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At least 1,405 records · Page 78Linked to original sources
PubMed1995

Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty.

From 1976 to 1992, 24 knees (24 patients) were treated for reinfection after reimplantation of a prosthesis to treat an infected total knee arthroplasty. Including the index total knee arthroplasty, the average number of total procedures for the affected knee was 9.3 procedures (range, 5-23 procedures), and surgical procedures used for the affected knee after reinfection averaged 3.7 procedures (range, 1-12 procedures). The final outcome included 10 knees with a successful knee arthrodeses, 5 patients with infected prostheses who were prescribed suppressive oral antibiotic treatment, 4 above the knee amputations, 3 persistent pseudarthroses of the knee joint, 1 resection arthroplasty, and 1 uninfected total knee prosthesis. A poor prognosis was associated with use of a hinged knee design: 3 of the 4 amputations were done after a hinge knee prosthesis was implanted; 2 patients had a persistent pseudarthrosis after a failed attempt at knee arthrodesis; 1 patient had a resection arthroplasty; and 1 patient had a retained infected prosthesis. A successful arthrodesis in which the initial attempt included use of an external fixation devices was more likely for prostheses without stems (75%) when compared with cemented stemmed prostheses (40%). Long intramedullary arthrodesis was successful in all 3 attempts. Aspiration for diagnosis followed by oral antibiotic suppression was universally unsuccessful in 4 patients, whereas early aggressive open debridement facilitated retention of the prosthesis in 4 of 6 patients. The increased difficulty in achieving a healed wound, a successful knee arthrodesis, and eradication of infection with subsequent nonprosthetic salvage procedures as well as the attendant morbidity associated with reinfection must be considered carefully and discussed with the patient before the reimplantation prosthesis is inserted to treat the infected total knee arthroplasty.

Adult↗
PubMed1992

Light-cured combination obturator prosthesis.

A technique for the fabrication of an open combination (hard-resilient) obturator prosthesis with VLC materials for patients undergoing partially edentulous maxillectomy is described. VLC denture resins and resilient liners are an exciting innovation in prosthodontic treatment and offer the maxillofacial prosthodontist a wider choice of treatment modalities. The technique and the resultant obturator prosthesis have the following advantages: 1. The ease and rapidity of the technique saves time for both the patient and the maxillofacial prosthodontist by introducing the open obturator prosthesis at the earliest opportunity. 2. The combination open obturator prosthesis provides a stable record base for securing jaw relation records. 3. The thickness and resiliency of the obturator prosthesis can be managed more easily. Flexibility and resiliency can be modified by the thickness of the resilient liner or by adding a rigid scaffolding according to the clinical requirements. 4. Prostheses are easy to repair or modify by using increments of VLC hard or resilient materials. 5. The combination VLC obturator prosthesis provides stability, retention, and decreased weight and obduration of residual palatal defects. 6. The technique can be used for partially edentulous or edentulous patients after maxillary resection.

Acrylic Resins↗
PubMedDate not supplied

Implant-supported facial prostheses.

The application of the principles of osseointegration to the craniofacial skeleton can offer the patient with defects from trauma or ablative cancer surgery a functional and esthetic restoration, with minimal morbidity. Implant-supported restorations offer a retrievable prosthesis with increased retention and support, by the use of tissue bars with clip retention, magnetic retentive mechanisms, or both. Implant-supported auricular, nasal, orbital, midfacial or combination prostheses are presently being provided for patients in hospitals, maxillofacial prosthetic training programs, and private practice settings in North America and elsewhere.

Bone Screws↗
PubMed2003

[Functional implantation reconstruction of acquired jaw defects after tumor resection].

