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PubMed2004

Marginal adaptation of three-unit fixed partial dentures constructed from pressed ceramic systems.

PURPOSE: This study compares the marginal accuracy of posterior metal ceramic (MC), all-ceramic IPS Empress 2 and experimental pressed ceramic (EPC-VP 1989/4) three-unit fixed partial dentures (FPD), before and after luting and after thermo-mechanical fatigue in a dual-axis chewing simulator. MATERIALS AND METHODS: Caries-free human teeth (n=160) were used as abutments for the fabrication of eighty posterior three-unit FPD, divided into two test-groups, IPS Empress 2 and EPC, of 32 samples each and one control group of 16 samples metal ceramic FPD. All FPD were cemented with Variolink II dual-curing resin cement. Half of the samples in each group were exposed to a dual-axis chewing simulator. RESULTS: The geometric mean marginal gap values (microm, before cementation, after cementation and after thermo-mechanical fatigue) amounted to 53, 63 and 62 for the ceramic metal FPD, 57, 71 and 68 for the Empress 2 FPD and 55, 67 and 68 for the EPC FPD. In all groups a statistically significant increase in marginal gap width was observed after cementation. The effect of functional loading in the chewing simulator on marginal gap was not significant. Marginal gap was lowest in the control group but differences with all-ceramic materials were small in all evaluation stages. CONCLUSION: Within the limits of this investigation, it can be concluded that marginal gap values of these all-ceramic materials and conventional MC techniques are on a similar level. In particular, almost all marginal gap values observed in this study were within the limits of clinical acceptance.

Bicuspid↗
PubMed2003

Applications of contact lens devices in the management of corneal disease.

Contact lens devices have a variety of therapeutic applications in the management of corneal diseases. A wide range of devices is available, some with very specific indications for use, including scleral lenses, silicone elastomer, collagen shields, large diameter corneal lenses, and silicone hydrogels. The traditional hydrogel contact lens is the most frequently used device and is indicated in at least 80% of cases. Common indications for use are relief of pain, promotion of corneal healing, mechanical protection and support, and control of corneal hydration, often a combination of effects being achieved. Visual improvement may be achieved but this is not the primary role of such devices.

Contact Lenses↗
PubMedDate not supplied

Experience of the small size (25 mm) Sorin Bicarbon bileaflet prosthetic valve in patients with small mitral annuli.

BACKGROUND: Currently, there is a tendency to use large-size prosthetic valves in mitral position in order to achieve better hemodynamic performance. We aimed to evaluate hemodynamic performance of 25 mm prosthetic valves in mitral position. METHODS: Between August 1998 and May 2000, a total of 40 patients, 34 women and 6 men (mean age 42 +/- 12 years), underwent mitral valve replacement with 25 mm bileaflet mechanical valve. Preoperative functional capacity was New York Heart Association classes III and IV in 31 patients. Major indication for surgery was severe mitral stenosis in all patients. RESULTS: Total hospital mortality was 5% (two patients). Mean follow-up period was 14.7 +/- 4.9 months (2 to 23 months). No thromboembolic event, paravalvular leak, mechanical failure, endocarditis were observed during the follow-up period. Postoperatively 92.5% of the patients were in the functional capacity of New York Heart Association class I. Postoperative echocardiographic observations have given an average pulmonary artery pressure of 29 +/- 2 mmHg, effective orifice area as 2.95 +/- 0.1 cm2, and mean prosthetic gradient as 6.5 +/- 2.7 mmHg. CONCLUSION: In short- and mid-term, small-size (25 mm) Sorin mechanical mitral valves had excellent hemodynamic performance in patients with severe mitral stenosis, moderate or serious pulmonary hypertension, and small mitral annuli, whose body surface area was smaller than 1.6 m2.

Adult↗
PubMed1997

Complete dentures in the prosthetic rehabilitation of elderly persons: five different criteria to evaluate the need for replacement.

The purpose of this study was to examine the condition and functional properties, as well as adjustment and replacement needs, of 288 complete dentures worn by 144 inhabitants of Helsinki over 75 years old. Five different criteria to evaluate the need for replacement were used: (I) criteria based on Oral Health Surveys-Basic Methods (WHO, 1987); (II) criteria based only on the clinical data collected during the examination; (III) criteria based only on examiners' subjective opinion of the condition of the dentures; (IV) criteria based on clinical data as well as examiners' experience and consultation with the patient; (V) criteria based only on patients' subjective opinion. Depending on the evaluation method used, 10-84% of the dentures were judged to be in need of replacement. Strict objective evaluation methods produced the highest figures for replacement need, and method (I, WHO, 1987) the lowest. The most justifiable replacement percentage (26%) was achieved when the dentist assessed treatment need together with the patient. This study documents the multiple subjective and objective difficulties related to the wearing of complete dentures. The study also highlights the well-recognized importance of regular annual reexaminations for those wearing complete dentures and the assessment of need for adjustment of the dentures. It also demonstrates that successful treatment decisions cannot be made solely on the basis of clinical examination or a dentist's subjective opinion, but should be formulated in close consultation with the patient.

