Wear at the implant-framework interface between titanium implant platform and the additively manufactured titanium and cobalt-chromium frameworks.

PURPOSE: To measure the wear at the implant interface between the Grade 4 titanium (Ti) of the implant and frameworks fabricated using two additively manufactured alloys (Ti alloy and cobalt-chromium [Co-Cr]) pre- and post-artificial aging. MATERIAL AND METHODS: Three-unit frameworks supported by two implants were additively manufactured (Atlantis; Dentsply Sirona) using Ti and Co-Cr dental alloys. Two implants (OsseoSpeed EV, Astra Tech; Dentsply Sirona) were torqued on each non-engaging framework. The assembled implant-frameworks were secured into polyurethane foam blocks. Groups were created based on the material and surface assessed: framework (Ti-framework and Co-Cr-framework groups) and implant (Ti-implant group). Two subgroups were created depending on the location: premolar (PM) and molar (M). Computed tomography images were obtained pre- (as manufactured) and post-simulated mastication procedures. The pre- and post-simulated mastication files of each specimen were aligned using the best-fit algorithm using a metrology program. Wear was measured by calculating the volumetric discrepancies at the implant interface on 64 measurement points per area analyzed. Three-way ANOVA and Tukey tests were used to analyze the data (α = 0.05). RESULTS: The mean volumetric discrepancy values ranged from 0.8 to 3.1 µm among all the subgroups tested. The group (framework vs. implant) (p < 0.001) and tooth location (p < 0.001) were significant factors of the mean volumetric discrepancy values obtained. The framework group presented with significantly lower volumetric discrepancy mean values (1 µm) compared with the implant group (3 µm), whereas the premolar area obtained significantly lower mean volumetric discrepancy values (1.9 µm) compared with the molar location (2.3 µm). CONCLUSIONS: Volumetric discrepancies were found at the implant-framework interface tested between the pre- and post-artificial aging measurements ranging from 1 to 3 µm after 1,200,000 cyclic loading that simulated approximately 12 months of function.

Trueness and precision of complete-arch photogrammetry implant scanning assessed with a coordinate-measuring machine.

STATEMENT OF PROBLEM: Photogrammetry technology has been used for the digitalization of multiple dental implants, but its trueness and precision remain uncertain. PURPOSE: The purpose of this in vitro investigation was to compare the accuracy (trueness and precision) of multisite implant recordings between the conventional method and a photogrammetry dental system. MATERIAL AND METHODS: A definitive cast of an edentulous maxilla with 6 implant abutment replicas was tested. Two different recording methods were compared, the conventional technique and a photogrammetry digital scan (n=10). For the conventional group, the impression copings were splinted to an additively manufactured cobalt-chromium metal with autopolymerizing acrylic resin, followed by recording the maxillary edentulous arch with an elastomeric impression using an additively manufactured open custom tray. For the photogrammetry group, a scan body was placed on each implant abutment replica, followed by the photogrammetry digital scan. A coordinate-measuring machine was selected to assess the linear, angular, and 3-dimensional discrepancies between the implant abutment replica positions of the reference cast and the specimens by using a computer-aided design program. The Shapiro-Wilk test showed that the data were not normally distributed. The Mann-Whitney U test was used to analyze the data (α=.05). RESULTS: The conventional group obtained an overall accuracy (trueness ±precision) value of 18.40 ±6.81 µm, whereas the photogrammetry group showed an overall scanning accuracy value of 20.15 ±25.41 µm. Significant differences on the discrepancies on the x axis (U=1380.00, P=.027), z axis (U=601.00, P<.001), XZ angle (U=869.00, P<.001), and YZ angle (U=788.00, P<.001) were observed when the measurements of the 2 groups were compared. Furthermore, significant 3-dimensional discrepancy for implant 1 (U=0.00, P<.001), implant 2 (U=0.00, P<.001), implant 3 (U=6.00, P<.001), and implant 6 (U=9.00, P<.001) were computed between the groups. CONCLUSIONS: The conventional method obtained statistically significant higher overall accuracy values compared with the photogrammetry system tested, with a trueness difference of 1.8 µm and a precision difference of 18.6 µm between the systems. The conventional method transferred the implant abutment positions with a uniform 3-dimensional discrepancy, but the photogrammetry system obtained an uneven overall discrepancy among the implant abutment positions.

A successful implant-supported fixed prosthesis in a patient with osteopetrosis: A clinical report.

