How meta-analytic evidence impacts clinical decision making in oral implantology: a Delphi opinion poll.

OBJECTIVES: To investigate the impact of meta-analytic evidence in scientific literature on clinical decision making in the field of oral implantology. METHODS: A Delphi opinion poll was performed at the meeting of the "Next Generation" Committees of the Austrian, German and Swiss Societies for Implantology (ÖGI, DGI and SGI). First, the experts gave their opinion on 20 questions regarding routine implant treatment (uninformed decisions), then they were confronted with up-to-date Level I evidence from scientific literature on these topics and again asked to give their opinion (informed decisions) as well as to rate the available evidence as satisfactory or insufficient. Topics involved surgical issues, such as immediate implant placement, flapless surgery, tilted and short implants and bone substitute materials, as well as opinions on prosthodontic paradigms, such as immediate loading, abutment materials and platform switching. RESULTS: Compared to their uninformed decisions prior to confrontation with recent scientific literature, on average, 37% of experts (range: 15-50%) changed their opinion on the topic. When originally favoring one treatment alternative, less than half were still convinced after review of meta-analytic evidence. Discrepancy between uninformed and informed decisions was significantly associated with insufficient evidence (P = 0.014, 49% change of opinion vs. 26% on topics rated as sufficiently backed with evidence). Agreement regarding strength of evidence could be reached for eight topics (40%), in three issues toward sufficiency and in five issues toward lack of evidence. CONCLUSION: Confrontation with literature results significantly changes clinical decisions of implantologists, particularly in cases of ambiguous or lacking meta-analytic evidence.

Systematic survey of natural radioactivity of soil in Slovenia.

Soil samples, from 70 points uniformly distributed over entire Slovenia, were analysed for (40)K, (232)Th and (226)Ra using gamma spectrometry, and for (234)U and (238)U using alpha spectrometry. The following ranges and averages of activity concentrations (Bq kg(-1)) were obtained: 98-2600 and 800 ± 520 for (40)K, 9-170 and 77 ± 33 for (232)Th, 12-270 and 63 ± 44 for (226)Ra, 12-84 and 34 ± 19 for (234)U, and 11-90 and 34 ± 19 for (238)U. With respect to lithology, the highest average values for (40)K and (232)Th were found at clastic sediments containing clay and for (226)Ra on carbonate rocks. Based on the measured activity concentrations, terrestrial gamma dose rates were calculated. The total dose rate ranged from 15 to 260 nGy h(-1), with arithmetic mean of 110 ± 49 nGy h(-1), being the highest over carbonates.

Functional outcome after surgical treatment of orbital floor fractures.

In the present article, the authors want to present the results of a retrospectively evaluated consecutive series of patients with surgically treated isolated orbital floor fractures (OFF; "blow-out fractures") concerning the functional outcome after OFF and give detailed recommendations based on the clinical and radiological findings. A series of 60 patients with isolated OFF over a 5-year period needing surgically repair at the same institution were evaluated. Patient data were analysed in terms of preoperative and postoperative clinical parameters and radiological findings. The analysed parameters were type of fracture, diplopia, gaze restriction, enophthalmos, materials used for repair, surgical approach and timing of the surgical intervention. Burst type fractures were more often found than punched-out fractures. The most frequently used surgical approach was a preseptal transconjunctival approach. An overall decrease of gaze restriction (93%), diplopia (89%) and enophthalmos (86%) was observed. According to the fracture size, we used Ethisorb patches in smaller fractures and resorbable or titanium meshes or autologous bone in larger fractures in most cases. Patients who underwent surgery more than 7 days after the trauma showed better results with regard to an improvement of diplopia and motility disturbances than patients who were treated immediately. In indicated cases, the surgical repair of OFF leads to very good results if the anatomical and functional properties of the orbit and its contents are respected. The applied strategy and means presented in our study proved of value and can therefore be recommended.