What Factors May Influence a Clinician's Choice for an Implant System for Their Patients?

BACKGROUND: Clinicians have to decide which implant system to use for their patients. Factors influencing a clinician's choice of a specific implant are not well-established. PURPOSE: The purpose of this study was to identify factors that may influence clinician's choice of implant. STUDY DESIGN, SETTING, SAMPLE: This cross-sectional study used a survey instrument and was sent to dentists. Inclusion criteria included if the doctor's name was the addressee and if their website indicated they utilize implants. Exclusion criteria included if the email address was directed to individuals other than the clinician or if the respondent does not place implants as indicated by their website. PREDICTOR VARIABLE: The predictor variable was the provider type (oral and maxillofacial surgeon, general dentist, prosthodontist, or periodontist). MAIN OUTCOME VARIABLE: The outcome variables were factors that may influence clinician's choice of implants, measured by their ranked responses. COVARIATES: Age and sex were the covariates. ANALYSES: The survey data were evaluated as group in total and separated for each provider type. Factors affecting clinical choice were ranked. A mean score was determined. Responses were evaluated using analysis of variance with significance at P value < .05 to determine if there differences among the groups. RESULTS: After applying inclusion/exclusion criteria, the final study sample consisted of 353 clinicians, of whom 230 (65.1%) responded to the survey. Factors scored as extremely or somewhat important were ranked from high to low as follows: clinical trial evidence (92%), ease of use (88%), familiarity with system (73%), restorative dentist's preference (72%), cost (63%), sales representative (59%), key opinion leader (66%), a laboratory's preference (45%), implant company providing continuing education (66%), and implant company can grow practice (65%). There were differences among providers for the factors that influence choice of implant for cost (P value = .02), sales representative (P value = .015), the key opinion leader (P value = .01), laboratory preference (P value = .002), providing continuing education (P value = .02), and implant company can grow my practice (P value = .035). CONCLUSION AND RELEVANCE: Four factors that highly influenced provider's choice of a specific implant were evidence for success, ease of use, cost, and familiarity with the implant.

[History of the implantable cardioverter-defibrillator in Germany]. / Die Geschichte des implantierbaren Kardioverter-Defibrillators in Deutschland.

The implantable cardioverter-defibrillator (ICD) was a breakthrough in the prevention of sudden cardiac death. After years of technical development in the USA, Michel Mirowski succeeded in proving reliable automatic defibrillation of ventricular tachyarrhythmias through initial human implantations in 1980, despite many obstacles. Nearly 4 years later, the first patients received ICDs at multiple centers in Germany. Subsequently, outside the USA, Germany became the country with highest implantation rates. The absolute number of implantations remained small as long as implantations required epicardial defibrillation electrodes and therefore thoracotomy by cardiac surgeons. Pacemaker-like implantation using a transvenous defibrillation electrode with a pectoral ICD became feasible in the early 1990s pushing implantation rates to the next level. Technical advancements were accompanied by clinical research in Germany, and often, the first-in-human studies were conducted in Germany. In 1991, the first guidelines for indications were established in the USA and Germany. Several randomized studies on indications were published between 1996 and 2009, mostly led by American teams with German participation, but also under German leadership (CASH, CAT, DINAMIT, IRIS). The DANISH study in 2016 questioned the results of these long-standing studies. Instead of providing ICDs to patients using a broad indication, future efforts aim to identify patients who, despite optimal medical therapy, cardiac resynchronization therapy (CRT), and/or catheter ablation, need protection against sudden cardiac death. Risk scores incorporating myocardial scars in magnetic resonance imaging (MRI) and genetic information are expected to contribute to more individualized and effective indications.

Transitioning From Teeth to Implants: A Narrative Review.

PURPOSE: Patients may need removal of their teeth with placement of implants for rehabilitation. The clinical problem is the status of the remaining teeth and how this affects the timing for implant placement and the method for provisionalization. The importance of this review is to document the different strategies including sequential tooth removal and grafting and the use of teeth to provide a fixed provisional rather than a removable provisional, to provide surgeons with a reference to maintain patient function during their rehabilitation. METHODS: Pubmed.gov was the information source. Years reviewed included 1990 to 2022. Inclusion criteria included only articles in peer-reviewed journals. Variables evaluated included the success for placing implants immediately into extraction sites, and the methods to transition between steps in their rehabilitation. Data collected were results of systematic reviews and independent clinical series, as well as case reports of prosthetic methods for transitioning. RESULTS: The search used terms which included implants in extraction sites (n = 205) and transitioning teeth to implants (n = 153). Twenty-one articles were reviewed involving extraction sites and 19 articles reviewed concerning transitioning from teeth to implants. The placement of implants immediately into excretion sites did have a relative risk for failure compared to implant placement in healed sites. The use of non-restorable teeth to support a fixed provisional prosthesis was successful; however, variability in reporting prevented a statistical analysis. CONCLUSION: The surgeon needs to utilize teeth to provide support during treatment phases in order to provide the patient with a fixed provisional prosthesis to allow for implant integration and to provide time for graft healing. Specific methods used for transitioning do not have a significant evidence base to recommend one method but routine prosthetic techniques have been used and are reported in case reports.

