Role of glucagon-like peptide-1 agonist in patients undergoing percutaneous coronary intervention or coronary artery bypass grafting: A meta-analysis.

Importance: Glucagon-like peptide-1 (GLP-1) protects against ischemia-reperfusion injury in patients with acute myocardial infarction (AMI). Controversy exists on the effects of GLP-1 on AMI patients undergoing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. Study objective: We aimed to investigate the cardioprotective effects of GLP-1 in AMI patients after PCI and CABG. Design: We searched PubMed, Web of Science, EBSCO, Scopus, and the Cochrane Library for relevant randomized controlled trials (RCTs) up to June 2021, with no restriction on publication date. The following search terms are used: "percutaneous coronary intervention" or "coronary artery bypass grafting" or "myocardial infarction" and "glucagon-like peptide 1" or "exenatide" or "liraglutide". Study selection: Articles were independently assessed by 2 reviewers. We included RCTs only that compared GLP-1 with control in AMI patients. Data extraction and synthesis: Continuous data were pooled as mean differences (MDs), while dichotomous variables were pooled as odds ratios (ORs), with 95% confidence interval (CI), using R software (meta package) for windows. Subgroup analysis according to the intervention type and GLP-agents were conducted. We assessed the heterogeneity among RCTs using the Q statistic and I2 statistic. We also tested publication bias by funnel plot-based methods. The quality of each study was assessed with the Cochrane risk of bias tool. Main outcomes and measures: Primary outcomes were changes of left ventricular ejection fraction (LVEF), myocardial infarct characteristics, salvage index. Secondary outcomes included major adverse cardiac events (MACE), gastrointestinal events, and hypoglycemia. Results: Nine RCTs (14 reports) including 1216 patients were included in this meta-analysis. At 3 months follow up, GLP-1 was associated with improved LVEF (MD = 2.81, 95% CI [0.69, 4.94]), infarct size in grams (MD = -5.71, 95% CI [-10.24, -1.18]), and salvage index (MD = 0.09, 95% CI [0.05, 0.14]). While, GLP-1 had less MACE rate than control (RR = 0.64, 95% CI [0.41, 0.99]), and higher gastrointestinal side effects (RR = 4.21, 95% CI [2.39, 7.41]). Conclusions and relevance: This meta-analysis illustrated that GLP-1 was associated with better LVEF and reduced infarct size in patients with AMI undergoing PCI and CABG surgery, although the mechanism on how this agent provide this benefit is not clear. Key points: Question: What is the effectiveness of Glucagon-like peptide-1 (GLP-1) agonist in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.Findings: This systematic review and meta-analysis illustrated that GLP-1 was associated with better left ventricular ejection fraction and reduced infarct size in patients with AMI undergoing PCI and CABG surgery, probably by reducing reperfusion injury.Meaning: GLP-1 could improve systolic and diastolic function, lowering the cardiovascular risk of morbidity and mortality in AMI patients.

Prosthetic outcomes and survival rates of implants placed with guided flapless surgery using stereolithographic templates: a retrospective study.

Recent technologic advances allow clinicians to place dental implants using computer-generated templates. However, there are limited data regarding treatment outcomes for implants placed using these techniques. The purpose of this retrospective study was to report the 2- to 4-year prosthetic outcomes and survival of dental implants placed by postdoctoral residents with a flapless surgical protocol using computer-based planning and stereolithographic surgical templates. Thirty-six patients were treated using the NobelGuide concept, comprising an image-based three-dimensional implant planning software and flapless implant surgery with stereolithographic templates.

Posterior maxillary segmental osteotomy for the implant reconstruction of a vertically deficient ridge: a 3-year clinical report.

A vertically deficient posterior maxillary edentulous ridge in conjunction with sinus pneumatization or extensive horizontal bone resorption presents significant challenges for implant placement and restoration with an implant-supported fixed prosthesis. Various surgical techniques have been reported for the reconstruction of the vertically deficient posterior maxilla: guided bone regeneration, sinus elevation, block and/or particulate grafting with barrier membranes, and distraction osteogenesis. This clinical report describes the technique, the management of intrasurgical complications, and the 3-year follow-up results of augmenting the vertically deficient posterior maxilla with a segmental osteotomy prior to rehabilitation with an implant-supported fixed prosthesis.

