Customized Allogeneic Bone Augmentation Improves Esthetic Outcome in Anteromaxillary Dental Implantation.

Purpose: In cases of severe atrophic maxilla or maxillary involution, augmentation is necessary for implant-supported prosthetics. Using bone grafts is a standard procedure, and using customized allogeneic bone blocks may be a predictable alternative before dental implantation. Clinical Findings. This case study shows the digital workflow, including a preimplantological augmentation by a customized allogeneic block, followed by soft tissue optimization and template-based dental implantation, after six months of healing. It is part of a three-year follow-up study on the resorption rate of allogeneic bone blocks. Outcomes. Allogeneic bone augmentation is an alternative treatment option to autologous bone grafts. It allows predictable advanced backward planning (ABP) even in the maxillary esthetic zone. Diameter-reduced implants show long-term stability of a minimum of three years after loading and excellent results of prosthetic fixtures. Conclusion: Prefabricated customized allogeneic blocks for augmentation may increase the fitting accuracy of the graft, decrease morbidity, and reduce the operation time in esthetic maxillary rehabilitation.

Advanced backward planning with custom-milled individual allogeneic block augmentation for maxillary full-arch osteoplasty and dental implantation:a 3-year follow-up.

In the case of maxillary involution, augmentation is necessary for implant-supported prosthetics. The use of bone grafts is standard; customized allogeneic bone blocks may be a predictable alternative before dental implantation. For maxillary full-arch reconstruction, this case shows a horse-shoe augmentation by four allogeneic blocks, followed by guided dental implantation and fixed prosthetics after 6 months of healing. Using allogeneic blocks is an option for full-arch maxillary augmentation and comparable with autologous bone grafts. There is no donor site comorbidity. Bone height is stable for a minimum of 3 years after loading with resorption less than 10% in vertical, buccolingual, and mesiodistal directions. Short-implants allow for the long-term stability of prosthetic fixtures. Prefabricated customized allogeneic blocks for augmentation may increase the fitting accuracy of the graft, decrease morbidity, and lower operation time in maxillary full-arch reconstruction. The percentage of resorption after 3 years is comparable to the commonly used iliac crest.

Association between working in awkward postures, in particular overhead work, and pain in the shoulder region in the context of the 2018 BIBB/BAuA Employment Survey.

BACKGROUND: Musculoskeletal disorders are the leading cause of work-related sick leave and incur substantial socioeconomic costs. With the aging of our society and employees, the problem is exacerbating, and prevention is becoming increasingly important. According to previous studies, exposure to awkward postures, such as overhead work, is associated with musculoskeletal problems. OBJECTIVE: This study aimed to determine the current prevalence of employees who work in awkward postures, specifically overhead, stratified by age, gender and occupation in the context of the 2018 BIBB/BAuA Employment Survey and to analyze associations between awkward working postures, in particular overhead work, and pain in the shoulder region. METHOD: The study is based on secondary data from the German 2018 BIBB/BAuA Employment Survey. We have included 14,327 of the 20,012 employees aged < 67 years who work at least 35 h per week who took part in the survey. The classification of participants in occupational groups is based on the BLOSSFELD classification. The multivariate analysis was conducted by applying robust Poisson regression models adjusted block by block to obtain the relation between the self-reported frequency of working in awkward postures, in particular overhead work, and the occurrence of arm pain and neck and shoulder pain. Prevalence ratios (PR) are reported as effect estimates. RESULTS: 12.7% of participants indicated that they are often exposed to awkward postures at work; 5.0% stated they often performed overhead work. The majority of these employees worked in agricultural, unskilled and skilled manual occupations. The crude prevalence is 17.4% for arm pain and 48.4% for neck and shoulder pain. If subjects reported that they often performed overhead work, the risk of arm pain increased by 18% (PR 1.18, CI 1.04-1.34, final model). CONCLUSION: Working in awkward postures, especially overhead work, is a risk factor for upper extremity musculoskeletal disorders. The development of prevention strategies should focus on the workforce in agricultural, unskilled and skilled manual occupations.