Osteopetrosis (marble bone disease) is a family of rare genetic disorders characterized by impaired osteoclast function leading to hyperdense, hypovascular, brittle bone. Typical imaging shows increased bone mass and thickened cortical and trabecular bone. Bones are more prone to fracture and osteomyelitis may develop. When considering dental implant placement in a patient with osteopetrosis, the potential for bony fracture and/or osteomyelitis should be considered along with the decreased likelihood of successful osseointegration because of hypovascularity. This clinical report describes an unusual imaging presentation and successful osseointegration of multiple dental implants supporting an implant-supported fixed mandibular prosthesis with long-term survival.

Implant-Abutment Discrepancy Before and After Acrylic Resin Veneering of Complete-Arch Titanium Frameworks Manufactured Using Milling and Electron Beam Melting Technologies.

PURPOSE: To assess the implant-abutment discrepancy of complete-arch frameworks manufactured using milling and additive electron beam melting (EBM) technologies, before and after acrylic resin veneering application. MATERIALS AND METHODS: A definitive implant cast with six implant replicas was digitized using a laboratory scanner. A software program was used to design an implant-supported framework which was manufactured using milling (M group) and EBM (EBM group) technologies (n = 10). In the M group, titanium milled specimens were fabricated. In the EBM group, titanium EBM specimens were obtained. A coordinate measurement machine (CMM) was used to assess the implant-abutment discrepancy at x-, y-, and z-axed between the specimens and the implant-abutment replicas of the definitive cast. The implant replicas positioned on the lateral incisor positions were not able to be assessed. The 3D gap discrepancy was calculated: 3 D = x 2 + y 2 + z 2 $3D\ = \sqrt {{x^2} + {y^2} + {z^2}}$ . Acrylic resin veneering procedures were finished and the same CMM measurements were completed. Three-way analysis of variance (ANOVA) test was used to analyze the data (α = 0.05). RESULTS: The manufacturing method (df = 1, F = 7.00, p = 0.009) and implant position (df = 3, F = 129.82, p < 0.001) were significant predictors of the x-axis discrepancy. The veneering procedures (df = 1, F = 21.55, p < 0.001) and implant position (df = 3, F = 95.42, p < 0.001) were significant predictors of the y-axis discrepancy. The manufacturing method (df = 1, F = 11.79, p = 0.001) was a significant predictor of the z-axis discrepancy. Lastly, the manufacturing method (df = 1, F = 5.11, p = 0.026), implant position (df = 3, F = 11.36, p < 0.001), and veneering procedures (df = 1, F = 41.56, p < 0.001) were significant predictors of the 3D gap discrepancy in which the manufacturing method explains the 2.37% of variation in the 3D gap discrepancy, the implant position explains the 15.82% of variation in the 3D gap discrepancy, and veneering procedures explain the 19.29% of variation in the 3D gap discrepancy results. CONCLUSIONS: The manufacturing methods, veneering procedures, and implant position influenced the linear implant-abutment discrepancy. The milled technique tested obtained lower linear implant-abutment discrepancy compared with the EBM method evaluated. The acrylic resin veneering procedures increased the implant-abutment discrepancy.

Discrepancy at the implant abutment-prosthesis interface of complete-arch cobalt-chromium implant frameworks fabricated by additive and subtractive technologies before and after ceramic veneering.