Computer-assisted design/computer-assisted manufacturing zirconia implant fixed complete prostheses: clinical results and technical complications up to 4 years of function.

OBJECTIVE: To report the clinical results and technical complications with computer-assisted design/computer-assisted manufacturing (CAD/CAM) zirconia, implant fixed complete dental prostheses (IFCDPs) after 2-4 years in function. MATERIALS AND METHODS: Fourteen consecutive edentulous patients (16 edentulous arches) were included in this study. Ten of the patients were women and four were men, with an average age of 58 years (range: 35-71). Ten mandibular and six maxillary arches were restored with porcelain fused to zirconia (PFZ) IFCDPs. Of the 16 arches, 14 received one-piece and 2 received segmented two-piece IFCDPs, respectively. The mean clinical follow-up period was 3 years (range: 2-4). At the last recall appointment, biological and technical parameters of dental implant treatment were evaluated. RESULTS: The implant and prosthesis survival rate following prosthesis insertion was 100% up to 4-year follow-up. The prostheses in 11 of the 16 restored arches were structurally sound, exhibited favorable soft tissue response, esthetics, and patient satisfaction. Five IFCDPs (31.25%) in four patients exhibited porcelain veneer chipping. Chipping was minor in three prostheses (three patients) and was addressed intraorally with polishing (one prosthesis) or composite resin (two prostheses). One patient with maxillary and mandibular zirconia IFCDP exhibited major porcelain chipping fractures which had to be repaired in the laboratory. Function, esthetics, and patient satisfaction were not affected in three of the four fracture incidents. Median crestal bone loss was 0.1 mm (0.01-0.2 mm). The presence of parafunctional activity, the IFCDP as opposing dentition, and the absence of occlusal night guard were associated with all the incidents of ceramic chipping. CONCLUSION: CAD/CAM zirconia IFCDPs are viable prosthetic treatment after 2-4 years in function, but not without complications. The porcelain chipping/fracture was the most frequent technical complication, with a 31.25% chipping rate at the prosthesis level. Despite the technical complications, increased patient satisfaction was noted.

Flapless CAD/CAM-guided surgery for staged transition from failing dentition to complete arch implant rehabilitation: a 3-year clinical report.

The transition of patients from failing dentition to complete arch implant rehabilitation often requires that the patient be rendered edentulous and has to wear a complete removable dental prosthesis for varying periods of time. This is objectionable to many patients. A staged treatment approach allows a fixed interim restoration, patient comfort, and prosthodontic control throughout the rehabilitation process. CAD/CAM-guided flapless implant surgery has the advantage of prosthetically driven implant placement and minimal postoperative sequelae. A patient with a failing dentition was treated with this combined protocol and was followed up for 3 years after loading. Implant and prosthesis survival rates were 100%, with no technical complications encountered up to the last recall. The purpose of this clinical report is to describe a combination of CAD/CAM-guided flapless surgery and a staged treatment approach, thereby giving the patient a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process. The various surgical, laboratory, and prosthetic stages are illustrated for the complete arch prosthetic rehabilitation, and the 3-year follow-up outcome is reported.

Accuracy of implant casts generated with splinted and non-splinted impression techniques for edentulous patients: an optical scanning study.

