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At least 19 recordsLinked to original sources
PubMed2000

Extramedullary fixation implants for extracapsular hip fractures.

BACKGROUND: Extramedullary fixation of hip fractures refers to the application of a plate and screws to the lateral side of the proximal femur. OBJECTIVES: To compare different types of extramedullary fixation implants for the surgical treatment of extracapsular hip fracture in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register and reference lists of relevant articles. Date of the most recent search: March 1998. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing extramedullary implants used in the fixation of extracapsular hip fracture in adults. DATA COLLECTION AND ANALYSIS: All three reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results of outcome measures were pooled by comparison. MAIN RESULTS: The methodological quality of all six included trials was poor and in no trial was there clear concealment of allocation. Three trials involving 355 patients compared a fixed nail plate (Jewett or McLaughlin) with the sliding hip screw (SHS). The limited data presented indicated an increased risk of fixation failure outcomes for fixed nail plates. One trial involving 233 patients compared the RAB plate (a fixed angle blade plate with an oblique connecting strut) with the SHS. In this trial both implants had a high incidence of fixation failure. There was a tendency to a lower incidence of cut-out, re-operation, fixation failure, leg shortening, varus deformity and mortality for the RAB plate. None of the differences in these outcomes were statistically significant. One trial involving 100 patients compared the Pugh nail and the SHS. There was no significant difference between implants for the outcome measures reported. One trial involving 176 patients with 182 fractures, compared the Medoff plate with the SHS. A significantly higher mean operative blood loss and longer mean operative time were reported for the Medoff plate. There was however a tendency to a lower risk of fixation failure for unstable trochanteric fractures fixed with the Medoff plate. REVIEWER'S CONCLUSIONS: The fixed nail plate was demonstrated to have to an increased risk of implant breakage and fixation failure in comparison to the SHS. Although the lack of evidence from randomised trials for other outcomes means that a firm conclusion of overall superiority of the SHS cannot be made, the increased fixation failure rate is a major consideration and indicates that the SHS is preferable. Insufficient information is available to draw firm conclusions of the clinical significance of differences between the SHS and either the RAB plate, the Pugh nail or the Medoff plate.

Bone Plates↗
PubMed2001

Do baseline characteristics accurately discriminate between patients likely versus unlikely to benefit from implantable defibrillator therapy? Evaluation of the Canadian implantable defibrillator study implantable cardioverter defibrillatory efficacy score in the antiarrhythmics versus implantable defibrillators trial.

OBJECTIVE: Our purpose was to evaluate whether baseline characteristics predictive of implantable cardioverter defibrillator (ICD) efficacy in the Canadian Implantable Defibrillator Study (CIDS) are predictive in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial. BACKGROUND: ICD therapy is superior to antiarrhythmic drug use in patients with life-threatening arrhythmias. However, identification of subgroups most likely to benefit from ICD therapy may be useful. Data from CIDS suggest that 3 characteristics (age > or =70 years, ejection fraction [EF] < or =0.35, and New York Heart Association class >II) can be combined to reliably categorize patients as likely (> or =2 characteristics) versus unlikely to benefit (<2 characteristics) from ICD therapy. METHODS: The utility of the CIDS categorization of ICD efficacy was assessed by Kaplan-Meier analysis and Cox hazards modeling. The accuracy of the CIDS score was formally tested by evaluating for interaction between categorization of benefit and treatment in a Cox model. RESULTS: ICD therapy was associated with a significantly lower risk of death in the 320 patients categorized as likely to benefit (relative risk [RR] 0.57, 95% confidence interval [CI] 0.37-0.88, P =.01) and a trend toward a lower risk of death in the 689 patients categorized as unlikely to benefit (RR 0.70, 95% CI 0.48-1.03, P =.07). Categorization of benefit was imperfect, as evidenced by a lack of statistical interaction (P =.5). Although 32 of the 42 deaths prevented by ICD therapy in AVID were in patients categorized as likely to benefit, all 42 of these patients had EF values < or =0.35. Neither advanced age nor poorer functional class predicted ICD efficacy in AVID. CONCLUSION: Of the 3 characteristics identified to predict ICD efficacy in CIDS, only depressed EF predicted ICD efficacy in AVID. Thus physicians faced with limited resources might elect to consider ICD therapy over antiarrhythmic drug use in patients with severely depressed EF values.