Aged↗
PubMed2000

The effect of venting on pulpward pressure transmission and seating on crown cementation: a laboratory study.

Measurable hydraulic forces towards the pulp chamber can occur whilst cementing a crown. This study investigated the effect of crown venting and the use of two different seating forces (100 and 2. 5 N) on pulpward pressure transmission. Forty single-rooted premolar teeth were collected from patients requiring extractions for orthodontic reasons. A standardized crown preparation was made and impressions taken to construct individual base-metal alloy crowns. The teeth were divided into four groups based on the type of crown (vented or non-vented) and force used (100 or 2.5 N). The teeth mounted on a specially constructed stand and connected to a 0-104 kPa pressure transducer. The pulp chamber was perfused with saline driven by nitrogen gas at 83 kPa for up to 2 h until a steady state perfusion rate was achieved. Crowns were cemented to the teeth on a uniaxial seating device using zinc phosphate cement. Simultaneous recordings of both pressure pulse and seating discrepancies were recorded. The 40-fold increase in seating force from 2.5 to 100 N resulted in a significant increase (P<0.001) in pulpward pressure in both vented and non-vented crowns. Seating was also significantly improved for the vented crowns regardless of which force was used. Venting had no significant effect on pulpward pressure transmission. It was concluded that a significant relationship existed between seating force and pulpward pressure transmission. Venting improved crown seating but did not have a demonstrable effect on pulpward pressure transmission.

Analysis of Variance↗
PubMed2001

Rehabilitation of the geriatric vascular amputee patient: a population-based study.

OBJECTIVES: To determine the rate of successful prosthetic fitting in geriatric vascular amputees in the community and to determine predictors of successful fit. DESIGN: Epidemiologic survey. SETTING: General community, Olmsted County, Minnesota. PATIENTS: All Olmsted County residents more than 65 years old who had a major lower extremity amputation (below knee amputation [BKA] or higher) for peripheral vascular disease between 1974-1995, of whom 199 were identified. Median age at amputation was 79.7 years with a median survival of 1.5 years. INTERVENTION: A retrospective chart review. MAIN OUTCOME MEASURE: Successful prosthetic fit. RESULTS: Amputation levels were: 64% BKA, 4.5% knee disarticulation, 31% above knee amputation (AKA), and 0.5% hip disarticulation. Only 36% of the population was successfully fitted, compared with 74% of patients referred to the Amputee Clinic. Major reasons for not being fitted included death, reamputation, cerebrovascular disease, and cognitive deficits. Increased age (p < .001), cerebrovascular disease (p < .001), dementia (p = .002), and AKA (p < .001) were associated with failure to fit. CONCLUSION: The high probability of successful prosthetic fitting reported among referral practices cannot be generalized to unselected elderly individuals. However, selected individuals can successfully be fitted with a prosthesis; knowledge of predictors of prosthetic fitting may facilitate setting of realistic goals during presurgical counseling in this age group.

Age Factors↗
PubMed2000

A prospective study of changes in aneurysm and graft length after endovascular exclusion of AAA using balloon and self-expanding endograft systems.

PURPOSE: Longitudinal shrinkage of aneurysms post-endovascular repair, employing unvalidated measurement techniques has been held to account for endograft disruption. In this study we record changes in aneurysm length, diameter and volume using the gold standard of calibrated spiral CT angiography (SCTA). METHOD: From 179 patients with AAA scanned by SCTA, 68 were selected for endografting. Twenty-seven had PTFE home-made prostheses while 41 patients had Talent endografts. SCTA was performed on the fifth postoperative day and 6-monthly intervals thereafter. The distance between the lowest renal artery and the aortic bifurcation (VBL - vertical body length) and the luminal centre line length (LCL) were measured. Maximal sac diameters and volumes were recorded using 3DCT reconstruction. RESULTS: Significant increase was noted in VBL (3.2) mm for PTFE-treated patients accompanied by an increase in sac volume at day 5 (12.5 ml). No changes in LCL or maximal diameters were evident. At 1.5 years further lengthening of both VBL (6.4 mm) and LCL (9.3 mm) was unaccompanied by sac diameter/volume changes. Talent patients - no changes in VBL or LCL were evident. Volumes and maximal AP and transverse diameters showed marked shrinkage: AP -11. 2 mm; transverse -2.6 mm; volumes by -35.5 ml at 6 months. CONCLUSION: With PTFE increase in VBL but not graft length, without concurrent changes in maximal diameters at day 5, is commensurate with increase in sac volume; after 1.5 years graft lengthening overtakes aortic lengthening. In Talent patients VBL/graft length remained unchanged. There is no evidence for longitudinal aneurysmal contracture. Volumes and maximal diameters for the Talent endograft but not for PTFE show shrinkage.