STATEMENT OF PROBLEM: Selective laser melting additive manufacturing (AM) technologies can be used to fabricate complete-arch cobalt-chromium (Co-Cr) implant-supported prostheses. However, the discrepancy at the implant-prosthesis interface with these fabrication techniques and after ceramic veneering remains unclear. PURPOSE: The purpose of the present in vitro investigation was to measure the discrepancy at the implant abutment-prosthesis interface before and after the ceramic veneering of frameworks fabricated by using subtractive and selective laser melting AM technologies. MATERIAL AND METHODS: A completely edentulous cast with 6 implant abutment replicas (Multi-unit Abutment RP Replicas; Nobel Biocare Services AG) was prepared. A total of 20 Co-Cr frameworks were fabricated using subtractive or computer numerical control milling (CNC group) and additive (AM group) technologies (n=10). A coordinate measurement machine was used to measure the linear and angular discrepancy at the implant abutment-prosthesis interface. Subsequently, a ceramic veneer was applied to each framework following the same standardized protocol. A bonding layer (Chromium-Cobalt Bonding; Bredent), 2 opaquer layers (Powder opaque and liquid UF; Creation CC), a layer of dentin ceramic (Dentine A3; Creation CC), a layer of enamel ceramic (Enamel S-59; Creation CC), and a glaze layer (Glaze paste and Liquid GL; Creation CC) were applied following the manufacturer's firing protocol. Coordinate measurement machine assessment was repeated to measure the linear and angular discrepancies after ceramic veneering procedures. Data were analyzed by using the Wilcoxon signedrank and Mann-Whitney U tests (α=.05). RESULTS: No statistically significant differences (P>.05) were demonstrated in assessing the discrepancies at the implant abutment-prosthesis interface between the groups except for the XZ angle of the CNC group (P<.05). Ceramic techniques produced significantly higher linear and angular discrepancies in both groups (P<.001) with a mean ±standard deviation increase in the 3-dimensional gap of 36.9 ±15.6 µm in the CNC group and 38.9 ±16.6 µm in the AM group. The AM group presented significantly higher discrepancy in the x-axis than the CNC group (P<.001). CONCLUSIONS: Manufacturing procedures did not significantly influence the discrepancy at the implant abutment-prosthesis interface, which was significantly increased after ceramic veneering, except for the XZ angle of the CNC group. The differences between the discrepancies at the implant abutment-prosthesis interface before and after ceramic application revealed no significant discrepancies among the groups, except in the AM group that presented a significantly higher discrepancy on the x-axis compared with the CNC group.

Comparison of conventional, photogrammetry, and intraoral scanning accuracy of complete-arch implant impression procedures evaluated with a coordinate measuring machine.

STATEMENT OF PROBLEM: Conventional implant impressions by using elastomeric impression material have been reported as a more reliable technique for a complete-arch implant record compared with intraoral scanner procedures. Photogrammetry technology may provide a reliable alternative to digital scanning or a conventional impression; however, its accuracy remains unclear. PURPOSE: The purpose of this in vitro study was to measure and compare the implant abutment replica positions of the definitive cast with the implant abutment replica positions obtained by the conventional technique, photogrammetry, and 2 intraoral scanners. MATERIAL AND METHODS: An edentulous maxillary cast with 6 implant abutment replicas (RC analog for screw-retained abutment straight) was prepared. Three impression techniques were performed: the conventional impression technique (CNV group) by using a custom tray elastomeric impression procedure after splinting the impression copings at room temperature (23°C), photogrammetry (PG group) technology (Icam4D), digital scans by using 2 different IOSs following the manufacturer's recommended scanning protocol, namely IOS-1 (iTero Element) and IOS-2 (TRIOS 3) groups (n=10). A coordinate measuring machine (CMM Contura G2 10/16/06 RDS) was used to measure the implant abutment replica positions of the definitive casts and to compare the linear discrepancies at the x-, y-, and z-axes and the angular distortion of each implant abutment replica position by using a computer aided-design software program (Geomagic) and the best fit technique. The 3D linear gap discrepancy was calculated. Measurements were repeated 3 times. The Shapiro-Wilk test revealed that the data were not normally distributed; therefore, the Kruskal-Wallis test was used to analyze the data, followed by pairwise Mann-Whitney U tests (α=.05). RESULTS: Significant y-axis linear and XY and YZ angular discrepancies were found among the CNV, PG, IOS-1, and IOS-2 groups (P<.05). The PG group obtained a significantly higher distortion on the y-axis and 3D gap compared with all the remaining groups (P=.004). The 3D discrepancy of the CNV group was 11.7 µm, of the IOS-1 group was 18.4 µm, of the IOS-2 was 21.1 µm, and of the PG group was 77.6 µm. In all groups, the interquartile range was higher than the median errors from the discrepancies measured from the definitive cast, indicating that the relative precision was low. CONCLUSIONS: The conventional technique reported the lowest 3D discrepancy for the implant abutment position translation capabilities of all the implant techniques evaluated. The intraoral scanners tested provided no significant differences in linear distortion compared with the conventional method. However, the photogrammetry system tested provided the least accurate values, with the highest 3D discrepancy for the implant abutment positions among all the groups.

Met-Hemoglobin Is a Biomarker for Poor Oxygen Delivery in Infants Following Surgical Palliation.