OBJECTIVE: Partial or full defects of jawbone following tumor resection frequently lead to a loss of mastication, an impaired speech function and a severe deformity of appearance. To improve the life quality of such patients, implantation or bone grafting-combined implantation was utilized to functionally reconstruct the jaw defects. METHODS: 1. Fragmental or full mandibular defects were reconstructed by vascularized or non-vascularized bone grafts in combination with immediate or delayed implants. 2. The unilateral maxillary defect with an edentulous counter-side was rehabilitated by a prosthesis secured on implants placed on the healthy side. 3. For bilateral maxillary defect, implants were placed in the zygmatic bone or augmented zygmatic bone to support a prosthesis with magnetic retention. RESULTS: 64 jaw defects (10 in maxilla; 54 in mandible) were reconstructed by three different methods to restore the appearance and functions. The longest follow-up period was 12 years and the shortest 5 year, only 6 implants were lost due to failure of osseointegration. The implant survival rate for the maxillary defects was 97.5%, for the mandibular defects with vascularized bone grafts was 97.1%, and with non-vascularized bone grafts was 97.7%. CONCLUSIONS: Implants-borne prosthesis is an applicable technique in restoration of maxillary defects. In case of insufficient zygomatic thickness, bone augmentation is often needed prior to implantation. As for the mandibular reconstruction, bone grafting in combination with implantation is an ideal method. Compared to non-vascularized bone grafting, the vascularized method is much more suitable for bone grafting beds with poor blood supply. From the practical point of view, non-vascularized bone graft in combination with implantation is more practicable. The reduced off-body time of bone grafts from donor to recipient site keeps most of osteoblasts vital and enables simultaneous implants to achieve osseointegration. This confirms the osteogenesis, osteoconduction and osteoinduction of bone autografts.

Adolescent↗
PubMedDate not supplied

Implant-supported removable overdentures in the edentulous maxilla: clinical and technical aspects.

PURPOSE: The aim of this article is to describe the indication criteria and the treatment planning for a maxillary implant-supported removable overdenture. Prostheses are designed according to the requirements of the bar system and the factors influencing the extension of the prosthesis base. MATERIALS AND METHODS: The decisive factors in determining whether a bar-retained overdenture prosthesis is indicated should be evaluated during the initial clinical examination and with the help of a reformatted computed tomographic (CT) scan that is performed with a radiologic template in place. Titanium markers represent the ideal location of the denture teeth in the diagnostic setup so that the implant position can be selected and the available space for the bar system can be assessed vertically and horizontally. RESULTS: For the overdenture prosthesis that is solely implant supported 6 to 8 implants are placed ideally at a distance of about 10 to 14 mm from center to center. A prefabricated bar system that allows the clips to be inserted between the implants can then be used. When the available bone restricts implant placement to adjacent tooth positions an individually milled bar that includes additional frictional pins and/or retentive elements needs to be planned. The prosthesis design, in particular its buccal and palatal flange extension, is determined during setup try-in, taking into account the patient's smile line, their need for facial support, and their phonetic requirements. CONCLUSION: The removable implant-supported overdenture offers flexibility in placing implants in either adjacent tooth positions or with greater distances between them depending on the available bone, as either conventional bar and clip systems or individually milled bars can be used. Adjustment of the buccal prosthesis flange and the palatal prosthesis base is made to fulfill the patient's requirements concerning esthetics, phonetics, comfort, and function.

Dental Implantation, Endosseous↗
PubMed2006

[Treatment of infected total knee arthroplasty. When does implant salvage make sense?].

Infection of a total knee arthroplasty can be classified as acute, chronic and haematogenic with and without implant loosening. A differentiated treatment concept for all types of infection is necessary. Furthermore, specific treatment has to be initiated early, as any delay is associated with a worsening of the prognosis. Treatment of infection with implant salvage may be one therapeutic option if the implant is not loose. According to the current literature, therapy with retention of the prosthesis may be promising: (1) in the case of early infection (<3 weeks of ongoing symptoms), (2) with unconstrained implants, (3) in the case of infection with a single organism that is susceptible to antibiotic therapy, (4) if soft tissue coverage is not affected, and (5) if the immune system is not compromised. Chronic infections, (semi-)constrained implants and soft tissue defects have to be considered as contraindications and implants should be removed. Early and consequent therapy with operative débridement and specific long-term antibiotic therapy are necessary to achieve implant salvage. The additional application of antibiotics addressing bacterial biofilms have helped to improve the prognosis. Due to the fact that revision arthroplasty is often associated with limited function after infection of the total knee joint, retention of the implant has to be considered a therapeutic alternative in early infection.