The Impacted Maxillary Canine in the Adult: A Narrative Review and Implant Treatment Options.

PURPOSE: The purpose of this article is to provide clinicians with options to restore the adult patient with an impacted maxillary canine using dental implants. Literature was reviewed to provide evidence for the methods suggested. METHODS: The search strategy utilized pubmed.gov to identify articles pertinent to identified treatment options. The search used terms which included dental implants and impacted tooth, tilted implants and fixed partial prostheses, 6 mm dental implants, and 4 mm dental implants. Articles were included if they reported dental implant procedures associated with impacted canines in adults, or if they reported on the use of tilted implants, immediate implant placement at time of canine removal, or the use of short implants. Articles with less than 12 months follow up were excluded. RESULTS: The search identified articles which included dental implants and impacted tooth (n = 142), tilted implants and fixed partial (n = 36), 6 mm dental implants (n = 182), and 4 mm dental implants (n = 162). From this search, 28 articles were collated that satisfied the inclusion criteria. The use of tilted implants had success rates ranging from 93% to 99%. Short implants had success rates ranging from 87 to 90% in the posterior maxilla. Immediate implant placement after removal of the impacted canine lacked long term reports. Two cases are included to demonstrate treatment planning using navigation to guide implant placement in an adult patient with an impacted maxillary canine. CONCLUSIONS: The evidence-based literature concerning implant placement associated with adult maxillary canines is limited. There is evidence to support tilting implants to avoid the impacted canine, or the use of short implants splinted together to avoid the impacted tooth. Other options had insufficient data to offer support.

Elucidating the nature of the proton radioactivity and branching ratio on the first proton emitter discovered 53mCo.

The observation of a weak proton-emission branch in the decay of the 3174-keV 53mCo isomeric state marked the discovery of proton radioactivity in atomic nuclei in 1970. Here we show, based on the partial half-lives and the decay energies of the possible proton-emission branches, that the exceptionally high angular momentum barriers, [Formula: see text] and [Formula: see text], play a key role in hindering the proton radioactivity from 53mCo, making them very challenging to observe and calculate. Indeed, experiments had to wait decades for significant advances in accelerator facilities and multi-faceted state-of-the-art decay stations to gain full access to all observables. Combining data taken with the TASISpec decay station at the Accelerator Laboratory of the University of Jyväskylä, Finland, and the ACTAR TPC device on LISE3 at GANIL, France, we measured their branching ratios as bp1 = 1.3(1)% and bp2 = 0.025(4)%. These results were compared to cutting-edge shell-model and barrier penetration calculations. This description reproduces the order of magnitude of the branching ratios and partial half-lives, despite their very small spectroscopic factors.

Maxillary Full Arch Restorations - Biological Complications: A Narrative Review Outlining Criteria for Long Term Success.

PURPOSE: Patients receiving full arch implant borne maxillary prostheses require functional, esthetic, and long term success. The importance of this review is to document the difficulty with implant maintenance, the prevalence of peri-implant disease, and the improvement in biologic health when using a prosthesis that can be maintained to minimize plaque. The objective is to provide surgeons with a reference to optimize surgical procedures that can result in improved hygiene and long term maintenance, as well as acceptable functional and esthetic goals. METHODS: Pubmed.gov was the information source. Years reviewed included 1990-2022. Inclusion criteria included only articles in journals referenced in pubmed.gov. The reports excluded were case reports, reports that only included implant survival, and articles without a statistical analysis to generate meaningful conclusions. Biological complications included bone loss, hygiene difficulty, mucositis and recession, the incidence of peri-implantitis, and how complications related to patient co-morbidities. Data collected included outcomes of the study including statistical significance. RESULTS: The search identified articles for review using terms which included full arch maxillary restorations (n = 736), long term success with full arch maxillary prostheses (n = 22), ceramic full arch restorations (n = 102), and complications with full arch restorations (n = 231). From this search, 53 articles were collated that satisfied the inclusion criteria. Factors found to be significant contributors to biological complications included bone loss and peri-implant disease, difficulty with daily hygiene access, plaque and biofilm coverage, and the need for continued maintenance for long term implant health. CONCLUSION: The surgeon needs to place implants to allow a full arch maxillary prosthesis to be fabricated with full access to the implants for maintenance, which should decrease the incidence of biological complications. With excellent maintenance full arch implant restorations can have limited peri-implant disease.