BACKGROUND: Infants with cyanotic congenital heart disease demonstrate wide fluctuations in hemoglobin (Hb), oxygen saturation, and cardiac output following palliation. Methemoglobin (Met-Hb), the product of Hb oxidation, may represent a compensatory mechanism during hypoxia and may be utilized as a biomarker. METHODS: Arterial and venous Met-Hb levels were obtained from infants requiring palliation. The primary outcome was to describe the relationship between Met-Hb and other indices of tissue oxygenation (venous saturation, estimated arteriovenous oxygen difference [Est AV-Diff], and lactate). Secondary outcomes were to determine the impact of elevated Met-Hb levels ≥1.0% and the effect of red blood cell (RBC) transfusion on Met-Hb levels. RESULTS: Fifty infants and 465 Met-Hb values were studied. Venous Met-Hb levels were significantly higher than arterial levels (venous: 0.84% ± 0.36% vs arterial: 0.45% ± 0.18%; P < .001). Venous Met-Hb demonstrated a significant inverse relationship with venous oxygen saturation (R = -0.6; P < .001) and Hb (R = -0.3, P < .001) and a direct relationship with the Est AV-Diff (R = 0.3, P < .001). A total of 129 (29.6%) venous Met-Hb values were elevated (≥1.0%) and were associated with significantly lower Hb and venous saturation levels and higher Est AV-Diff and lactate levels. Methemoglobin levels decreased significantly following 65 RBC transfusions (0.94 ± 0.40 vs 0.77 ± 0.34; P < .001). Linear mixed models demonstrated that higher venous Met-Hb levels were associated with lower measures of tissue oxygenation and not related to any preoperative clinical differences. CONCLUSION: Methemoglobin may be a clinically useful marker of tissue oxygenation in infants following surgical palliation.

Elevated free hemoglobin and decreased haptoglobin levels are associated with adverse clinical outcomes, unfavorable physiologic measures, and altered inflammatory markers in pediatric cardiac surgery patients.

BACKGROUND: There are data suggesting that free hemoglobin (Hb), heme, and iron contribute to infection, thrombosis, multiorgan failure, and death in critically ill patients. These outcomes may be mitigated by haptoglobin. STUDY DESIGN AND METHODS: 164 consecutively treated children undergoing surgery for congenital heart disease were evaluated for associations between free Hb and haptoglobin and clinical outcomes, physiologic metrics, and biomarkers of inflammation RESULTS: Higher perioperative free Hb levels (and lower haptoglobin levels) were associated with mortality, nosocomial infection, thrombosis, hours of intubation and inotropes, increased interleukin-6, peak serum lactate levels, and lower nadir mean arterial pressures. The median free Hb in patients without infection (30 mg/dL; 29 interquartile range [IQR], 24-52 mg/dL) was lower than in those who became infected (39 mg/dL; IQR, 33-88 mg/ 31 dL; p = 0.0046). The median mechanical ventilation requirements were 19 (IQR, 7-72) hours in patients with higher levels of haptoglobin versus 48 (IQR, 18-144) hours in patients with lower levels (p = 0.0047). Transfusion dose, bypass duration, and complexity of surgery were all significantly correlated with Hb levels and haptoglobin levels. Multivariate analyses demonstrated that these variables were independently and significantly associated with outcomes. CONCLUSIONS: Elevated pre- and postoperative levels of free Hb and decreased levels of haptoglobin were associated with adverse clinical outcomes, inflammation, and unfavorable physiologic metrics. Transfusion, RACHS score, and duration of bypass were associated with increased free Hb and decreased haptoglobin. Further investigation of the role of hemolysis and haptoglobin as potential mediators or markers of outcomes is warranted.

Effect of simulated intraoral variables on the accuracy of a photogrammetric imaging technique for complete-arch implant prostheses.

