 (70%) of group II (p = NS). The most frequently found MVCM were annular dilatation (n = 13) cases and elongated chordae (n = 14). Hammock MV was found in nine patients (15%). RESULTS: Six (10%) hospital deaths occurred. Mortality was 5% (n = 1) in group I, and 13% (n = 5) in group II (p = 0.4). Mean repair techniques per patient was 2.05+/-0.4 and 2.3+/-0.3 in groups I and II respectively (p = 0.009). Mechanical ventilation time was 2.1+/-1 and 2.8+/-0.7 days in groups I and II (p = 0.003). The incidence of postoperative mitral regurgitation grade > or =1 was significantly higher in group II (p = 0.008). At five-year follow up, actuarial survival was 91.5% in group I and 86% in group II (p = 0.037). Actuarial reoperation-free survival was 85% in group I and 73% in group II (p = 0.01). Multivariate analysis showed age >12 months (p = 0.033), hammock MV (p = 0.0088) and ACHD (p = 0.0048) were strong predictors for poor event-free survival. CONCLUSION: MV repair for MVCM provides acceptable early and mid-term outcome in terms of mortality and freedom from reoperation. ACHD significantly reduce early and late postoperative survival and freedom from reoperation.

Adolescent↗
PubMed2003

Defective direct composite restorations--replace or repair? A survey of teaching in Scandinavian dental schools.

A questionnaire based survey was undertaken in Scandinavian dental schools to investigate aspects of the teaching of the repair of failing direct composite restorations, as a conservative alternative to total restoration replacement. The findings indicate that all undergraduate students in Scandinavian schools are taught and gain clinical experience in the repair of direct composite restorations. Although the findings reveal general agreement in relation to the teaching of reasons and operative procedures for the repair of direct composite restorations, variations were found in relation to the teaching of indications for, and the expected longevities of such repairs.

Attitude of Health Personnel↗
PubMed2005

[Surgical treatment of cataract].

Today, the most frequently performed of all operative interventions is considered to be surgery for cataract. Modern surgical techniques applied under local anesthesia, tiny incisions that close spontaneously, reliable biometric methods, and the availability of artificial lenses, all combine to produce excellent results. In view of the low complication rate, this procedure can be recommended even in very old patients.

Aged↗
PubMed2006

The occurrence of postoperative pulmonary homograft stenosis in adult patients undergoing the Ross procedure.

BACKGROUND AND AIM OF THE STUDY: The Ross procedure employs an autologous pulmonary valve to replace the aortic valve, but requires pulmonary homograft replacement. Concerns regarding long-term homograft function may limit the adoption of this technique. Herein, the incidence of, and factors leading to, stenosis of the homograft were examined. METHODS: Data were collected from 131 patients (32 females, 99 males) who underwent a Ross procedure between July 1994 and December 2003. Complete follow up data were collected from 113 of 125 (90.4%) living patients. Donor valve information, including storage time, was supplied by the graft manufacturers. Data were analyzed using chi-square tests, t-test and logistic regression. RESULTS: The mean patient follow up was 703 +/- 574 days (median 599 days; range: 2 to 2,408 days). Echocardiographic stenosis had occurred in 14 patients (12.4%). Four patients (3.2%) required homograft replacement, and two required balloon valvuloplasty. There was no significant difference in graft vendor, recipient, donor age or blood type match between stenotic and non-stenotic recipients. Donor valve size was appropriate for the recipients, and greater than predicted by recipient body surface area (BSA). Donor valves that developed stenosis had a shorter storage time after processing (160 +/- 100 versus 249 +/- 223 days; p = 0.03). Male donor valves became stenotic in 9.9% (7/71) of male recipients, but in none of 20 females. Female donor valves became stenotic in 27.3% (3/11) of male recipients, and in 28.6% (2/7) females. Logistic regression showed donor gender to be a significant predictor for stenosis (p = 0.007; odds ratio 14.1 for female/male donors; 95% CI 2.1-96.4). CONCLUSION: Donor valves which developed stenosis had a shorter mean cryopreservation time than those that did not develop stenosis. In addition, female donor homografts appeared to develop stenosis at a greater rate, independent of patient age, graft size to BSA match, and blood type.

Adolescent↗
PubMed2006

Coexistent congenital aortic defects, aneurysm of sinus of valsalva, atrial septal defect and infective endocarditis: a case report.

Coarctation of the Aorta is frequently associated with bicuspid aortic valve. This is a risk factor for infective endocarditis. Aneurysm of a sinus of Valsalva is a rare defect with a prevalence of 0.09%. They are associated in 10% of cases with a bicuspid aortic valve and less frequently with coarctation of the aorta and atrial septal defect. It is extremely rare the association of coarctation of the aorta with an atrial septal defect. This is one of the first cases reported in Puerto Rico of an adult patient with coarctation of the aorta in association with a bicuspid aortic valve, a ruptured aneurysm of a sinus of Valsalva and an atrial septal defect. The patient is a 22 year old male with coarctation of the aorta diagnosed since childhood who was admitted at the Cardiovascular Center of Puerto Rico with signs of heart failure due to infective endocarditis secondary to a teeth infection. Upon evaluation with transthoracic and transesophageal echos, he was found to have a coarctation at the aortic isthmus, aortic root dilatation, bicuspid aortic valve with vegetation, severe aortic and tricuspid regurgitation, aneurysm of the non coronary sinus of Valsalva with perforation to the right atrium, biatrial enlargement and a dilated right ventricle. Successful antibiotic treatment of endocarditis was achieved followed by surgical replacement of the aortic valve and ascending aorta with closure of the non coronary sinus of Valsalva was done. An secundum atrial septal defect was found and was also closed. Surgical correction of the coarctation of the aorta was postponed for a future time. The patient had a successful postsurgical recovery and was discharged home with anticoagulation treatment.

Abnormalities, Multiple↗
PubMedDate not supplied

[Color-coded cardiac Doppler].

Color flow mapping with Doppler technique was reviewed. We describe the advantages and technical was reviewed. We describe the advantages and technical limitations of the technique. The usefulness of color flow mapping in acquired and congenital disease was studied. We conclude that new information was added, concerning complex intracardiac flow, in order to the traditional study with classic continuous and pulsed Doppler examination.

Cardiomyopathies↗
PubMed1996

Mitral homograft for tricuspid valve endocarditis complicating a congenital fistula between the right coronary artery and right ventricle.

The authors report a case of tricuspid endocarditis complicating a congenital coronary artery fistula to the right ventricle in an eight-year-old female. The patient underwent valve replacement using a cryopreserved mitral homograft. Six months later, clinical and echocardiographic status are excellent. Using a mitral homograft for tricuspid endocarditis is a recognized approach in adults, whereas in pediatric cases it is exceptional. Homografts could prove to be a valid procedure in children when repair is not feasible, although one could expect a more rapid deterioration.

Child↗
PubMed1996

[Left ventricular pseudoaneurysm recognized 9 years after mitral valve replacement and repeated heart failure of 3 years duration: a case report].

A 66-year-old woman had suffered from repeated heart failure beginning 6 years after mitral valve replacement. Left ventricular pseudoaneurysm was discovered 9 years after the replacement, while no evidence including histology was obtained for the cause of the pseudoaneurysm except the mitral valve replacement. The progression of aortic valve stenosis and the formation of the pseudoaneurysm may have contributed to the onset of congestive heart failure. Surgical treatment was successful. Although left ventricular pseudoaneurysm after mitral valve replacement is rare, careful echocardiographic examination is necessary for detecting such a complication in patients after surgery.

Aged↗