How to Avoid Errors When Using Navigation to Place Implants - A Narrative Review.

PURPOSE: Surgeons placing implants use navigation for implant placement accuracy. The importance of this review is to document the sources of error that are involved with navigation so surgeons can recognize factors to decrease error. The objective is to provide surgeons with a reference to optimize navigation. METHODS: Pubmed.gov was the information source. Years reviewed included 2010 to 2022. The inclusion criteria included only articles in peer-reviewed journals. In vitro results were included only if they involved testing of variables microgap, cone beam computerized tomography (CBCT) accuracy evaluation, or accuracy of printed models. Variables were searched and evaluated. Data collected included the objectives and outcomes of the study including statistical significance. The conclusions made by the authors were confirmed by evaluating the data analysis, and then these conclusions were listed in each error-related topic. RESULTS: The search used terms which included guided implant surgery complications (n = 4,029), accuracy of CBCT scanners (n = 319), accuracy of implant navigation (n = 983), and the error between drills and static guides (n = 3). From this search, 70 articles were collated that satisfied the inclusion criteria. There are multiple sources of error that are less than 1 mm, including but not limited to errors associated with the scanner and method for scanning, errors associated with merging scanned files with the CBCT scan, errors using different guide stent fabrication methods, errors associated with intraoperative techniques, the learning curve, and planning error. If small errors are not taken into consideration, implant placement errors can exceed 1-2 mm of platform location and angulation errors in excess of 8°. CONCLUSION: The surgeon needs to take into consideration controllable factors that will result in the avoidance of implant malposition and thus be able to effectively utilize navigation for accurate implant placement.

Intraoperative Diagnosis of "Bronchus Suis", a Variant of Tracheal Bronchus.

Bronchus suis, also known as tracheal bronchus, is a rare congenital anatomic variant in which an aberrant bronchus develops above the carina. Often asymptomatic, bronchus suis may be detected during imaging or manipulation of the airway. Here we describe a case where bronchus suis was visualized by fiberoptic bronchoscopy performed intraoperatively for the evaluation of desaturation and management of endotracheal secretions. It is important for anesthesiologists to consider the possibility of tracheal bronchus in patients with acute respiratory compromise.

Evidence-Based Criteria for an Ideal Abutment Implant Connection-A Narrative Review.

IMPORTANCE: Long-term success with a dental implant restoration relies on a stable connection between the abutment and the implant. The purpose of this article is to review current knowledge of the abutment interface, identify problems that develop due to wear and mismatch of parts, and use a problem list to propose a solution. The objective was to provide a concise overview that clinicians can then use to choose a system that addresses the problems of the abutment implant interface. OBSERVATIONS: Manufacturing methods will result in surface variations across the surface of the abutment and implant. Microgaps change in dimension upon function due to wear. Bacterial leakage can lead secondary to functional wear, and the microgap will get larger. The increase in the microgap with function has been clinically verified. Micromotion will result in larger areas of surface gap in both flat and conical connections, with gaps larger than the size of bacteria. CONCLUSIONS AND RELEVANCE: For an ideal abutment, an implant system must have high tolerances for manufacturing with minimal gap formation along the abutment to implant surface; a connection that is resistant to micromotion; screws that have minimal deformation during loading; and a microgap less than 1 micron which is maintained during implant function.

Algorithmic Approach to Reconstruct Major Implant and Dental Complications.

PURPOSE: Patients with failing implants or teeth may require multiple procedures to correct their problems. The purpose of this article was to describe an algorithmic approach for clinicians to use to simplify the restoration of the patient. METHODS: The topics for this article were used to search for references using PubMed. Topics included the effect of thickening thin gingiva to promote stable soft tissue margins, the use of different bone graft materials for sockets and for ridge augmentation, and methods to use digital technology for efficient planning. Other sources were book chapters, which had an extensive reference section including multiple case series and clinical trial results. Based on the search results, references were chosen that would verify the techniques suggested to be used for these problems. For this narrative, diagnostic information is described using virtual digital methods rather than analog methods to develop the final prosthetic plan, which guides the surgical procedures. The surgical phases are described in detail. RESULTS: The gingiva needs to be healthy and thick to support a hard tissue graft. The timing of procedures begins with assessment of the quality of the soft tissue and the loss of both soft and hard tissues. The operative procedures should be based on the final prosthetic plan, created digitally, to provide information that is required to properly position soft and hard tissue grafts and the implants. CONCLUSIONS: This organized, algorithmic approach can be used for many situations that clinicians are seeing in their daily practice due to complications that can occur.