Aged↗
PubMed2003

Dental implants in reconstructed jaws: implant longevity and peri-implant tissue outcomes.

PURPOSE: The study aimed to evaluate the clinical status and survival of dental implants inserted in reconstructed jaws, with particular reference to the peri-implant tissues. MATERIALS AND METHODS: We conducted a clinical follow-up study based on 29 rehabilitated patients after oral tumor surgery, who received autogenous bone grafts from the ilium and endosseous implants (14 maxillary and 15 mandibular cases; 140 implants) for functional jaw reconstruction between 1988 and 1999. Clinical records of the patients were reviewed retrospectively. Clinical parameters of plaque index, probing pocket depth, and bleeding on probing were assessed around the implants and control teeth at 4 locations (mesiobuccal, distobuccal, mesiolingual, and distolingual). Implant mobility was assessed clinically and objectively using a Periotest (Gulden; Siemens, Bensheim, Germany) equipment for those implants supporting removable prostheses. Radiographically, the proportion of implant length remained osseointegrated was measured. RESULTS: With a mean follow-up time of 50 months, 90.7% of the 140 implants placed were functional in supporting dental prostheses; 4.3% of implants failed in osseointegration and the remaining 5.0% implants were osseointegrated but nonfunctional. A total of 493 sites of 127 functional implants and 392 sites of 98 control teeth were assessed. No significant difference was found between the implants and control teeth parameters, except on the probing pocket depth. The mean peri-implant probing depth was 3.5 mm, and 52.7% of the measured sites were 3 mm or less. More than one third of the implants (35.9%) presented with increased probing depth (> or =4 mm), and this was significantly higher than in the control teeth (P <.001, chi(2) test). Bleeding on probing was found in 19.3% of the measured peri-implant sites, corresponding to 42.2% of the dental implants. Of the implants, 28.9% were completely free from plaque and 9.4% show visible plaque accumulation. Mobility assessment was feasible on 32 implants and no mobility was detected. Radiographically, the mean implant length remained in bone was 81.1%, with 82.6% in the maxilla and 79.4% in the mandible. Implant survival rate calculated using the Kaplan-Meier method was 86.9% for 5 years. Based on the defined criteria, the success rate of implants placed in reconstructed jaws in this study was 90.7%. CONCLUSION: Endosseous implants can be successfully placed in reconstructed jaws for oral rehabilitation with maintenance of reasonable health status of the peri-implant tissues in the long-term.

Adolescent↗
PubMedDate not supplied

Immediate versus delayed loading of dental implants in the maxillae of minipigs: follow-up of implant stability and implant failures.

PURPOSE: To assess the course of the stability and the failure rate of dental implants placed in the partially edentulous maxillae of minipigs. MATERIALS AND METHODS: Three months after tooth removal, implants were placed in 9 minipigs. Six implants (XiVE; Friadent, Mannheim, Germany) were placed on each side of the posterior maxilla after preparation of the implant sites either by an osteotome technique or with spiral drills. Implant stability was assessed by resonance frequency analysis (RFA) at the time of placement, at second-stage surgery (which took place after a healing periods of 1, 2, 3, 4, or 5 months), and after a loading period of 6 months. RESULTS: Implant stability was significantly influenced by the healing period (P = .007). Implant stability decreased after 1 to 3 months of healing for both of the placement techniques and increased after a healing period of 4 months. After implant site preparation by an osteotome technique, 6 of 12 immediately loaded implants, 18 of 24 implants loaded after healing periods of 1 to 3 months, and 1 of 18 implants loaded after a healing period of 4 or 5 months were lost. After implant site preparation using spiral drills, 7 of 12 immediately loaded implants, 12 of 24 implants loaded after healing periods of 1 to 3 months, and 2 of 18 implants loaded after healing periods of 4 or 5 months were lost. Broad overlapping of confidence intervals for the number of implant failures revealed that there was no relevant difference between immediate and early functional loading for either of the 2 techniques. DISCUSSION AND CONCLUSION: Implant loading after healing periods of 1 to 3 months did not improve implant survival compared to immediate loading in the posterior maxillae of minipigs. Not until a healing period of 4 months was reached did implant stability begin to increase. Only when functional loading was started at this point in time was maximal implant survival achieved.