Aged↗
PubMed2002

Comparison of a mechanical acetabular alignment guide with computer placement of the socket.

We hypothesized that use of mechanical acetabular guides for intraoperative alignment leads to variations between the actual and desired implant orientation. Acetabular implant orientation using only the mechanical guide was studied in 78 patients (82 hips) undergoing primary total hip arthroplasty. A computer-assisted navigation system was used to measure alignment and to monitor the orientation of the pelvis during surgery. When using the mechanical guide, there was significant variation in cup alignment from the desired goal of 45 degrees of abduction and 20 degrees of flexion, and this would have resulted in unacceptable acetabular alignment in 78% of hips. With the support system used, there was significant variability in pelvic orientation during surgery. The mean anteversion of the pelvis was an average of 18 degrees from the optimal orientation. These results show a clear need to develop more reliable tools than were used or anatomically based alignment strategies to provide reproducible and accurate acetabular alignment.

Acetabulum↗
PubMed2002

Femoral revision: distal fixation with fluted, tapered grit-blasted stems.

Fluted, tapered grit-blasted titanium stems for revision total hip arthroplasty have been used extensively in Europe and have been reported to provide mostly favorable results. These stems are tapered to gain axial stability and fluted to gain rotational stability in the femoral diaphysis. Grit-blasted titanium provides a surface for bone ongrowth. Such implants can solve certain problems not addressed easily by other standard revision techniques. The clinical durability of modular implants, introduced to make these implants more user-friendly and more versatile, remains to be proved. These implants require special techniques for implantation, particularly when long-stemmed implants are used.

Arthroplasty, Replacement, Hip↗
PubMed2002

Polyethylene liner cementation into fixed acetabular shells.

A patient presenting with a secure cementless acetabular component and with femoral head penetration through the polyethylene liner is a common clinical problem. Cementing a new liner into the fixed shell is one option. We evaluated this option in a clinical series of 17 cases and with a preliminary mechanical study. In the 1 clinical failure (5.9%), the failure occurred at the cement-liner interface. The most important variable in optimizing the mechanical strength of the cemented liner construct was adequate preparation of the cement-liner interface. This approach to treating the patient with a fixed cementless shell and a worn polyethylene liner can provide a durable construct with minimal morbidity.

Aged↗
PubMed1999

The effect of the additional use of grommets in silicone implant arthroplasty of the metacarpophalangeal joints.

After silicone arthroplasty of the metacarpophalangeal (MP) joint there is increasing osteolysis, subsidence and fracture of the implants in the longer postoperative term. In 44 patients with rheumatoid arthritis (54 hands) 151 arthroplasties of the metacarpophalangeal joint were assessed at a mean of 3.9 years postoperatively. In 57 arthroplasties titanium protectors (grommets) were used. There were no significant differences in the clinical outcomes with respect to swelling, correction of ulnar deviation, range of active movement and grip strength. The additional use of grommets in MP joint arthroplasty slightly reduced reactive osteolysis, protected the spacers from breakage and slightly reduced the amount of pain with only a few additional complications in the midterm follow-up.

Activities of Daily Living↗
PubMed2005

Unicompartmental knee arthroplasty: troubleshooting implant positioning and technical failures.

Improvements to implant design and the advent of minimally invasive surgery have increased the popularity of unicompartmental knee arthroplasty. Minimally invasive techniques for implant placement can augment the unicompartmental knee arthroplasty procedure and allow for more rapid rehabilitation and return to activities of daily living. Nevertheless, new technologies are accompanied by learning curves and rediscovery of past mistakes. Unicompartmental knee arthroplasty tends to be more technically demanding than total knee arthroplasty, and complications occur with placement of unicompartmental knee devices. This article discusses proper and improper implantation techniques and provides technical guidance and suggestions for improving the outcomes of unicompartmental knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2002

[Bone defects in revision total knee arthroplasty: classification and management].

The goal of bone reconstruction in revision total knee arthroplasty is to provide a stable support for the implant and to re-establish the correct joint line. Therefore, a useful, therapy-based classification of the defects is necessary. According to Stockley et al. (1992), the defects are classified into contained and uncontained defects. Uncontained defects can be reconstructed using structural allografts or metal wedges. In contained defects, cancellous allograft can be used. For aseptic loosening of total knee arthroplasty, the defect classification according to Engh and Parks (1994) can be helpful because of its recommendations for reconstruction. In case of the more common first or second graded defects, reconstruction is performed using modular revision components or allografts. For the rare third graded defects, bulk allografts or modular tumour endoprostheses are recommended. On the basis of more than 150 revision total knee arthroplasties performed in our hospital the classification of bone defects and their clinical consequences are presented in this review.

Arthroplasty, Replacement, Knee↗