Prediction of Residual Alveolar Bone Height in the Posterior Maxilla After Dental Extractions.

PURPOSE: After tooth extraction in the posterior maxilla, bone resorption often limits implant placement unless additional grafting procedures are performed. However, it is difficult to predict the amount of bone that will remain after extraction based on current evidence. The purpose of this study was to develop a method for predicting the postextraction alveolar bone height in the posterior maxilla. PATIENTS AND METHODS: The authors conducted a retrospective cohort study that included all patients who were treated for the extraction and replacement of a maxillary first molar with a dental implant from 2008 to 2019. Potential predictor variables included thirteen pre-extraction radiographic measurements obtained via cone-beam computed tomography. The outcome variable was having more than 6 mm of bone height from the alveolar crest to the sinus floor after extraction. Decision tree analyses were used to search for the best predictors of this outcome using random forest analysis with a maximum of 3 randomly chosen covariates in each candidate tree. RESULTS: A total of 63 patients were included in the study; 55.6% were women, and the mean age was 57.6 ± 14.5 years. In this study population, having a bone height from the furcation to the maxillary sinus floor of <6.7 mm had a 7.1% chance of having >6 mm of bone height postoperatively, whereas those patients with ≥6.7 mm at the same position preoperatively had a 61.9% chance of having >6 mm of bone height postoperatively (P < .001). CONCLUSIONS: This study suggests that patients with <6.7 mm of bone from the furcation to the sinus are at increased risk of having insufficient bone to support a dental implant without additional grafting at the maxillary first molar position. When treating these patients, the surgeon should consider performing a procedure at the time of extraction to increase bone height or explain additional bone grafting is expected for ideal implant placement.

Apixaban versus PhenpRocoumon: Oral AntiCoagulation plus antiplatelet tHerapy in patients with Acute Coronary Syndrome and Atrial Fibrillation (APPROACH-ACS-AF): Rationale and design of the prospective randomized parallel-group, open-label, blinded-endpoint, superiority, multicenter-trial of a triple therapy versus a dual therapy in patients with Atrial Fibrillation and Acute Coronary Syndrome undergoing coronary stenting.

BACKGROUND: A regimen of dual (DAT) vs. triple (TAT) antithrombotic therapy reduces bleeding in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, recent evidence suggests that DAT may be associated with an increased ischemic risk. This raises the question whether DAT rather than TAT should be recommended to AF patients that undergo PCI for acute coronary syndrome (ACS), carrying a particularly high risk of both bleeding and ischemic events, studied only as subgroups of previous trials. METHODS AND DESIGN: The APPROACH-ACS-AF-(DZHK-7) trial is a multicenter prospective, randomized, open-label, blinded endpoint (PROBE) trial which will include patients presenting with an ACS managed by PCI and requiring oral anticoagulation (OAC) due to AF. The trial will test, whether a DAT-regimen comprising clopidogrel plus the non-Vitamin-K-antagonist oral anticoagulant (NOAC) apixaban is superior to a TAT-regimen of vitamin-K-antagonist (VKA) plus dual anti-platelet therapy (APT) with respect to bleeding. A total of 400 patients will be randomized 1:1 to a control-arm with guideline-recommended TAT with VKA plus clopidogrel and acetylsalicylic-acid and a study arm receiving DAT comprising apixaban plus clopidogrel. Patients will be followed-up for 6 months. The primary endpoint of the study is the cumulative incidence of BARC type ≥2 bleeding, secondary endpoints include a composite clinical ischemic outcome and net clinical outcome. CONCLUSIONS: APPROACH-ACS-AF is the first trial dedicated to ACS patients, testing whether in terms of bleeding a DAT with NOAC is superior to a TAT regimen with VKA in high-risk ACS patients with AF.

Predictive Performance of Physiology-Based Pharmacokinetic Dose Estimates for Pediatric Trials: Evaluation With 10 Bayer Small-Molecule Compounds in Children.