Anti-Infective Agents↗
PubMed2001

Prosthetic restoration following maxillary trauma utilising a fixed removable implant-supported prosthesis: a case report.

Patients with traumatic head injuries may suffer from tooth loss, as well as involvement of associated soft tissues and bone. Conventional prostheses are often bulky and unretentive. Osseo-integrated implants have made it possible to treat these patients with more retentive, aesthetically and functionally improved prostheses. This case illustrates the use of a fixed removable implant-supported prosthesis for a patient with severe maxillary trauma. A bar connecting the implants was individually designed to have parallel sides and vertical channels prepared in it. The corresponding removable prosthesis features retentive pins which engage the prepared grooves in the bar to provide adequate frictional retention and stability for the prosthesis. This treatment modality restored the missing teeth, alveolar bone, soft tissues and oral function while at the same time facilitating good oral hygiene.

Adult↗
PubMed1996

Surgical management of prosthetic valve obstruction with the Sorin tilting disc prosthesis.

BACKGROUND AND AIMS OF THE STUDY: Thrombotic occlusion is a potentially fatal complication of heart valve replacement surgery. The purpose of this report is to present our experience in the treatment of this group of patients, with emphasis on valve debridement as an effective surgical cure. MATERIAL AND METHODS: Of 299 operative survivors undergoing valve replacement with Sorin Carbocast tilting disc prostheses at our institution 270 could be followed up: 18 of them (6.7%) developed thrombosis within 26 months. All thrombotic blocks occurred in the mitral position. Anticoagulation was sub-therapeutic in 13 patients. Clinically, the patients presented with dyspnea, congestive cardiac failure, acute pulmonary edema or chest pain. Prosthetic valve closure sounds were absent or muffled in all patients and new murmurs developed in two. The average duration of symptoms was 3.0 days (range eight hours to 15 days). Diagnosis was made on physical examination alone, and echocardiographic confirmation was possible in 11 patients. Ten underwent emergency surgery, all by valve debridement with retention of the prosthesis. RESULTS: Of the operated patients, eight survived with restoration of prosthetic valve function. Complications including hypoxic encephalopathy and acute renal failure occurred in two patients (20%). One death occurred 13 months later due to renal failure. At a follow up of 18 to 32 months (mean 21.3 months), seven patients are alive and well, and in NYHA functional class I or II. One patient developed a recurrent prosthetic valve thrombotic occlusion, and underwent successful surgical debridement for a second time. Thrombolysis was attempted in two cases with early success, but recurrent prosthetic valve thrombosis occurred. CONCLUSIONS: The incidence of PVT was 6.7% in 270 patients with Sorin tilting disc valves implanted and followed up for 26 months. Though thrombolysis is initially successful, recurrent valve thrombosis is a risk. Emergency surgical treatment allowed 70% mid term survival after valve debridement alone. Adequate anticoagulation and regular medical follow up postoperatively need to be strongly emphasized.

Adolescent↗
PubMed1995

Total knee arthroplasty with the kinematic condylar prosthesis. A ten-year follow-up study.

Of 168 consecutive knees (118 patients) that had been treated with an arthroplasty with use of a kinematic total condylar prosthesis that allowed retention of the posterior cruciate ligament, 119 knees (eighty-four patients) were available for review at a mean of 10.0 +/- 0.7 years after the operation. The Hospital for Special Surgery knee score improved significantly, from a mean of 55 +/- 12 points preoperatively to a mean of 81 +/- 9 points at ten years (p < 0.0001). Radiolucent lines about the patellar component, present in thirty-five of eighty-three knees at the latest follow-up examination, were related to malpositioning of the tibial and femoral components. Six revisions were performed, and four of them were for a loose patellar component. The rate of deep infection was 1 per cent (one knee). Complications occurred in twenty-six knees (22 per cent). With revision as the end point, the rate of survival of the prostheses was estimated to be 96 per cent at ten years. The knee scores, the rate of survival of the implants, and the range of motion of the knees in the current study were similar to those reported previously for patients who had insertion of a total condylar prosthesis with sacrifice of the posterior cruciate ligament and for those who had substitution of the posterior cruciate ligament with a posterior stabilized prosthesis. A prosthesis that has a metal-backed tibial component and that allows preservation of the posterior cruciate ligament provides durable results, but loosening of the patellar component remains a major problem.