Analysis of Variance↗
PubMedDate not supplied

Clinical evaluation of dental implants with surfaces roughened by anodic oxidation, dual acid-etched implants, and machined implants.

PURPOSE: The purpose of this study was the clinical and radiographic comparison of dental implants with surfaces roughened by anodic oxidation (TiUnite), dual acid-etched implants (Osseotite), and machined implants. MATERIALS AND METHODS: Seventy-four patients (mean age, 52.8 +/- 14.2 years; range, 23 to 80 years; 41 men and 33 women) received 198 dental implants-58 TiUnite implants (25 patients), 52 Osseotite implants (27 patients), and 88 machined implants (22 patients). Clinical measurements and radiographs were evaluated at the time of surgery, at the restorative phase, and 2 years postloading. To account for statistical correlation among multiple implants in the same subject, a "per patient" mode of analysis was conducted. A 1-way analysis of variance of bone loss was conducted by type of implant as well by area of the mouth. In addition, differences in mean bone loss were tested for bone density category, gender, and smoking status using Student t tests. RESULTS: Eighteen TiUnite implants (31.0%) were placed in the maxilla and 40 (69.0%) in the mandible. The Osseotite group included 29 maxillary implants (55.8%) and 23 mandibular implants (44.2%). The machined group included 49 maxillary implants (55.7%) and 39 mandibular implants (44.3%). All 198 implants were considered radiographically and clinically successful. No mobility, signs of infection, or inflammation were detected. DISCUSSION: Implant size, location, bone quality, gender, age, and smoking did not influence the comparative clinical outcomes of the 3 groups (P > .05). A trend toward greater coronal bone loss in the TiUnite group was detected. CONCLUSION: Within the limitations of the present study, TiUnite, Osseotite, and machined dental implants had similar short-term clinical outcomes. No statistically significant differences in bone loss could be detected among implant groups or among the different regions of the oral cavity. The present data underlined the significance of surgical and prosthetic treatment planning.

Adult↗
PubMedDate not supplied

Early experience with Wide-Platform Mk II implants. Part I: Implant survival. Part II: Evaluation of risk factors involving implant survival.

Part I of this study describes the survival of a wide-platform, wide-diameter implant (Wide-Platform Mk II). Beginning in January 1997, 85 Wide-Platform Mk II implants were placed in the jaws of 63 patients (35 males and 28 females). Male patients experienced 10 implant failures, and female patients lost 9 implants. The mean time of implant follow-up was 286 days (median, 280), with a maximum of 734 days and a minimum of 0 days. Implant loss was 19% in the mandible and 29% in the maxilla. Kaplan-Meier analysis showed a probability of implant failure after 1 year of 0.649 (confidence interval, 0.455 to 0.926) in the maxilla and of 0.751 (confidence interval, 0.616 to 0.915) in the mandible. No apparent relationship was noted between implant survival and implant length. Part II of this study evaluated the association between the survival of a new implant design and a number of potential risk factors. A retrospective chart review was conducted for all patients who received Wide-Platform Mk II implants and who agreed to allow a medical records review for research purposes. Kaplan-Meier survival curves were used to assess the probability of implant survival relative to time. The relationships between implant survival and implant location, history of tobacco use, current tobacco use, sinus grafting, bruxism, and root canal therapy were assessed by Cox proportional hazards modeling. Although the hazard ratio showed an increased risk of implant failure with some factors, particularly a history of root canal therapy in the site of implant placement (hazard ratio 3.2, P = .10), none of the factors were statistically significant. The Wide-Platform Mk II implant used in this population group was associated with a high failure rate, but the failure rate was not related to any specific risk factors reviewed.

Adult↗
PubMed1998

Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction.