The association between manual handling operations and pain in the hands and arms in the context of the 2018 BIBB/BAuA Employment Survey.

BACKGROUND: Manual handling operations (MHO) are tasks performed by hand that require repetitive and forceful hand and arm movements. MHO are currently performed in many workplaces in skilled and unskilled jobs in the production and service sectors. MHO are considered as work-related health risk factors. The relationship between MHO and the occurrence of disorders of the upper extremities has been established. MHO can cause diseases such as tenosynovitis or carpal tunnel syndrome. This study aims to assess the current prevalence of MHO in the German workforce and to evaluate the relationship between MHO and the occurrence of hand and arm complaints. METHODS: The analysis was based on the German 2018 BIBB/BAuA Employment Survey. For this analysis we included subjects aged between 16 and 66 who work at least 35 h per week. The self-reported frequency of MHO (never; rarely; sometimes; often) was considered as the exposure of interest and was stratified by gender and occupation. Prevalence ratios (PR) were used to report the relationship between MHO and self-reported pain in the hands and arms (robust log-linear Poisson regression). Adjustments were made for age, gender, actual weekly working hours, psychosocial workload, and other physical workloads. The regression analyses considered complete cases. RESULTS: The analyses included 14,299 employees. Frequent MHO were reported by 32.6% of men and 31.1% of women. These workloads were often reported by respondents who work in the agricultural sector (men: 70.1%; women: 79.0%), in unskilled (men: 59.4%; women: 66.9%), and skilled manual occupations (men: 72.7%; women: 66.7%). A higher frequency of self-reported MHO was associated with a higher prevalence of hand complaints (PR 2.26 CI 2.00-2.55 "often" vs. "never" = ref.) as well as arm pain (PR 1.73 CI 1.55-1.92 for "often" vs. "never" = ref.). CONCLUSION: MHO are still frequent in many occupations. The shown association between MHO and pain in the hands and arms demonstrates the importance of MHO in the current German workforce and the necessity to further develop prevention strategies.

Intraosseous anesthesia in symptomatic irreversible pulpitis: Impact of bone thickness on perception and duration of pain.

BACKGROUND: Intraosseous anesthesia (IO) allows the anesthetic solution to be injected directly into the cancellous bone. The anesthetic solution immediately reaches the periapical region, and thus the axonal area of the nerve, where it can temporarily disable the sodium pump. The effect is felt almost without any time delay, and only a small amount of anesthetic solution is required. METHODS: This study aims to investigate the efficacy of IO using the Anesto® device after infiltration anesthesia (IA) and/or inferior alveolar nerve block anesthesia (IANB) failed to work in symptomatic irreversible pulpitis (hot tooth). The 33 patients included in the study were treated additionally with 1.7 ml articaine hydrochloride with 1:100,000 epinephrine hydrochloride (Ultracain® D-S, Sanofi-Aventis, Frankfurt, Germany) IO. RESULTS: The electrical pulp test showed that 95.76% of the volunteers reacted positively to the combination of IANB or IA with the IO. In women, the additive IO was effective at 97.22%. In men, the IO led to pain elimination in 94.00% of cases. The duration of the IO was less than a quarter of an hour (13.03 min). The IO worked longer in women than in men (13.61 min vs. 12.33 min). Overall, more than every third tooth that needed trepanation was located in the posterior area of the mandible (36.4%). Treatment of hot teeth in this area was associated with an increased pulse rate and increased residual pain. There was a moderate correlation (Spearman-Rho [IRI] = 0.280) between the Visual Analog Scale (VAS) score and bone density, and a significant correlation (IRI = 0.612) between subjective residual pain and bone width. The IO resulted in a moderate, transient increase in the pulse rate by approximately 20 bpm. This is similar to the temporary increase in heart rate after conventional anesthesia techniques in non-preloaded patients and can be considered clinically irrelevant. CONCLUSION: IO with the Anesto® device as an extension and deepening of local pain elimination is recommended for the treatment of hot teeth.