[Oral microbiology: traditional prostheses and implant prostheses].
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Immunohistochemical analysis of vascular prostheses implanted with the left ventricular assist system.
BACKGROUND: Dacron vascular prostheses are associated with thromboembolic complications and inflammatory responses; impregnation with bovine collagen reportedly stimulates additional inflammatory/immunologic complications. The Novacor (Baxter Healthcare Corp., Oakland, CA, USA) left ventricular assist system uses Dacron inflow and collagen-impregnated Dacron outflow prostheses. METHODS: Explanted inflow and outflow prostheses were evaluated for inflammatory/immunologic, hemostatic, anticoagulant, and fibrinolytic pathways. Non-implanted prostheses immersed in whole blood or plasma were used as controls. RESULTS: Immunoglobulins and complement components were observed in all prostheses with activated macrophages being present only in implanted prostheses. Antithrombin III was observed in all prostheses whereas fibrin, tissue plasminogen activator, and alpha-2 plasmin inhibitor were present only in implanted prostheses. Endothelial and smooth muscle cells associated with vascular structures containing collagen type IV and laminin were observed solely in implanted prostheses. CONCLUSION: An inflammatory response occurs and key components of hemostatic, anticoagulant, and fibrinolytic pathways are present within implanted prostheses. These processes are accompanied by endothelial and smooth muscle cell infiltration which appear to lay the foundation for neovessel development.
Antithrombin III↗
Maintenance of osseointegrated implant prostheses.
UNLABELLED: Implant-retained prostheses need to be re-evaluated on a regular basis. This should include review of the effectiveness of oral hygiene procedures to maintain soft tissue health, evaluation of the integrity and function of the prosthetic superstructure and comparison of radiographic bone levels at appropriate intervals. CLINICAL RELEVANCE: All dental care professionals need to be aware of the maintenance care requirements of patients treated with dental implants. With the increase in numbers of patients treated there will be greater demands to provide this care in general practices.
Alveolar Bone Loss↗
The design and fabrication of fiber-reinforced implant prostheses.
The use of fiber composite technology in the creation of metal-free implant prostheses may solve many of the problems associated with a metal alloy substructure such as corrosion, toxicity, complexity of fabrication, high cost, and esthetic limitations. Laboratory and clinical research evaluating glass fiber-reinforced composite prostheses used to restore and replace teeth has shown that these materials exhibit excellent mechanical properties and can form a chemical bond to resin-based veneer materials such as those used in the fabrication of certain types of implant prostheses. Two different designs of fiber-reinforced composite implant prostheses have been developed and placed in human subjects. One design (screw-retained, retrievable prosthesis) is used with implant abutments that allow for screw-retained prostheses; the other design is used with abutments that retain prostheses with a luting material. Both designs are described in this article. The prostheses have functioned well in a small group of preliminary subjects, but clinical trials with larger subject populations are needed to more completely evaluate the potential of fiber-reinforced composites in implant prosthodontics.
Cementation↗
AICRG, Part IV: Patient satisfaction reported for Ankylos implant prostheses.
PROBLEM: Although many maxillary dentures exhibit sufficient retention and stability for patients to adapt well to them, mandibular dentures present a major challenge. The introduction of the endosseous dental implant provided the opportunity for the patient to have esthetic replacements (implant prostheses) that were retentive and stable for all missing natural teeth. METHOD: This paper reports on the satisfaction of over 470 patients with implant prostheses fabricated using a new and innovative implant design (Ankylos, Dentsply-Friadent, Mannheim, Germany). RESULTS: A total of 1500 Ankylos implants were placed, restored, and followed for 3 to 5 years. Patients were asked to respond to a series of questions related to their satisfaction with their new replacements for missing natural teeth. A total of 95.6% of the patients rated chewing ability with Ankylos prosthesis as excellent to good; 92.2% indicated a significant improvement in their ability to chew; 92.6% reported overall clinical function much better than conventional dentures; 99.1% indicated that speech had improved or was not changed; 96.3% indicated hot and cold foods tasted better; 98.8% indicated no pain or discomfort during clinical function; 99.4% liked their new implant prosthesis; 98.0% would seek implant-prostheses treatment again, if necessary; 99.1% would recommend implant prostheses to friends and relatives; and 98.8% indicated the advantages of Ankylos prostheses far exceeded any disadvantages that may exist. CONCLUSIONS: Patients indicated that they (1) were highly satisfied with the final results of the replacements for their natural teeth that were retained or supported by this new implant design, (2) would not hesitate to recommend this form of treatment to their friends and relatives, and (3) would not hesitate to seek the same treatment again if necessary in the future.
Bone Screws↗
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↗
Clinical complications with implants and implant prostheses.
The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.
Alveolar Bone Loss↗
A prospective study on the maintenance of implant prostheses in private practice.