BACKGROUND: The accuracy of implant casts generated with various impression techniques was mainly investigated in vitro resulting in limited clinical data. PURPOSE: (1) To compare the three-dimensional (3-D) accuracy of splinted and non-splinted impression techniques to the control casts (verification jigs) that had been used for actual patient treatment; and (2) to determine the maximum level of clinically undetectable misfit. The null hypothesis was that there would be no significant difference in the accuracy of casts generated with different impression techniques. MATERIALS AND METHODS: The implant casts used for the prosthetic rehabilitation of 12 edentulous jaws with CAD/CAM zirconia, implant-fixed complete dental prosthesis (IFCDP) were included in this study. Intraoral acrylic jigs were used to fabricate index casts. Splinted and non-splinted, open-tray techniques were used to generate two casts. Optical scanning acquisition of the x-coordinates, y-coordinates and z-coordinates of the implant positions for each individual cast was performed. The "best fit" algorithm was used with computer software to superimpose the scanning datasets. Group I (n=12) included casts from the splinted impression technique vs. acrylic jig casts, and group II (n=12) included casts from non-splinted technique vs. jig casts. RESULTS: The paired t-test and Wilcoxon's signed ranks test were used to compare the 3-D discrepancies within and between groups I (splinted vs. jig) and II (non-splinted vs. jig), respectively. Significant difference was found at the x-axis, y-axis and 3-D between groups I and II (P<0.05), but not in the vertical z-axis (P>0.05). Within subject, global 3-D discrepancies between groups I and II were significantly different (P<0.05), corroborated by in vivo observations of clinical fit. Implant position in the arch affected the 3-D accuracy of casts for both anterior and posterior implants (P<0.05). CONCLUSION: The splinted technique generated more accurate master casts than the non-splinted technique for one-piece IFCDPs in edentulous jaws and the null hypothesis was rejected. These clinical implications demonstrate improved accuracy of splinted impression techniques compared with the non-splinted technique. For the external connection, the implant system used in this study, a 3-D misfit ranging from 59 to 72 µm, may be considered the maximum discrepancy resulting in an acceptable clinical fit with one-piece IFCDPs.

Effect of splinted and nonsplinted impression techniques on the accuracy of fit of fixed implant prostheses in edentulous patients: a comparative study.

PURPOSE: The effect of different implant impression techniques on the accuracy of casts has been investigated mostly in vitro, and clinically relevant evidence is scarce. The purpose of this study was to investigate the effect of implant impression techniques--specifically, splinted versus nonsplinted--on the accuracy of fit of fixed implant prostheses in edentulous patients. MATERIALS AND METHODS: This clinical study included 12 edentulous patients (13 edentulous arches). All patients had undergone computer-guided, prosthetically driven implant surgery. Splinted (with acrylic resin) and nonsplinted pickup implant impression techniques were used to generate two different casts. Intraoral verification jigs were made to fabricate a third index cast (prosthesis fabrication cast); these made up a control group. All patients were definitively rehabilitated with one-piece zirconia prostheses. The accuracy of fit of each prosthesis was evaluated indirectly by examining them clinically and radiographically while they were fit on the generated casts. RESULTS: Of the 13 splinted casts, 12 presented with accurate clinical fit when the zirconia prosthesis was seated on its respective cast. Only 6 of the 13 nonsplinted casts showed accurate clinical fit. The zirconia prostheses fit accurately on all respective casts of the control group (prosthesis fabrication cast) as well as intraorally. The differences between the test groups and between the nonsplinted and control groups were statistically significant. No statistically significant differences were found between the splinted and control groups. CONCLUSION: There is clinical evidence that the splinted impression technique generates more accurate implant impressions and master casts than the nonsplinted technique for complete-arch, one-piece fixed prostheses.

Immediate loading of the maxilla with prefabricated interim prosthesis using interactive planning software, and CAD/CAM rehabilitation with definitive zirconia prosthesis: 2-year clinical follow-up.

UNLABELLED: Immediate loading in implant dentistry has provided several advantages for both patients and clinicians. Recent advances in computer-aided design/computer-aided manufacturing (CAD/CAM) technology, medical imaging and rapid prototyping have added to the armamentarium of implant dentistry in terms of efficiency, accuracy and predictability. Rapid prototyping and CAD/CAM technology are used to fabricate stereolithographic surgical templates for flapless implant placement. In addition to that, this technology is also used for the fabrication of zirconia frameworks. The zirconia-based implant restorations are gaining popularity in implant prosthodontics combining esthetic properties with strength and biocompatibility. The purpose of this article is to illustrate the steps for implant rehabilitation of the edentulous maxilla with zirconia prosthesis and report the 2-year clinical follow-up of novel technological advances in surgical placement, provisionalization and fabrication of a definitive restoration. CLINICAL SIGNIFICANCE: A comprehensive approach to full mouth implant rehabilitation using cutting edge technology is illustrated in a simplified manner.