STATEMENT OF PROBLEM: Conventional impression techniques to obtain a definitive cast for a complete-arch implant-supported prosthesis are technique-sensitive and time-consuming. Direct optical recording with a camera could offer an alternative to conventional impression making. PURPOSE: The purpose of this in vitro study was to test a novel intraoral image capture protocol to obtain 3-dimensional (3D) implant spatial measurement data under simulated oral conditions of vertical opening and lip retraction. MATERIAL AND METHODS: A mannequin was assembled simulating the intraoral conditions of a patient having an edentulous mandible with 5 interforaminal implants. Simulated mouth openings with 2 interincisal openings (35 mm and 55 mm) and 3 lip retractions (55 mm, 75 mm, and 85 mm) were evaluated to record the implant positions. The 3D spatial orientations of implant replicas embedded in the reference model were measured using a coordinate measuring machine (CMM) (control). Five definitive casts were made with a splinted conventional impression technique of the reference model. The positions of the implant replicas for each of the 5 casts were measured with a Nobel Procera Scanner (conventional digital method). For the prototype, optical targets were secured to the implant replicas, and 3 sets of 12 images each were recorded for the photogrammetric process of 6 groups of retractions and openings using a digital camera and a standardized image capture protocol. Dimensional data were imported into photogrammetry software (photogrammetry method). The calculated and/or measured precision and accuracy of the implant positions in 3D space for the 6 groups were compared with 1-way ANOVA with an F-test (α=.05). RESULTS: The precision (standard error [SE] of measurement) for CMM was 3.9 µm (95% confidence interval [CI] 2.7 to 7.1 µm). For the conventional impression method, the SE of measurement was 17.2 µm (95% CI 10.3 to 49.4 µm). For photogrammetry, a grand mean was calculated for groups MinR-AvgO, MinR-MaxO, AvgR-AvgO, and MaxR-AvgO obtaining a value of 26.8 µm (95% CI 18.1 to 51.4 µm). The overall linear measurement error for accurately locating the top center points (TCP) followed a similar pattern as for precision. CMM (coordinate measurement machine) measurement represents the nonclinical gold standard, with an average error TCP distance of 4.6 µm (95% CI 3.5 to 6 µm). All photogrammetry groups presented an accuracy that ranged from 63 µm (SD 17.6) to 47 µm (SD 9.2). The grand mean of accuracy was calculated as 55.2 µm (95% CI 8.8 to 130.8 µm). CONCLUSIONS: The CMM group (control) demonstrated the highest levels of accuracy and precision. Most of the groups with the photogrammetric method were statistically similar to the conventional group except for groups AvgR-MaxO and MaxR-MaxO, which represented maximum opening with average retraction and maximum opening with maximum retraction.

Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion Strategy in Infants Requiring Cardiac Operation.

BACKGROUND: The optimal hemoglobin for infants after cardiac operation is unknown. Red blood cells (RBCs) are commonly transfused to maintain high hemoglobin concentrations in the absence of a clinical indication. We hypothesized that infants can be managed with a postoperative conservative RBC transfusion strategy, resulting in lower daily hemoglobin concentrations, without evidence of impaired oxygen delivery (ie, lactate, arteriovenous oxygen difference [avO2diff]), or adverse clinical outcomes. METHODS: Infants weighing 10 kg or less undergoing biventricular repair or palliative (nonseptated) operation were randomly assigned to either a postoperative conservative or liberal transfusion strategy. Conservative group strategy was RBC transfusion for a hemoglobin less than 7.0 g/dL for biventricular repairs or less than 9.0 g/dL for palliative procedures plus a clinical indication. Liberal group strategy was RBC transfusion for hemoglobin less than 9.5 g/dL for biventricular repairs or less than 12 g/dL for palliative procedures regardless of clinical indication. RESULTS: After the operation of 162 infants (82 conservative [53 biventricular, 29 palliative], 80 liberal [52 biventricular, 28 palliative]), including 12 Norwood procedures (6 conservative, 6 liberal), daily hemoglobin concentrations were significantly lower within the conservative group than the liberal group by postoperative day 1 and remained lower for more than 10 days. The percentage of patients requiring a RBC transfusion, number of transfusions, and volume of transfusions were all significantly lower within the conservative group. Despite lower hemoglobin concentrations within the conservative group, lactate, avO2diff, and clinical outcomes were similar. CONCLUSIONS: Infants undergoing cardiac operation can be managed with a conservative RBC transfusion strategy. Clinical indications should help guide the decision for RBC transfusion even in this uniquely vulnerable population. Larger multicenter trials are needed to confirm these results, and focus on the highest risk patients would be of great interest.

Longer RBC storage duration is associated with increased postoperative infections in pediatric cardiac surgery.

