RESUMO
OBJECTIVE: To compare manual plaster cast and digitized model analysis for accuracy and efficiency. MATERIAL AND METHODS: Nineteen plaster models of orthodontic patients in permanent dentition were analyzed by two calibrated examiners. Analyses were performed with a diagnostic calliper and computer-assisted analysis after digitization of the plaster models. The reliability and efficiency of different examiners and methods were compared statistically using a mixed model. RESULTS: Statistically significant differences were found for comparisons of all 28 teeth (P < 0.001), mandibular intermolar width (IMW, P = 0.0453), and overjet (P < 0.001 to P = 0.0329). Single-tooth measurements tended to have larger values when measured manually and the SD was between 0.06 and 1.33mm. Digital analyses gave significantly higher values for mandibular IMW and overjet. Less time was needed for digital measurements. CONCLUSION: Clinical significance of the differences between the methods compared did not appear significant. 3D laser-scanned plaster model analysis appears to be an adequate, reliable, and time saving alternative to analogue model analysis using a calliper.
Assuntos
Modelos Dentários , Odontometria/métodos , Sobremordida/patologia , Simulação por Computador , Desenho Assistido por Computador , Dentição Permanente , Humanos , Imageamento Tridimensional/métodos , Lasers , Mandíbula/patologia , Odontometria/instrumentação , Reprodutibilidade dos TestesRESUMO
INTRODUCTION: The purpose of the present study was to investigate and compare early biofilm formation on biomaterials, which are being used in contemporary fixed orthodontic treatment. METHODS: This study comprised 10 healthy volunteers (5 females and 5 males) with a mean age of 27.3 +-3.7 years. Three slabs of different orthodontic materials (stainless steel, gold and ceramic) were placed in randomized order on a splint in the mandibular molar region. Splints were inserted intraorally for 48 h. Then the slabs were removed from the splints and the biofilms were stained with a two color fluorescence assay for bacterial viability (LIVE/DEAD BacLight-Bacterial Viability Kit 7012, Invitrogen, Mount Waverley, Australia). The quantitative biofilm formation was analyzed by using confocal laser scanning microscopy (CLSM). RESULTS: The biofilm coverage was 32.7 ± 37.7% on stainless steel surfaces, 59.5 ± 40.0% on gold surfaces and 56.8 ± 43.6% on ceramic surfaces. Statistical analysis showed significant differences in biofilm coverage between the tested materials (p=0.033). The Wilcoxon test demonstrated significantly lower biofilm coverage on steel compared to gold (p=0.011). Biofilm height on stainless steel surfaces was 4.0 ± 7.3 µm, on gold surfaces 6.0 ± 6.6 µm and on ceramic 6.5 ± 6.0 µm. The Friedman test revealed no significant differences between the tested materials (p=0.150). Pairwise comparison demonstrated significant differences between stainless steel and gold (p=0.047). CONCLUSION: Our results indicate that initial biofilm formation seemed to be less on stainless steel surfaces compared with other traditional materials in a short-term observation. Future studies should examine whether there is a difference in long-term biofilm accumulation between stainless steel, gold and ceramic brackets.
Assuntos
Biofilmes/crescimento & desenvolvimento , Imageamento Tridimensional , Microscopia Confocal/métodos , Braquetes Ortodônticos/microbiologia , Adulto , Cerâmica/análise , Feminino , Ouro/análise , Voluntários Saudáveis , Humanos , Masculino , Teste de Materiais/métodos , Ortodontia/métodos , Estudos de Amostragem , Sensibilidade e Especificidade , Aço Inoxidável/análise , Propriedades de Superfície , Adulto JovemRESUMO
Peri-implant infections from bacterial biofilms on artificial surfaces are a common threat to all medical implants. They are a handicap for the patient and can lead to implant failure or even life-threatening complications. New implant surfaces have to be developed to reduce biofilm formation and to improve the long-term prognosis of medical implants. The aim of this study was (1) to develop a new method to test the antibacterial efficacy of implant surfaces by direct surface contact and (2) to elucidate whether an innovative antimicrobial copolymer coating of 4-vinyl-N-hexylpyridinium bromide and dimethyl(2-methacryloyloxyethyl) phosphonate (VP:DMMEP 30:70) on titanium is able to reduce the attachment of bacteria prevalent in peri-implant infections. With a new in vitro model with semi-coated titanium discs, we were able to show a dramatic reduction in the adhesion of various pathogenic bacteria (Streptococcus sanguinis, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis), completely independently of effects caused by soluble materials. In contrast, soft tissue cells (human gingival or dermis fibroblasts) were less affected by the same coating, despite a moderate reduction in initial adhesion of gingival fibroblasts. These data confirm the hypothesis that VP:DMMEP 30:70 is a promising antibacterial copolymer that may be of use in several clinical applications.