Use of vacuum-formed templates to guide tooth preparation and insertion of interim restorations.

Ideal tooth preparation and interim prostheses are critical to a predictable esthetic and functional outcome in the treatment of full-mouth-fixed restorations. During the treatment stages, multiple procedures need to be considered for a successful and predictable outcome. These include the parallel preparation of multiple abutment teeth followed by the relining of the interim prostheses. The purpose of this article is to describe a technique to simplify tooth preparation and facilitate subsequent insertion of a complete-arch-fixed interim prosthesis using vacuum-formed templates.

Fabrication of a custom abutment for a wide-diameter implant in a situation with limited interocclusal space.

This article illustrates a technique to solve the esthetic and functional challenges of restoring implants in situations with limited interocclusal clearance. As manufactured, some wide implants lack a gold cylinder abutment that attaches directly to the implant. Instead, an intermediate abutment is provided with the system. However, with limited interocclusal space, it is not feasible to restore an intermediate abutment due to the increased restorative space required. This article describes a technique to fabricate a customized abutment that directly connects to a wide-diameter implant, resulting in a functional and esthetic restoration.

Complete arch implant rehabilitation using subtractive rapid prototyping and porcelain fused to zirconia prosthesis: a clinical report.

The applications of various technological advances in implant dentistry and in all aspects of the diagnostic, treatment planning, surgical, and restorative phases are gaining popularity. Additive rapid prototyping and computer-aided design/computer-aided manufacturing (CAD/CAM) technology are used to generate stereolithographic surgical guides and prefabricated interim prostheses to facilitate implant surgery and immediate loading, respectively. Subtractive rapid prototyping is used for fabrication of zirconia frameworks for definitive implant prostheses. This clinical report describes the comprehensive application of these technological advances in implant rehabilitation to optimize surgical and prosthodontic outcomes as well as patient comfort.

Flapless implant placement: a technique to eliminate the need for a removable interim prosthesis.

Computer-guided flapless surgery for implant placement using stereolithographic templates is gaining popularity. The advantages of this surgical protocol are its minimally invasive nature, accuracy of implant placement, predictability, and reduced time required for definitive rehabilitation. One of the disadvantages, however, pertains to complete arch implant rehabilitation. An existing protocol for complete arch flapless computer-guided implant surgery necessitates the patient to be rendered completely edentulous and to wear a removable complete denture for varying periods of time. This may be objectionable to the patient. This article illustrates a technique which uses a modified radiographic template to overcome this limitation. The patient may have a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process.

Use of stereolithographic templates for surgical and prosthodontic implant planning and placement. Part II. A clinical report.

Eight implants were placed in the posterior part of the mandible using computer-generated stereolithographic templates. Preoperative implant simulation was done on a 3D computer model created by reformatted computerized tomography data. The surgeon and the prosthodontist positioned the simulated implants in the most favorable position addressing all concerns with regard to anatomy, biomechanics, and esthetics. The length and diameter of each implant along with the angulation/collar of abutments required for a screw-retained prosthesis were determined. Stereolithographic templates were then fabricated by incorporating the precise spatial position of the implants within the bone as previously planned during the computer simulation. The templates were fabricated to seat directly on the bone and were stable. The first template was used to complete osteotomies with a 2-mm twist drill followed by the second template for the 3-mm drill. Implants were placed and allowed to integrate for 4 months. After second-stage surgery, the definitive abutments were torqued into place followed by insertion of the definitive screw-retained prostheses. Dimensions of all implants and abutments were the same as planned during the computer simulation.

Use of stereolithographic templates for surgical and prosthodontic implant planning and placement. Part I. The concept.

Surgical and prosthodontic implant complications are often an inadvertent sequelae of improper diagnosis, planning, and placement. These complications pose a significant challenge in implant dentistry. Presented in this article is a technique using a highly advanced software program along with a rapid prototyping technology called stereolithography. It permits graphic and complex 3D implant simulation and the fabrication of computer-generated surgical templates. These templates seat directly on the bone and are preprogrammed with the individual depth, angulation, and mesio-distal and bucco-lingual positioning of individual implants as planned during the 3D computer simulation.