Finite element analysis (FEA) has been proven to be a precise and applicable method for evaluating dental implant systems. By means of FEA, a parasaggital model was digitized from a computed tomography (CT)-generated patient data set, and various single-tooth, osseointegrated, two-dimensional dental implant models were simulated. The specific aims of the study were to: (1) examine the effect of implant diameter variation (3.8 mm-6.5 mm) of both a press-fit, stepped cylindrical implant type and a press-fit, straight cylindrical implant type as osseointegrated in the posterior mandible; (2) compare the stress-dissipating characteristics of the stepped implant versus the straight implant design; and (3) analyze the significance of bite force direction (vertical, horizontal, and oblique 45 degrees) on both implant types. The results of the FEA suggested that (1) using the widest diameter implant is not necessarily the best choice when considering stress distribution to surrounding bone, but within certain morphological limits, for both implant types, an optimum dental implant exists for decreasing the stress magnitudes at the bone-implant interface; (2) stress is more evenly dissipated throughout the stepped cylindrical implant when compared to the straight implant type; and (3) it is important in FEA of dental implants to consider not only axial forces (vertical loading) and horizontal forces (moment-causing loads), but also to consider a combined load (oblique bite force), since these are more realistic bite directions and for a given force will cause the highest localized stress in cortical bone. The theoretical analysis performed implies that clinically, whenever possible, an optimum, not necessarily larger, dental implant should be used based on the specific morphological limitations of the mandible and that a stepped cylindrical design for press-fit situations is most desirable from the standpoint of stress distribution to surrounding bone.

Alveolar Process↗
PubMedDate not supplied

New orthopaedic implant management tool for computer-assisted planning, navigation, and simulation: from implant CAD files to a standardized XML-based implant database.

Computer-Assisted Orthopaedic Surgery (CAOS) has made much progress over the last 10 years. Navigation systems have been recognized as important tools that help surgeons, and various such systems have been developed. A disadvantage of these systems is that they use non-standard formalisms and techniques. As a result, there are no standard concepts for implant and tool management or data formats to store information for use in 3D planning and navigation. We addressed these limitations and developed a practical and generic solution that offers benefits for surgeons, implant manufacturers, and CAS application developers. We developed a virtual implant database containing geometrical as well as calibration information for orthopedic implants and instruments, with a focus on trauma. This database has been successfully tested for various applications in the client/server mode. The implant information is not static, however, because manufacturers periodically revise their implants, resulting in the deletion of some implants and the introduction of new ones. Tracking these continuous changes and keeping CAS systems up to date is a tedious task if done manually. This leads to additional costs for system development, and some errors are inevitably generated due to the huge amount of information that has to be processed. To ease management with respect to implant life cycle, we developed a tool to assist end-users (surgeons, hospitals, CAS system providers, and implant manufacturers) in managing their implants. Our system can be used for pre-operative planning and intra-operative navigation, and also for any surgical simulation involving orthopedic implants. Currently, this tool allows addition of new implants, modification of existing ones, deletion of obsolete implants, export of a given implant, and also creation of backups. Our implant management system has been successfully tested in the laboratory with very promising results. It makes it possible to fill the current gap that exists between the CAS system and implant manufacturers, hospitals, and surgeons.

Computer-Aided Design↗
PubMed2005

A comparison of implant extrusion rates and postoperative pain after evisceration with immediate or delayed implants and after enucleation with implants.

PURPOSE: To examine implant extrusion rates after evisceration with immediate or delayed implants in patients with culture-proven endophthalmitis. To compare postevisceration and postenucleation pain. METHODS: This prospective, nonrandomized interventional case series included four groups of patients: group 1, 25 endophthalmitis patients undergoing evisceration with immediate implants; group 2, 15 endophthalmitis patients undergoing evisceration with delayed implants; group 3, 31 patients without endophthalmitis undergoing evisceration with immediate implants; and group 4, eight patients undergoing enucleations with implants. Standardized techniques and follow-up schedules were used. Postoperative pain was assessed by weighted frequency of pain medications used during two 48-hour periods. Statistical analysis was performed. Retrospective review of two series of patients undergoing evisceration was performed. RESULTS: No cases of implant extrusion occurred during an average follow-up of 37.9 months. Average implant size was 19.0 mm. Conjunctival dehiscence occurred in one patient. Average total pain scores were 20.8 in endophthalmitis patients with immediate implants; 22.1 in endophthalmitis patients with delayed implants; 20.3 in patients without endophthalmitis and with immediate implants; and 23.1 in patients with enucleations and immediate implant insertions. Retrospective review suggested possible causes of implant extrusion. CONCLUSION: Both immediate and delayed implant techniques appear safe in patients with endophthalmitis, with the former being simpler, more cost-effective, and perhaps less painful. Prolonged antibiotic therapy and smaller implants may render a false sense of security against implant extrusion; good surgical technique and meticulous postoperative wound care are essential. Postenucleation pain appears more severe than postevisceration pain.