OBJECTIVES: Infants and children undergoing open heart surgery routinely require multiple RBC transfusions. Children receiving greater numbers of RBC transfusions have increased postoperative complications and mortality. Longer RBC storage age is also associated with increased morbidity and mortality in critically ill children. Whether the association of increased transfusions and worse outcomes can be ameliorated by use of fresh RBCs in pediatric cardiac surgery for congenital heart disease is unknown. INTERVENTIONS: One hundred and twenty-eight consecutively transfused children undergoing repair or palliation of congenital heart disease with cardiopulmonary bypass who were participating in a randomized trial of washed versus standard RBC transfusions were evaluated for an association of RBC storage age and clinical outcomes. To avoid confounding with dose of transfusions and timing of infection versus timing of transfusion, a subgroup analysis of patients only transfused 1-2 units on the day of surgery was performed. MEASUREMENTS AND MAIN RESULTS: Mortality was low (4.9%) with no association between RBC storage duration and survival. The postoperative infection rate was significantly higher in children receiving the oldest blood (25-38 d) compared with those receiving the freshest RBCs (7-15 d) (34% vs 7%; p = 0.004). Subgroup analysis of subjects receiving only 1-2 RBC transfusions on the day of surgery (n = 74) also demonstrates a greater prevalence of infections in subjects receiving the oldest RBC units (0/33 [0%] with 7- to 15-day storage; 1/21 [5%] with 16- to 24-day storage; and 4/20 [20%] with 25- to 38-day storage; p = 0.01). In multivariate analysis, RBC storage age and corticosteroid administration were the only predictors of postoperative infection. Washing the oldest RBCs (> 27 d) was associated with a higher infection rate and increased morbidity compared with unwashed RBCs. DISCUSSION: Longer RBC storage duration was associated with increased postoperative nosocomial infections. This association may be secondary in part, to the large doses of stored RBCs transfused, from single-donor units. Washing the oldest RBCs was associated with increased morbidity, possibly from increased destruction of older, more fragile erythrocytes incurred by washing procedures. Additional studies examining the effect of RBC storage age on postoperative infection rate in pediatric cardiac surgery are warranted.

An in vitro comparison of photogrammetric and conventional complete-arch implant impression techniques.

STATEMENT OF PROBLEM: Conventional impression techniques for recording the location and orientation of implant-supported, complete-arch prostheses are time consuming and prone to error. The direct optical recording of the location and orientation of implants, without the need for intermediate transfer steps, could reduce or eliminate those disadvantages. PURPOSE: The objective of this study was to assess the feasibility of using a photogrammetric technique to record the location and orientation of multiple implants and to compare the results with those of a conventional complete-arch impression technique. MATERIAL AND METHODS: A stone cast of an edentulous mandibular arch containing 5 implant analogs was fabricated to create a master model. The 3-dimensional (3D) spatial orientations of implant analogs on the master model were measured with a coordinate measuring machine (CMM) (control). Five definitive casts were made from the master model with a splinted impression technique. The positions of the implant analogs on the 5 casts were measured with a NobelProcera scanner (conventional method). Prototype optical targets were attached to the master model implant analogs, and 5 sets of images were recorded with a digital camera and a standardized image capture protocol. Dimensional data were imported into commercially available photogrammetry software (photogrammetric method). The precision and accuracy of the 2 methods were compared with a 2-sample t test (α=.05) and a 95% confidence interval. RESULTS: The location precision (standard error of measurement) for CMM was 3.9 µm (95% CI 2.7 to 7.1), for photogrammetry, 5.6 µm (95% CI 3.4 to 16.1), and for the conventional method, 17.2 µm (95% CI 10.3 to 49.4). The average measurement error was 26.2 µm (95% CI 15.9 to 36.6) for the conventional method and 28.8 µm (95% CI 24.8 to 32.9) for the photogrammetric method. The overall measurement accuracy was not significantly different when comparing the conventional to the photogrammetric method (mean difference = -2.6 µm, 95% CI -12.8 to 7.6). CONCLUSIONS: The precision of the photogrammetric method was similar to CMM, but lower for the conventional method as compared to CMM and the photogrammetric method. However, the overall measurement accuracy of the photogrammetric and conventional methods was similar.

Selection patterns of dietary foods in edentulous participants rehabilitated with maxillary complete dentures opposed by mandibular implant-supported prostheses: a multicenter longitudinal assessment.