Adult↗
PubMedDate not supplied

Toward identifying specification requirements for digital bone-anchored prosthesis design incorporating substructure fabrication: a pilot study.

PURPOSE: This paper is the first in a series that aims to identify the specification requirements for advanced digital technologies that may be used to design and fabricate complex, soft tissue facial prostheses. MATERIALS AND METHODS: Following a review of previously reported techniques, appropriate and currently available technologies were selected and applied in a pilot study. This study uses a range of optical surface scanning, computerized tomography, computer-aided design, and rapid prototyping technologies to capture, design, and fabricate a bone-anchored auricular prosthesis, including the retentive components. The techniques are assessed in terms of their effectiveness, and the results are used to identify future research and specification requirements to direct developments. RESULTS: The case study identifies that while digital technologies may be used to design implant-retained facial prostheses, many limitations need to be addressed to make the techniques clinically viable. It also identifies the need to develop a more robust specification that covers areas such as resolution, accuracy, materials, and design, against which potential technologies may be assessed. CONCLUSION: There is a need to develop a specification against which potential technologies may be assessed for their suitability in soft tissue facial prosthetics. The specification will be developed using further experimental research studies.

Biocompatible Materials↗
PubMed1998

Isolated metal-backed patellar component revision following total knee arthroplasty.

BACKGROUND: Twenty-two consecutive revisions for failed metal-backed patellar components following total knee arthroplasty in 17 patients were retrospectively reviewed. All had similar total condylar knee prosthesis inserted with retention of the posterior cruciate ligament and resurfacing of the patella with a metal-backed component. There were 3 male and 14 female patients. RESULTS: The mean time to failure of the patellar component was 60 months (range 26 to 93 months). The majority of patients presented with metallic crepitus (86.4%) and knee pain (72.7%). At surgery, full thickness polyethylene wear exposing the metal-backing was present in 81.8% with surface damage of the femoral components present in 40.9%. All 22 cases underwent successful isolated patellar component revision with all polyethylene patellar components. CONCLUSION: Resurfacing of the patella in total knee arthroplasty with metal-backed patellar components carries a significant risk of early failure and the use of these components is no longer practised at our institution.

Aged↗
PubMed1987

A classification of precision attachments.

This overview of attachments is intended to provide an explanation of the design characteristics of 13 different groups. The clinical situation for which an attachment is intended will place specific demands that can be met more closely if the forces acting on the prosthesis are considered. No universal or ideal design is available, so if attachments are used, they should be selected from the group with the most suitable characteristics for the task required. The stress-breaking effect of attachments is vague. They offer a potential for rotational and resilient movement between the prosthesis and the abutment teeth, but the amount of stress that must be broken to protect the periodontium of the teeth may exceed the capabilities of any particular attachment used. Nevertheless, attachments can provide an effective answer to prosthesis stability and retention in a way that is cosmetically pleasing.

Denture Design↗
PubMed1990

An evaluation of the surface characteristics of a facial prosthetic elastomer. Part I: Review of the literature on the surface characteristics of dental materials with maxillofacial prosthetic application.

Silicone elastomers are used to construct a wide variety of maxillofacial prostheses and appliances. These applications dictate that an elastomer-tissue interface is present. The behavior of this interface will vary according to the method of retention of the prosthesis, the nature of the tissue surface, and whether the prosthesis is externally applied or occupies an intratissue location. Understanding the behavior of the silicone-tissue interface is consequently important. Part I of this series of three articles is a review of the literature on the surface characteristics of dental materials with maxillofacial prosthetic application. The review considers surface texture, indentation hardness, wettability, and reaction of tissues to surface texture of restorative materials.