Adolescent↗
PubMed2000

[Histological and histomorphometric results of implantation of dental implants by early and late implantation].

In this study, a histologic and histomorphometric analysis of delayed and immediate-placed implants was performed. An implantation of 16 self-cutting conical titanium screw implants was carried out in 8 beagle dogs. Of these implants, 8 were placed immediately after extraction of the second premolar and 8 implants were placed after 6 months of healing after extraction. For dynamic histomorphometry, fluorochrome bone markers were injected at two different times prior to euthanasia. The specimens were examined macroscopically and microscopically 8 months after implantation. A histologic, dynamic, and static histomorphometry was performed with the aid of different computer programs. A mean surface of osseointegration of 75.7% and a mean soft tissue implant contact surface of 24.2% was seen in immediate-placed implants. For delayed implantation, an osseointegrated surface of 80.7% and a soft tissue covering of 19.3% was examined. The fibrogenic structures in the cervical implant part were more dense and there were more adhesive epithelial elements (hemidesmosomes) around delayed implants. The result of the dynamic and static histomorphometry showed no significant differences in the two groups (P < 0.1). In conclusion, it can be stated that a new steady-state of the soft and hard tissue around dental implants was seen 8 months after implant insertion in both groups. There was a pseudoankylotic healing in the osseous part. The lower level of osseointegration in immediate-placed implants was caused by early resorption of bone in the crestal part. Thus, a larger part of the implant was surrounded by soft tissue and a long epithelial attachment resulted.

Alveolar Process↗
PubMed2003

Effects of deslorelin acetate implants in horses: single implants in stallions and steroid-treated geldings and multiple implants in mares.

Three experiments were performed to test the following hypotheses: 1) stallions and/or progesterone-estradiol-treated geldings could serve as models for the effects of a single implant of the GnRH analog, deslorelin acetate, on LH and FSH secretion by mares; and 2) multiple implants of deslorelin acetate could be used as a means of inducing ovarian atrophy in mares for future study of the mechanisms involved in the atrophy observed in some mares after a single implant. In Exp. 1, nine light horse stallions received either a single deslorelin implant (n = 5) or a sham injection (n = 4) on d 0. In Exp. 2, 12 geldings received daily injections of progesterone on d -20 through -4, followed by twice-daily injections of estradiol on d -2 to 0. On the morning of d 0, geldings received either a single deslorelin implant (n = 6) or a sham injection (n = 6). Daily injections of progesterone were resumed on d 2 through 15. In Exp. 1, plasma LH and FSH were elevated (P < 0.05) in the treatment group relative to controls at 4, 8, and 12 h after implant insertion. In the treated stallions, FSH was decreased (P < 0.05) on d 3 to 13, and LH was decreased on d 6 to 13. In Exp. 2, plasma LH and FSH were elevated (P < 0.05) at 4,8, and 12 h after deslorelin implant insertion. Plasma LH was suppressed (P < 0.05) below controls on d 2 to 7, 9, and 11 to 15; plasma FSH was suppressed (P < 0.05) on d 4 to 15. In Exp. 3, 21 mares were used to determine whether multiple doses of deslorelin would cause ovarian atrophy. Mares received one of three treatments: 1) sham injections; 2) three implants on the first day; or 3) one implant per day for 3 d (n = 7 per group). Treatment with multiple implants increased (P < 0.05) the interovulatory interval by 14.8 d and suppressed (P < 0.01) LH and FSH concentrations for approximately 25 d; no mare exhibited ovarian atrophy. In conclusion, after an initial short-term increase in LH and FSH secretion, deslorelin implants caused long-term suppression of both gonadotropins in stallions as well as in geldings treated with progesterone and estradiol to mimic the estrous cycle. It is likely that either of these models may be useful for further study of this suppression in horses. Although multiple implants in mares suppressed gonadotropin secretion longer than a single implant, the lack of ovarian atrophy indicates that the atrophy observed after a single implant in previous experiments was likely due to the susceptibility of individual mares.