STATEMENT OF PROBLEM: Documentation of long-term changes in food intake is lacking for those treated with a maxillary complete denture opposed by a mandibular, screw-retained, implant-supported fixed prosthesis. PURPOSE: The purpose of this study was to evaluate the selection patterns of dietary foods over 5 years for edentulous participants treated in a multicenter prospective clinical trial that compared cast alloy versus laser-welded titanium frameworks of an implant-supported prostheses opposed by maxillary complete dentures to rehabilitate edentulous participants. MATERIAL AND METHODS: The study assessed data from a multicenter prospective clinical trial that followed edentulous participants from an initial baseline of wearing existing complete dentures to implant placement, restoration with a mandibular implant-supported prosthesis opposed by a maxillary complete denture, to follow-up assessment of these treatments over 5 years. The 32 participants in the cohort were treated at 5 of 9 participating centers. The data collected included 2 dietary forms, a standardized 4-day food diary form, and a dietary habits questionnaire. Each participant completed forms before entering into treatment (control) and at the 1- and 5-year follow-up assessment after being treated with a maxillary complete denture opposing a mandibular complete-arch fixed implant-supported prosthesis. Descriptive statistics were calculated for each measure at each assessment point. Regression analysis and the Sign test were used to calculate change in the participants' nutritional status (α=.05). RESULTS: Among the findings, it was noted that difficulty in masticating hard, raw, and fibrous foods decreased and intake of vegetable portions increased significantly from 2.5 to 3.3 servings. Participant comfort in eating in public places and their enjoyment of eating were significantly improved from 50% of participants being uncomfortable with their prior complete denture treatment to only 4% after 5 years. CONCLUSIONS: Within the limitations of this study, it was concluded that vegetable intake and ability to masticate raw, hard, and fibrous food for these participants improved when they received a mandibular implant-supported prosthesis opposed by a maxillary complete denture. According to the analysis and findings, the overall eating experience was more pleasurable, and eating in public was more comfortable after replacement of complete dentures with a mandibular implant-supported prosthesis.

In vitro assessment of three types of zirconia implant abutments under static load.

STATEMENT OF PROBLEM: Although various zirconia abutments have been introduced, insufficient data exist regarding the maximum load capacity of internal tri-channel connection zirconia implant abutments with various implant-abutment interfaces. PURPOSE: The purpose of this in vitro study was to compare the maximum load capacity of 3 different types of internal tri-channel connection zirconia abutments and to assess their mode of failure. MATERIAL AND METHODS: The study investigated 3 groups (n=20) of zirconia implant abutments with different implant-abutment interfaces. Group AllZr consisted entirely of zirconia (Aadva CAD/CAM Zirconia Abutment), group FrZr of a titanium insert friction-fitted to the zirconia abutment component (NobelProcera Abutment Zirconia), and group BondZr of a titanium insert bonded to the zirconia abutment component (Lava Zirconia abutment). All the abutments were thermal cycled for 20 000 cycles between 5°C and 55°C. Sixty test implants made of titanium (Dummy NobelReplace) were embedded in autopolymerizing acrylic resin, and 60 zirconia copings (Lava Zirconia) with a uniform thickness of 2.0 mm were fabricated and bonded to the abutments. A universal testing machine was used to statically load all the specimens at a crosshead speed of 1 mm/min. The maximum load was recorded and used as the failure load. The fractured specimens were collected and representative specimens were studied with a stereomicroscope and scanning electron microscope (SEM). One-way ANOVA and post hoc comparisons with the Tukey HSD tests were used for statistical analysis (α=.05). RESULTS: The mean (SD) maximum load capacity was 484.6 (56.6) N for NobelProcera, 503.9 (46.3) N for Aadva, and 729.2 (35.9) N for Lava abutments. The maximum load capacity of Lava abutments was significantly higher than that of Aadva or NobelProcera (P< 05). No significant difference between Aadva and NobelProcera abutments was noted. The mode of failure among the Aadva, NobelProcera, and Lava abutments was different. CONCLUSIONS: With standard diameter internal tri-channel connection implants, the maximum load capacity of the Lava abutment was significantly higher than that of the Aadva or NobelProcera abutment. No significant difference in maximum load capacity was noted between Aadva and NobelProcera abutments. However, the fracture behavior of all 3 abutments was different.

Complete arch implant impression technique.

When making a definitive impression for an arch containing multiple implants, there are many reported techniques for splinting impression copings. This article introduces a splint technique that uses the shim method, which has been demonstrated to reduce laboratory and patient chair time, the number of impression copings and laboratory analogs needed, and the ultimate cost.

Washing red blood cells and platelets transfused in cardiac surgery reduces postoperative inflammation and number of transfusions: results of a prospective, randomized, controlled clinical trial.

