Immediate loading of implants with fixed restorations in the completely edentulous mandible: report of 27 patients from a private practice.

Numerous authors have documented clinical success in loading threaded implants at the time of implant placement when carefully controlled surgical and restorative protocols are followed. This clinical series documents the application of immediate loading techniques to fixed mandibular restorations in 27 patients who were edentulous or had non-restorable mandibular dentitions. Eighteen patients had complete conventional maxillary dentures, while 9 had natural or fixed prosthetic maxillary dentitions. Twelve different restorative dentists provided prosthetic support for these patients and used 4 different restoration types: laboratory- or office-processed, with cement or screw retention. Five to 8 threaded implants were placed in each patient. One hundred sixty-one of the 186 implants that were placed by the authors were loaded immediately using fixed provisional restorations of the various designs. More than 99% (160/161) of the immediately loaded implants and 99.5% (185/186) of all implants were clinically integrated and radiographically successful at the time of final evaluation for restoration fabrication. After final implant evaluation, no additional implant losses occurred, indicating an implant survival rate of nearly 100% over a mean of 25.0 months (range 13 to 41 months) following implant placement. While a strong preference for cement-retained restorations was apparent, all prostheses showed similar success. The data and the experience described in this report indicate that immediate loading with fixed restorations using appropriate surgical and restorative techniques can be a predictable technique for rehabilitation of the completely edentulous mandible.

Ultrastructure of durapatite-periodontal tissue interface in human intrabony defects.

The ultrastructure of the interface between Durapatite (hydroxylapatite) and human periodontal tissues was examined. Durapatite was implanted into the intrabony periodontal defects during periodontal surgery. Reentry procedures were performed after 1 year and the tissues in the defects were biopsied and processed for transmission electron microscopy. Nineteen tissue blocks from four patients were examined, 17 contained Durapatite particles embedded in fibrous tissue and two contained particles encased in bone, all without inflammation. The fibrous connective tissue consisted of densely packed collagen fibrils surrounding the implant particles. The bone surrounding the Durapatite consisted in one case of relatively mature bone, and in the other of osteoid tissue. A granular, amorphous, collagen-free, electron-dense layer was routinely observed between implant and tissue. This layer was thicker in the bone-encased samples than in those surrounded by fibrous connective tissue. Except for the particle surrounded by mature bone, this layer was continuous with an organic meshwork located on the periphery of the implant spaces. The ultrastructural features of the interface are consistent with the existence of a mucopolysaccharide "bonding zone" described by other investigators. The organic meshwork appears to outline areas similar in size and shape to the individual crystallites of hydroxylapatite. This may indicate that the reactive surface of hydroxylapatite is much larger than merely the exterior surface of the implant, a finding which may explain the apparently good tissue adhesion to the implant.

Teamwork in psychiatric settings.

A study designed to examine factors that contribute to effective team functioning in inpatient psychiatric facilities showed that most respondents, who were all members of such teams, agreed that teamwork helped to improve treatment plans for individual clients. Using data from the study, roles that social workers take as team members are examined and important issues about team functioning are raised.