Animals↗
PubMed2004

[Study of two types of dental implants for immediate loading (expansion implants and locking pin implants) in the Beagle dog].

Titanium implants have become a treatment of choice for total or partially edentulous patients. The method, however, requires a double surgical time and the placement of the dental prosthesis after a healing phase of 3 to 6 months during which the patients have a toothless mandible with the top of the implants emerging at the gengiva. Immediate loading of standard implants is responsible for micromotions which induce implant failure. New designs of implants would allow an immediate anchoring in the bone, would prevent the shearing forces and would precociously authorize the setting of the prosthesis. We made an experimental study in the Beagle dog. After partial tooth removal, two types of implants were placed (expansion implants and locking pin implants). After 2 weeks, the implants were covered with a gold-palladium prosthesis and left in place during 12 weeks. After sacrifice, a study by resonance frequency (ISQ) and histomorphometry was done. The two types of implants were covered by the same quantity with bone (volume and interface) without interposition of fibrous tissue. The locking pin implants were associated with an increase in the ISQ parameter of stability, higher than that of the expansion implants. The locking pin implant, tested in the dog which has a chewing function close to man, appears interesting for the immediate loading with dental prosthesis.

Animals↗
PubMed2005

Oxidized titanium implants (Nobel Biocare TiUnite) compared with turned titanium implants (Nobel Biocare mark III) with respect to implant failure in a group of consecutive patients treated with early functional loading and two-stage protocol.

OBJECTIVES: The purpose of this study was to compare two implant types of similar shape but with different surfaces with respect to implant failure. MATERIAL AND METHODS: A total of 136 patients were treated with Nobel Biocare Implants between January 2001 and December 2002. Totally 394 implants were placed, of which 199 were oxidized titanium implants (Nobel Biocare TiUnite and 195 with turned titanium surface (Nobel Biocare Mark III. Sixty-three patients underwent a one-stage surgical protocol, of which 24 were objected to early functional loading. The remaining 73 patients were treated with a traditional two-stage surgical protocol. All patients were followed for a minimum of 5 months after loading of the implants. Implants were classified as survivals when clinically stable and fulfilling purported function without any discomfort to the patient, with no signs of infection or ongoing pathologic process. RESULTS: Seven implants were lost in five patients (two males and three females), six in the maxilla and one in the mandible. All failed implants were Mark III implants, inserted following the traditional two-stage protocol. The implant success rate was 98.2% for the whole-patient group, divided as a 100% success rate following the implants with oxidized surface (Nobel Biocare TiUnite compared with a success rate of 96.4% with implants with turned surface (Nobel Biocare Mark III).

Adult↗
PubMed1985

Iowa cochlear implant clinical project: results with two single-channel cochlear implants and one multi-channel cochlear implant.

Cochlear implants have become a realistic alternative for the management of profoundly deaf patients. A variety of implants with differing electrode designs and coding strategies have been developed by nine major implant centers around the world. Each center has their "star" patient, but objective comparisons between these different implant designs are unavailable. In order to determine the performance characteristics of the present generation of cochlear implants, comparison data are vital. We have developed an independent center where uniform objective comparisons of different cochlear implants can be performed longitudinally. This report will present results of nine patients implanted with three different cochlear implant prostheses. Four patients have been implanted with the Los Angeles (House) single-channel implant, three patients have received the Vienna (Hochmair) single-channel intracochlear device, and two patients have been implanted with the Melbourne (Clark) 21-channel unit. All patients have had 11 months or more of experience with their cochlear prostheses. The results of a comprehensive audiologic battery which includes audiovisual and environmental tasks are presented. All implants provide significant improvement in speechreading and sound awareness. The findings to date suggest that there is strong correlation between top-down cognitive processing (as reflected by lip reading skills) and performance with cochlear implants.