Development and guidance of dosing schemes in children have been supported by physiology-based pharmacokinetic (PBPK) modeling for many years. PBPK models are built on a generic basis, where compound- and system-specific parameters are separated and can be exchanged, allowing the translation of these models from adults to children by accounting for physiological differences. Owing to these features, PBPK modeling is a valuable approach to support clinical decision making for dosing in children. In this analysis, we evaluate pediatric PBPK models for 10 small-molecule compounds that were applied to support clinical decision processes at Bayer for their predictive power in different age groups. Ratios of PBPK-predicted to observed PK parameters for the evaluated drugs in different pediatric age groups were estimated. Predictive performance was analyzed on the basis of a 2-fold error range and the bioequivalence range (ie, 0.8 ≤ predicted/observed ≤ 1.25). For all 10 compounds, all predicted-to-observed PK ratios were within a 2-fold error range (n = 27), with two-thirds of the ratios within the bioequivalence range (n = 18). The findings demonstrate that the pharmacokinetics of these compounds was successfully and adequately predicted in different pediatric age groups. This illustrates the applicability of PBPK for guiding dosing schemes in the pediatric population.

Preliminary Results Using a Friction-Fit Crown to Abutment Connection.

One of the chronic problems with traditional cement or screw retention of crowns to implants is the development of biologic and technical complications, including soft tissue complications, bone loss, screw loosening, loss of retention, and veneering material fractures. The purpose of this case series report is to document preliminary results, specifically crown retention, using a friction-fit connection of crown to abutment. A sample composed of patients who had one or more implants restored between July 1, 2019, and October 30, 2019, were enrolled in this retrospective case-control series. Each patient had their crown connected to the implant abutment using a friction-fit system. Patients were seen for routine follow-up for documentation of crown retention, and 24 crowns were followed. After 6 months of follow-up, 100% of the crowns retained retention and did not become loose under normal masticatory function. The use of a friction-fit connection provided excellent retention of the crown to the abutment over the 6-month follow-up period.

Porous Bone Increases the Risk of Posterior Mandibular Implant Failure.

PURPOSE: Our recent study indicated that patients with osteoporosis had an increased risk for early and late implant failure perhaps due to a large cancellous space. Therefore, the purpose of the article is to explore the relationship between the amount of cancellous space in an implant site and implant failure. PATIENTS AND METHODS: The authors conducted a retrospective cohort study on patients who received dental implants in the posterior mandible at the senior author's practice from January 1, 2008 to October 1, 2019. The primary outcome variable was time to implant failure. The primary predictor variable was the amount of cancellous bone between the buccal and lingual cortices (cancellous space). Other study variables included demographic variables, medical history variables, and implant site measurements. Statistical analysis was performed using descriptive statistics, chi-squared tests, single variable and multiple Cox proportional hazard analyses. RESULTS: The study cohort (n = 220) was composed of 62.3% women and the average age was 58.2 years. The median follow-up time was 3.5 years (range: 1-12). Five-year survival rates for patients with a cancellous space of <4 mm was 100%, with a cancellous space of 4-6 mm was 95.3%, with a cancellous space of 6-8 mm was 88.2%, and with a cancellous space of >8 mm was 64.1%. In the final multivariate Cox proportional hazard model adjusting for age, gender, smoking status, site and buccal cortex width, cancellous space remained significantly associated with time to implant failure (aHR 1.7 per millimeter change [1.4 - 2.2], P < .0001). CONCLUSIONS: The width of the cancellous space and subsequent gap between implant and cortical bone should be considered when placing implants into the mandibular molar sites. When the patient presents for an implant in the mandibular molar region, if the cancellous space is large, the patient should be informed of the risk.

What Factors Are Associated With Implant Failure?

PURPOSE: Recognition of patient-specific risk factors should reduce implant failure. The purpose of this study was to identify risk factors associated with implant failure and to determine if these factors differ over time after implant placement. METHODS: The investigators implemented a retrospective case-controlled study and enrolled a sample composed of patients who had 1 or more implants removed from December 1, 2007 to February 29, 2020. Risk factors were grouped into demographic, medical history, and treatment-related variables. The primary outcome variable was whether the patient's implant failed, with control patients including those without implant failure. The duration was recorded for follow-up from the time of implant placement to the last visit or implant removal. Backward variable selection was used to predict whether an implant failed within 1 year, 1 to 4 years, or after 4 years in 3 multivariable logistic regressions. RESULTS: Of 224 patients in this cohort, 82 experienced an implant failure. The mean age was 58.6 ± 15.3 years, and 53.1% were females. Patients with osteoporosis had an increased risk of failure in each period. Alcohol use, smoking, depression, and penicillin allergy were all associated with an increased probability of failure within 1 or more of the periods considered. CONCLUSIONS: This study has identified multiple discrete risk factors for implant failure and has demonstrated that these factors are associated with implant failure at different periods after placement.