This study examined the adjustments, repairs, time, and costs required to maintain 69 implant prostheses in private prosthodontic practice for an average of 22 months after placement. For the removable prosthesis design, the most common adjustment was contouring the prosthesis and the most common repair was retentive component replacement. Screw tightening or fracture repair were the most frequently needed modifications for fixed implant prostheses. Each removable implant prosthesis averaged four times as many postplacement adjustments and almost twice as many repairs as did each fixed implant prosthesis, and the mean length of each maintenance appointment was also longer for removable prostheses. Mean repair costs were approximately 60% higher for the removable design.
Adult↗
The control of male stress incontinence by implantable prostheses.
Twenty-six patients were treated by implantable prostheses in a 10-year period, 22 by primary Kaufman III and four by primary Rosen. Sixteen of 22 patients having the Kaufman III procedure were cured or markedly improved over a follow-up period of 6 months to 10 years. The Rosen prosthesis, whilst simple to install and making the patient continent, eventually produced urethral fistulae in all cases. The Kaufman III prosthesis appears to be the procedure of choice in uncomplicated male stress incontinence.
Adult↗
Determination of the patency of vascular prostheses implanted in the rat aorta by means of ultrasonic blood-flow measurements.
Patency of vascular prostheses implanted in the rat aorta is usually confirmed by reoperation and inspection of the distal stump of the aorta for pulsations. Repeated reoperation on rats included in long-term investigations is not possible because of the increasing formation of scar tissue and adhesions at the site of the distal aorta. Consequently, noninvasive ultrasonic Doppler measurement was investigated to determine whether this method could provide accurate information about the patency of an implanted prosthesis. A total of 37 rats with 10-cm-long prostheses implanted in the aorta (groups C nonsupported prostheses, n = 12; and D supported prostheses, n = 25), eight normal nonoperated controls (group A), and three rats with a ligated aorta (negative controls, group B) were studied over a period of 12 weeks. The Dopplerrecordings obtained in the normal animals served as controls for the recordings of rats with an implanted prosthesis. A prosthesis was considered patent if the Dopplermeasurements obtained from the femoral artery resembled that of the normal pattern. In seven cases a prosthesis was suspected to be occluded since the Dopplermeasurements resembled those obtained after aortic ligation. Autopsy confirmed the Dopplermeasurements in all cases. No Dopplermeasurements returned to normal in the femoral artery in the aorta-ligated rats even after longer periods post-operation. It is concluded that Dopplermeasurements can accurately provide information about the patency of a vascular prosthesis implanted in the rat aorta.
Animals↗
Terminology for implant prostheses.
The use of systematic terminology for implant prostheses can simplify communication within the scientific community. However, a review of the current literature demonstrates the lack of uniformity in this field. It is the purpose of this manuscript to suggest uniform terminology based on conventional prosthodontic terms that will simplify communication in the profession.
Dental Implants↗
Cost analysis of fabricating implant prostheses.
This prospective study analyzed the time and costs involved in fabricating implant prostheses in private practice and the factors affecting prosthesis design. Esthetic was the most commonly reported factor influencing the decision to use a fixed or removable prosthesis, while cost was infrequently cited. The single-tooth fixed implant required the least time to fabricate and had the lowest clinical fees, while the removable bar/clip prosthesis had the highest fees and demanded the greatest amount of time to fabricate. Single-tooth fixed and individual attachment removable prostheses generated approximately half the hourly income produced by multiple-unit fixed and bar/clip removable implant prostheses, and the individual attachment design had the highest ratio of expenses to income.
Canada↗
Ultrastructural alterations of polytetrafluoroethylene prostheses implanted in abdominal wall provoked by infection: clinical and experimental study.
Infection of an expanded polytetrafluoroethylene (ePTFE) prosthesis after implant is a major drawback of its use in current clinical practice. The aim of the present study was to compare the behavior of such prostheses implanted into New Zealand rabbits with that of prostheses infected after clinical implant. Experimental implants of ePTFE Soft Tissue Patch were performed to repair defects (7 x 5 cm) created in the abdominal wall of 10 rabbits. Prior to implant the prostheses were contaminated with Staphylococcus aureus. Five animals implanted with noncontaminated ePTFE prostheses served as controls. All the animals were sacrificed at 30 days after implant. For the clinical study, specimens were taken from three ePTFE implants that had been found to be infected after intervention. The clinical and experimental implant specimens were processed for light microscopy and scanning electron microscopy. Macroscopic and microscopic examination of experimental and clinical implants revealed alterations to the ePTFE structure, such as areas of fragmentation, fracture lines, and detachment of fine layers of ePTFE that harbored numerous Staphylococcus colonies. Neoformed tissue around contaminated implants was arranged more loosely, and on occasion large spaces between fibers gave rise to an "unknitted" appearance with respect to the control implants. It may be concluded that microporous ePTFE prostheses show similar behavior following experimental or clinical implant in the presence of infection. Irreversible changes to the structure of the prosthesis are produced owing to colonization of the biomaterial by microorganisms, which in most cases necessitates total replacement of the prosthesis.