Assuntos
Antibacterianos/química , Materiais Revestidos Biocompatíveis/química , Polímeros/química , Titânio/química , Antibacterianos/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Adesão Celular/efeitos dos fármacos , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Humanos , Teste de Materiais , Propriedades de SuperfícieRESUMO
Late implant failures, caused by the inflammation of surrounding tissues are a problem in implant dentistry. The path of bacterial transmission from teeth to implants is not completely understood. Therefore, the purpose of this study was to analyze intraindividual bacterial transmission characterizing subgingival microbiomes in teeth and implants, both in healthy subjects and in those with signs of periodontitis or peri-implantitis. Samples of peri-implant and dental sulcus fluid were collected. To identify the predominant microbiota, amplified fragments of bacterial 16S rRNA gene were separated by single strand conformation polymorphism analysis, sequenced and taxonomically classified. A total of 25 different predominant genera were found in the diseased group and 14 genera in the healthy group. Species richness did not differ significantly between implants, neighboring teeth and teeth with largest probing depth in the diseased group. Additionally, no differences between teeth and implants in the healthy group were detected. In contrast, microbial diversity varied between the different sampling points. Species richness is similar in healthy and diseased sites, but the composition of the bacterial community differed within the individual subjects. The underlying analyses strongly suggest that complete transmission from neighboring teeth to implants is unlikely.
RESUMO
In the present study we aimed to analyze the bacterial community structure of oral biofilms at different maturation stages in young healthy adults. Oral biofilms established on membrane filters were collected from 32 human subjects after 5 different maturation intervals (1, 3, 5, 9 and 14 days) and the respective phylogenetic diversity was analyzed by 16S rDNA amplicon sequencing. Our analyses revealed highly diverse entire colonization profiles, spread into 8 phyla/candidate divisions and in 15 different bacterial classes. A large inter-individual difference in the subjects' microbiota was observed, comprising 35% of the total variance, but lacking conspicuous general temporal trends in both alpha and beta diversity. We further obtained strong evidence that subjects can be categorized into three clusters based on three differently occurring and mutually exclusive species clusters.
Assuntos
Bactérias/crescimento & desenvolvimento , Biofilmes/crescimento & desenvolvimento , Saúde , Boca/microbiologia , Humanos , Especificidade da Espécie , Adulto JovemRESUMO
BACKGROUND: To test the hypothesis that the oral cavity is a potential source for implantable pacemaker and cardioverter defibrillators infections, the bacterial diversity on explanted rhythm heart management devices was investigated and compared to the oral microbiome. METHODS: A metagenomic approach was used to analyze the bacterial diversity on the surfaces of non-infected and infected pacemakers. The DNA from surfaces swaps of 24 non-infected and 23 infected pacemaker were isolated and subjected to bacterial-specific DNA amplification, single strand conformation polymorphism- (SSCP) and sequencing analysis. Species-specific primer sets were used to analyze for any correlation between bacterial diversity on pacemakers and in the oral cavity. RESULTS: DNA of bacterial origin was detected in 21 cases on infected pacemakers and assigned to the bacterial phylotypes Staphylococcus epidermidis, Propionibacterium acnes, Staphylococcus aureus, Staphylococcus schleiferi and Stapyhlococcus. In 17 cases bacterial DNA was found on pacemakers with no clinical signs of infections. On the basis of the obtained sequence data, the phylotypes Propionibacterium acnes, Staphylococcus and an uncultured bacterium were identified. Propionibacterium acnes and Staphylococcus epidermidis were the only bacteria detected in pacemeaker (n = 25) and oral samples (n = 11). CONCLUSIONS: The frequency of the coincidental detection of bacteria on infected devices and in the oral cavity is low and the detected bacteria are highly abundant colonizers of non-oral human niches.The transmission of oral bacteria to the lead or device of implantable pacemaker or cardioverter defibrillators is unlikely relevant for the pathogenesis of pacemaker or cardioverter defibrillators infections.