OBJECTIVES: Children undergoing cardiac surgery with cardiopulmonary bypass are susceptible to additional inflammatory and immunogenic insults from blood transfusions. We hypothesize that washing red blood cells and platelets transfused to these patients will reduce postoperative transfusion-related immune modulation and inflammation. DESIGN: Prospective, randomized, controlled clinical trial. SETTING: University hospital pediatric cardiac intensive care unit. PATIENTS: Children from birth to 17 yrs undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Children were randomized to an unwashed or washed red blood cells and platelet transfusion protocol for their surgery and postoperative care. All blood was leuko-reduced, irradiated, and ABO identical. Plasma was obtained for laboratory analysis preoperatively, immediately, and 6 and 12 hrs after cardiopulmonary bypass. Primary outcome was the 12-hr postcardiopulmonary bypass interleukin-6-to-interleukin-10 ratio. Secondary measures were interleukin levels, C-reactive protein, and clinical outcomes. MEASUREMENTS AND MAIN RESULTS: One hundred sixty-two subjects were studied, 81 per group. Thirty-four subjects (17 per group) did not receive any blood transfusions. Storage duration of blood products was similar between groups. Among transfused subjects, the 12-hr interleukin ratio was significantly lower in the washed group (3.8 vs. 4.8; p = .04) secondary to lower interleukin-6 levels (after cardiopulmonary bypass: 65 vs.100 pg/mL, p = .06; 6 hrs: 89 vs.152 pg/mL, p = .02; 12 hrs: 84 vs.122 pg/mL, p = .09). Postoperative C-reactive protein was lower in subjects receiving washed blood (38 vs. 43 mg/L; p = .03). There was a numerical, but not statistically significant, decrease in total blood product transfusions (203 vs. 260) and mortality (2 vs. 6 deaths) in the washed group compared to the unwashed group. CONCLUSIONS: Washed blood transfusions in cardiac surgery reduced inflammatory biomarkers, number of transfusions, donor exposures, and were associated with a nonsignificant trend toward reduced mortality. A larger study powered to test for clinical outcomes is needed to determine whether these laboratory findings are clinically significant.

Freedom of rotation of selected overdenture attachments: an in vitro study.

STATEMENT OF PROBLEM: Attachments for mandibular overdentures may not allow for adequate freedom of rotation. PURPOSE: The purpose of this study was to subject 3 commonly used stud types of resilient attachments to rotation and to measure and compare the degree of rotation that occurs before the attachments bind. MATERIAL AND METHODS: Three stud attachments (ERA, Locator Extended Range, O-Ring System) with their corresponding metal housings were evaluated, first for a single implant system and secondly for a 2-attachment parallel implant system for the mandibular arch. Both the manufacturers' most and least retentive components were tested in each system. In the Locator system, the medium retention (3 lbs) for the standard is the most retentive of the extended range. A total of 60 test specimens, 5 per group, were fabricated. The attachments were connected to a 115-mm rod and attached to a testing device composed of a base, implant analogs, and a vertical plate holding graph paper. A free-sliding plastic block, which supported the metal rod parallel to the base, was removed to release the rod. The distance the rod fell was photographed and input into a computer with software designed to measure linear movement. Three-way ANOVA with heteroscedasticity consistent standard errors was used for data analyses (α=.05). RESULTS: Significant differences found among the most retentive components showed that the Locator had a greater freedom of rotation than the ERA (P=.001). The most retentive components in all systems showed that 1 attachment had a greater freedom of rotation than 2 (P=.005). When testing the least retentive components, all systems were significantly different (P<.003), with the freedom of rotation ranking being O-Ring System > Locator Extended Range > ERA. For all 3 systems, the least retentive components showed the most freedom (P≤.008). CONCLUSIONS: The least retentive components offer greater rotation than the most retentive components for all attachment systems tested and for both single and double attachments. Using the most retentive components, the Locator Extended Range attachment allows greater rotation than does the ERA for both single and double attachments. Using the least retentive components, the ORS attachment allows the most rotation and ERA the least for both single and double attachments. Using the most retentive components, one attachment allows greater rotation than does 2 attachments for the attachment systems evaluated.

The use of computer-aided manufacturing during the treatment of the edentulous mandible in an oral radiation therapy patient: clinical report.

This clinical report describes the treatment of an edentulous patient with previous radiation therapy to the base of the tongue. A computer-aided manufactured titanium framework was used to fabricate the implant-supported fixed complete denture and meet the functional and psychosocial needs of the patient.