Abdominal Muscles↗
Improved textured surfaces for implantable prostheses.
Textured surfaces have been shown to reduce scar tissue formation around implanted prostheses compared with identical smooth surface controls in applications such as compliance chambers for artificial heart systems. The authors have developed and evaluated alternative textured surfaces to the polyester velour surface that has been used on those devices. These new textured surfaces are fabricated with materials known to provoke a diminished tissue response compared with polyester fibers. Two new textured surfaces have been examined: a surface composed of extruded 25 micron diameter polyurethane fibrils (PF) woven into a fabric, and an integrally textured silicone rubber surface (TS) with nonfibril geometry applicable to silicone rubber implants such as mammary prostheses. In both cases, tissue fixation to the textured surface depends primarily on mechanical interdigitation with the complicated surface morphology of the implant rather than on chemical bonding. Two types of control were employed: polyester velour fabric (PV) as a textured surface, and smooth silicone rubber (SS). Each surface was first characterized with scanning electron microscopy (SEM), and test specimens consisting of 1 cm diameter by 1 mm thickness disks were then prepared and implanted subcutaneously in a series of 16 adult New Zealand white rabbits. After 8 weeks the samples were explanted and histologic sections prepared for analysis. In all cases a thin, organized tissue capsule surrounded the implant. While the tissue capsule on average was thinner surrounding the textured surface implants, variations in the individual host response were more significant. Tissue attachment was minimal with SS, present with PF, and greatest with TS and PV.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Modifications in the abdominal wall after prostheses implant in guinea pigs. Experimental preliminary study].
The treatment of giant incisional hernias is often not possible without the use of alloplastic materials (prostheses, meshes). Some of the modern prostheses seem to be quite "biocompatible" from the chemical point of view, but, the manner of using them is associated with certain complications (infection, seroma formation, intestinal obstruction, digestive fistula and failure of the repair). This preliminary experimental study on Guinea pigs had as a purpose the evaluation of the prostheses incorporation in the abdominal wall, the appearance of specific complications and the need of the biomaterial fixation. The macroscopic and microscopic study used 59 Guinea pigs, utilizing polypropylene (Marlex) and polyester (Mersilene and Plastex) prostheses, implanted pre-peritoneal and intraperitoneal, with or without fixation. The lack of incorporation of the prostheses was observed especially with the Plastex mesh (7 cases). Intestinal adhesions have been the rule after intraperitoneal implant of the prostheses; we registered a case of intestinal obstruction and a case of digestive fistula. Concluding, it is recommended the utilization of quality prostheses, especially polypropylene (Marlex) and no longer use of the Romanian polyester mesh (Plastex) which has obvious "biocompatible" problems. The intraperitoneal implant of the prostheses is not indicated. Adequate anchoring af the biomaterials prevents the subsequent migration.
Abdominal Muscles↗
Evaluation of master cast techniques for multiple abutment implant prostheses.
This study compared the accuracy of three techniques used to fabricate master casts for implant prostheses. A metal model with six implants and standard abutments and a matching template were fabricated. Impressions of the model were made in Impregum and cast in Die Keen. The casts were divided into three groups of 15 casts: group A--solid casts; group B--Pindex; and group C--Zeiser system. Each cast was visually evaluated for fit of the template. Positional accuracy of the abutments was numerically assessed using an optical comparator. Visual analysis showed that only casts sectioned with the Zeiser system allowed a passive fit of the template. Statistical analysis of numerical findings indicated that casts made with the Zeiser system were significantly more accurate than solid casts, which in turn were more accurate than those made with the Pindex system.
Dental Abutments↗
The use of removable artificial gingiva in laboratory procedures for periodontal and implant prostheses.
This paper describes a laboratory procedure for use in periodontal and implant prostheses wherein an artificial removable gingiva, which reproduces the patient's gingival architecture, is fabricated on the working cast. This procedure allows the technician to achieve better crown contour and cervical adaptation of the prosthesis and facilitates ceramic procedures.
Dental Implants↗
Speech with maxillary implant prostheses: ratings of articulation.
Speech is often perturbed after placement of maxillary implant-retained prostheses. We tested the hypothesis that the rate of speech errors varies with prosthetic design. Thirty edentulous subjects with mandibular implant prostheses entered two within-subject crossover trials. Subjects wore maxillary fixed prostheses and removable long-bar overdentures (Trial 1), or overdentures with and without palates (Trial 2). Test words from a French language speech battery were recorded after each prosthesis had been worn for two months. The percentages of stops, fricatives, and vowels correctly perceived by lay judges were calculated. Subjects produced a significantly higher percentage of sounds correctly with overdentures than with fixed prostheses. Between-treatment differences were significant for stops and fricatives (p < 0.01), but not for vowels. There were no significant differences in error rates between the two overdentures. In conclusion, maxillary implant overdentures with and without palates enable patients to produce more intelligible speech than fixed prostheses.
Adult↗