Adult↗
PubMed2000

Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures.

BACKGROUND: Cephalocondylic intramedullary nails which are inserted proximally to distally (cephalocondylic) have been used for the surgical treatment of extracapsular hip fractures. OBJECTIVES: To update and expand our review comparing the Gamma nail with the sliding hip screw (SHS) by comparing all cephalocondylic intramedullary nails with extramedullary implants for the surgical treatment of extracapsular hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, select orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists, colleagues and implant manufacturers. Date of the most recent search: June 1998. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results were pooled. MAIN RESULTS: The one trial of 230 patients comparing the Kuntscher-Y nail with the SHS, reported no major difference the outcome aside from a significantly increased number of patients with leg shortening, and a tendency for poorer recovery of mobility in the Kuntscher-Y nail group. Fourteen trials comparing the Gamma nail with the SHS were included, with data available for 1977 patients. The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased re-operation rate. There were no major differences in the incidence of wound infection, mortality or medical complications between implants. Data were inadequate to determine if there were differences for other outcomes. Two trials involving 231 patients compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group: all cases of operative and later fracture of the femur and haematoma occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. REVIEWER'S CONCLUSIONS: Further evidence is required before any conclusions can be drawn on the relative merits of the Kuntscher-Y nail and the SHS. Given the lower complication rate of the SHS in comparison with the Gamma nail, it appears that for trochanteric fractures the SHS is superior. Further evidence is still required to confirm this, as well as to determine if the Gamma nail, or modifications of the Gamma nail, have advantages for selected fracture types (for example, subtrochanteric fractures). From the limited evidence available, IMHS appears to have the same problems as the Gamma nail, but other theoretical advantages of the IHMS can not be ruled out.

Bone Nails↗
PubMed2006

A clinical report on the 18-month cumulative survival rates of implants and implant prostheses with an internal connection implant system.

Titanium implants have been successful in both dentulous and edentulous patients. The original Brånemark titanium implants were introduced with external hex connections between implants and abutments. Successes and failures/complications with both the biology and mechanics of this connection system have been reported. In an attempt to improve the predictability and success of implant/abutment connections, internal connections between implants and abutments were developed significantly differently from external implant/abutment connections in terms of size, surface area, and geometry. Forty-five consecutive partially edentulous patients were treated with 83 implants (Osseotite Certaina). The implants were allowed to heal for at least 8 weeks without occlusal loading. All were restored with single, nonsplinted restorations. The implants were loaded with fully functional occlusions for at least 1 year. Recall appointments were scheduled at 1, 6, 12, 18, 24, and 36 months after implant placement. Eighty-two of the 83 implants were clinically stable and considered to be osseointegrated 18 months after occlusal loading for a cumulative survival rate (CSR) (implants) of 100%. All of the abutment screws and restorations were non-mobile 18 months after occlusal loading for a CSR (prostheses) of 100%. This internal implant/abutment connection was clinically successful and should benefit restorative dentists involved in implant dentistry by decreasing the number of maintenance visits and problems associated with dental implant treatment.

Adolescent↗
PubMed2006

[Long-term experience of immediate implant loading using DenTi implants. Part 1. Material, methods and experience in immediate loading of DenTi implants].

Immediate loading of dental implants have been widely used to retain and support crossarch partial dentures. Normally 3-6 months after implantation complete osseointegration is established, this period may be shortened with immediate loading of implants. The purpose of this study was to evaluate the factors that may influence the long-term success of immediate implant loading. The immediate loading technique with DenTi implants was introduced 12 years ago, and during this period the clinical results have been followed up on 257 DenTi implants in 83 patients. 62 patients and with 263 implants placed with submerged technique were recruited into the control group. The retrospective long-term follow-up examination has revealed that the success rate of DenTi implants with traditional two stage surgery was 97.4%. The success rate of DenTi implants with immediate loading was 95.71%. According to the date of the success rata and prognosis of immediate loaded implants are comparable to the traditional two stage submerged implants.

Adult↗