Dental Materials↗
PubMed1996

The effect of simulated function on the retention of bar-clip retained removable prostheses.

Patients wearing bar-clip retained removable prostheses may have loss of retention because of changes within the bar-clip assembly. This in vitro study recorded and compared the retention of one- and two-clip retained simulated mandibular complete denture prostheses before and after simulated function. Cast metal Hader bars and clip holders were used to make 10 one-clip and 10 two-clip specimen pairs. Tensile removal values before and after simulated function were recorded and compared by repeated-measures analysis of variance and Student tau tests (significance level 0.05). The results revealed that the use of two clips instead of one significantly increased retention of the simulated prosthesis. It was also found that there was a significant loss of retention after the specimens were placed on the bars and then removed once for both the one- and two-clip groups. Simulated function did not cause a significant change in retention for either group.

Analysis of Variance↗
PubMed1997

Implant placement in prosthodontics practice: a five-year retrospective study.

UNLABELLED: Dental implants have revolutionized dentistry in every aspect of treatment including surgery, restorative dentistry, and orthodontic treatment planning. PURPOSE: This retrospective study analyzes the treatment of completely and partially edentulous patients in a prosthodontics practice and the Edmonton Implant Seminar. MATERIAL AND METHODS: All implant surgery was performed by the prosthodontist. The majority of implants (336) were restored by the prosthodontist (71%). A total of 135 restorations were provided by 12 different general practitioners (29%) in a study group environment. RESULTS: Of 471 implants that were placed, 453 (96.2%) integrated successfully. Treatment groups were divided into single implant restoration (19.3%), fixed partial dentures (51%), overdentures (12.3%), and mandibular fixed partial denture cantilever (17.6%). Retention of final prosthesis was 99.4%. Of 18 failures, four occurred between Stage I and II surgeries, 11 occurred between Stage II surgery and final impressions, and three occurred after placement of final restorations. All three restorative failures were single implants. CONCLUSION: The results indicated that implant placement by a prosthodontist is comparable to the success of previous studies.

Adolescent↗
PubMed1997

Clinical evaluation of implants retaining edentulous maxillary obturator prostheses.

PURPOSE: Fabricating a maxillary obturator can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in the edentulous maxillectomy patient. This article provides clinical retrospective analysis of osseointegrated implants used to retain maxillary obturators. MATERIAL AND METHODS: Patient charts and radiographs were reviewed to determine implant status, bone loss patterns, and implant survival rates. Twenty-six patients were included with 102 implants placed, from which there were 19 intact withdrawals (implants lost because of recurrent disease or patient death), five implants with unknown status, 24 implant failures, and 54 functional implants. RESULTS: The overall survival rate for implants in this patient population was 69.2%. The percent implant survival rate was 63.6% for the irradiated group (67.0% before radiation, 50.0% after radiation) and 82.6% for the nonirradiated group. Implants located in anterior sites demonstrated statistically significant differences in annual bone height changes compared with posterior sites. CONCLUSIONS: The majority of implant failures (18 of 24) occurred either at stage II surgery or before loading. Implants placed during tumor resection, implants placed within the maxillectomy defects, and implants receiving postoperative radiation demonstrated low survival rates.

Adult↗
PubMed2001

Could irrigation, debridement and antibiotic therapy cure an infection of a total hip arthroplasty?

Seven patients suffering from an acute (less than two weeks) infection of a total hip arthroplasty were treated by irrigation and debridement, with appropriate antibiotic therapy and retention of the prosthesis. They were followed for an average of 30 months. Infection did not recur in five (71%) patients, but the other two required further surgery. We conclude that a cure can be obtained by this method, although the results are inferior to re-implantation. A minimal procedure spares a patient the morbidity and cost of a more extensive operation. Higher success rates might have been achieved by selecting patients infected with organisms of low virulence, but there are insufficient data to predict whether this treatment would decrease the success of subsequent re-implantation.

Anti-Bacterial Agents↗