Immediate vs. early loading of dental implants: 3-year results of a randomized controlled clinical trial.

OBJECTIVES: The aim of the present study was to test whether or not immediately loaded implants exhibit the same survival rates as early loaded implants. MATERIAL AND METHODS: Eleven patients with bilateral free end mandibles were randomly assigned to treatment either with immediately (test) or early loaded implants (control). Test implants received provisionals in occlusion on the day of surgery, control implants 6 weeks later. Parameters assessed included implant stability quotient (ISQ), plaque, prosthesis stability and radiographs at baseline (implant insertion), 1 and 3 years. The statistical analysis was performed by means of Student's paired t-test and Wilcoxon's signed-rank test. The level of significance was set at P<0.05. RESULTS: After a mean observation period of 39.8 months (36.7-53.1), three test implants were lost in two patients resulting in a survival rate of 85% compared with 100% for control implants. At baseline, the mean marginal bone level was significantly higher at test implants (mean=0.36 mm, SD +/-0.5) compared with control implants (1.08+/-0.37 mm). For both test and control implants, the bone level significantly decreased from baseline to 3 years (test: 1.51+/-0.79 mm; control: 0.89+/-0.94 mm). The bone loss until 3 years was not significantly different between test and control group. There was no significant difference for ISQ both at test and control implants between baseline (test: 63.59+/-4.62 mm, control: 65.35+/-7.43 mm) and 3 years (test: 66.47+/-7.47 mm, control 68.80+/-8.75 mm). CONCLUSIONS: Immediate loading was associated with a lower implant survival rate. Although the test implants were placed with increased sink depth compared with the control implants, the marginal bone levels were not different between test and control at 3 years.

Immediate occlusal loading of Brånemark implants applied in various jawbone regions: a prospective, 1-year clinical study.

BACKGROUND: The original protocol for dental implant treatment ad modum Brånemark was based on submerged healing prior to loading. For patients, immediate implant function could reduce cost and increase attractiveness of implant treatment. PURPOSE: The goal of this study was to evaluate the short-term success rate of immediately loaded implants placed in various regions of the jaws. MATERIALS AND METHODS: Forty-one patients received a total of 127 immediately loaded implants (76 maxillary and 51 mandibular). Seventy-one percent of the patients received their prosthetic restoration the same day and the others within 11 days. All prosthetic constructions were in full contact in centric occlusion. Clinical follow-up examinations were performed at 1 week, 2 weeks, and at 1, 2, 3, 6, and 12 months after implant loading. The study was completed 1 year after loading. RESULTS: Twenty-two implants were lost in 13 patients (including 7 maxillary implants lost in 1 patient). The cumulative success rate of the implants was 82.7% after 1 year of prosthetic loading. All sites with implant losses were re-implanted, using a two-stage technique, with no further complications reported. Ninety-one percent of implants placed in regions other than the posterior maxilla were successful compared with 66% of implants placed in the posterior maxilla. Implants in patients with a parafunctional habit (bruxers) were lost more frequently than those placed in patients with no parafunction (41% vs. 12%). Implants subjected to guided bone regeneration were more successful compared with those not subjected to regeneration procedures (90% vs. 67%). CONCLUSIONS: The immediate loading concept is a realistic treatment alternative in various jawbone regions except for the posterior part of the maxilla. High occlusal loads should be considered a risk factor. On the other hand, implants in combination with bone defects frequently are penetrating cortical layers to a higher extent, thereby contributing to implant stability during the healing phase and consequently do not inevitably jeopardize the treatment result. However, further controlled clinical studies with larger sample sizes need to be performed to evaluate the influence of different parameters on treatment outcome.

[The marginal adaptation and wear resistance of a fine hybrid composite inlay in vitro]. / Marginale Adaptation und Verschleissfestigkeit eines Feinhybridkomposit-Inlays in vitro.

A lab and a production batch of a new fine hybrid composite material were tested in adhesive MOD inlays. Using a long term in vitro test the wear resistance of both formulations and the marginal adaptation of the production batch were quantitated. The wear results were compared to the results generated with an amalgam control. The initial marginal adaptation in enamel was excellent totaling 95.9% (occlusal) to 99.5% (axial) of "continuous margin" at the tooth/cement interface. These values slightly decreased after loading to 81.4% (occlusal) and 93.8% (axial), respectively. In dentine however, insufficient marginal qualities were found (32.0% "continuous margin" initial and 18.9% after loading). The adhesion between inlay and composite cement was excellent and load stable. Both composite batches were significantly more wear resistant than the amalgam control and abraded the opposing enamel cusps significantly less than amalgam.

[Diverticular disease of the colon (author's transl)]. / Divertikelkrankheit des Dickdarmes. Internmedizinische Aspekte

Admission diagnosis of 100 patients with diverticular disease of the colon indicated that the clinical features of the disease is still relatively unknown. The most important cardinal symptoms are abdominal complaints, irregular stools and/or bleeding from the large intestine. These symptoms occur with about equql frequency in patients with diverticular disease, whether or not there was evidence of inflammatory complications. If there is clinically manifest diverticulum formation of the colon, the term "diverticular disease" seems appropriate, since transition between diverticulosis and diverticulitis is fluid. In addition to bleeding and attacks of diverticulitis, fistulae and gut narrowing with or without ileus are other complications. Mechanical small-intestinal ileus with involvement of the small intestine in the inflammatory diverticulitis mass was a feature of several of the authors' cases. Low-residue diet is contra-indicated because such food probably plays an important part in the aetiology and pathogenesis of diverticular disease.

Tonsillar hypertrophy in an adult with obesity-hypoventilation syndrome. The use of the flow-volume loop.

A 29-year-old obese man had marked tonsillar hypertrophy, somnolence, hypoxemia, and hypercapnia. Endotracheal intubation followed by tracheostomy relieved the hypoventilation. Weight loss improved the arterial blood gas levels. Sequential upright and supine flow-volume loops were compatible with a fixed upper-airway obstruction (such as would occur) with enlarged tonsils) prior to tonsillectomy. Following surgery, the expiratory flow-volume curve was abnormal in the supine position, consistent with the additional diagnosis of posterior pharyngeal hypotonia. Thus, in this patient the unique combination of tonsillar hypertrophy, posterior pharyngeal hypotonia, obesity, and a depressed respiratory center led to retention of carbon dioxide.

[Syncope in glossopharyngeal neuralgia]. / Synkopale Anfälle bei Glossopharyngikusneuralgie

The case is presented of a 51-year-old man with symptomatic glossopharyngeal neuralgia who exhibited syncope during some of the neuralgic attacks. Clinically and pathophysiologically, these syncopes differ from the "carotid sinus syndrome" by the fact that they are caused by irritation of the sensory fibers of the IXth cerebral nerve instead of the pressoreceptors in the carotid sinus. While carbamazepine (Tegretol) had only transient beneficial effects, complete relief of symptoms was obtained by intracranial section of the glossopharyngeal nerve.