Assuntos
Desfibriladores/microbiologia , Boca/microbiologia , Marca-Passo Artificial/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Idoso , Biofilmes , DNA Bacteriano/análise , DNA Bacteriano/isolamento & purificação , Feminino , Humanos , Masculino , Metagenômica , Propionibacterium acnes/genética , Propionibacterium acnes/isolamento & purificação , Staphylococcus/genética , Staphylococcus/isolamento & purificaçãoRESUMO
OBJECTIVES: We here investigated whether experimental gingivitis enhances systemic markers of inflammation which are also known as surrogate markers of atherosclerotic plaque development. BACKGROUND: Gingivitis is a low-level oral infection induced by bacterial deposits with a high prevalence within Western populations. A potential link between the more severe oral disease periodontitis and cardiovascular disease has already been shown. METHODS: 37 non-smoking young volunteers with no inflammatory disease or any cardiovascular risk factors participated in this single-subject interventional study with an intra-individual control. Intentionally experimental oral inflammation was induced by the interruption of oral hygiene for 21 days, followed by a 21-days resolving phase after reinitiation of oral hygiene. Primary outcome measures at baseline, day 21 and 42 were concentrations of hsCRP, IL-6, and MCP-1, as well as adhesion capacity and oxLDL uptake of isolated blood monocytes. RESULTS: The partial cessation of oral hygiene procedures was followed by the significant increase of gingival bleeding (34.0%, P<0.0001). This local inflammation was associated with a systemic increase in hsCRP (0.24 mg/L, Pâ=â0.038), IL-6 (12.52 ng/L, Pâ=â0.0002) and MCP-1 (9.10 ng/l, Pâ=â0.124) in peripheral blood samples between baseline and day 21, which decreased at day 42. Monocytes showed an enhanced adherence to endothelial cells and increased foam cell formation after oxLDL uptake (P<0.050) at day 21 of gingivitis. CONCLUSIONS: Bacterial-induced gingival low-level inflammation induced a systemic increase in inflammatory markers. Dental hygiene almost completely reversed this experimental inflammatory process, suggesting that appropriate dental prophylaxis may also limit systemic markers of inflammation in subjects with natural gingivitis. International Clinical Trials Register Platform of the World Health Organization, registry number: DRKS00003366, URL: http://apps.who.int/trialsearch/Default.aspx.
Assuntos
Biomarcadores/sangue , Gengivite/fisiopatologia , Inflamação/fisiopatologia , Adulto , Sequência de Bases , Células Cultivadas , Primers do DNA , Placa Dentária/microbiologia , Feminino , Gengivite/sangue , Gengivite/microbiologia , Humanos , Inflamação/sangue , Masculino , Reação em Cadeia da Polimerase , Valores de Referência , Adulto JovemRESUMO
One of the principal problems in oral implantation is inflammation of peri-implant hard and soft tissues caused by bacterial biofilms. The purpose of the present study was to evaluate the microbial diversity of peri-implant biofilms on 2 different implant-anchored attachment types in vivo. Samples of peri-implant sulcus fluid were collected from 8 patients with implant-supported bar attachments and 8 patients with implant-anchored telescopic double crown attachments. Samples of sulcus fluid of the adjacent teeth were also collected from the partially edentulous patients with implant fixed telescopic double crowns. The mixed amplicons of 16S rRNA fragments of different bacterial origins were separated by use of single-strand conformation polymorphism analysis to identify the predominant bacterial genera. With 3.5 ± 2.1 different predominant bacterial genera in the sulcus fluid surrounding implant-supported bar attachments and 6.3 ± 3.1 different predominant genera in the sulcular fluid of implant-anchored double crown attachments, the differences were not statistically significant (P = .11). The microbial diversity in the sulcus fluid surrounding the remaining dentition was similar to that of the implant fixed telescopic attachments (6.3 ± 2.1). Aside from host response and other individual factors, the microbial diversity of peri-implant biofilms seems to be impaired by cofactors such as the possibility of cleaning the implant-supported supraconstructions and the different plaque-retaining sites. Nevertheless, these differences do not lead to statistically significant differences in the microbial diversity of peri-implant plaques.
Assuntos
Biofilmes , Implantes Dentários/microbiologia , Retenção em Prótese Dentária/instrumentação , Líquido do Sulco Gengival/microbiologia , Idoso , Idoso de 80 Anos ou mais , Biodiversidade , Coroas/microbiologia , Feminino , Fusobacterium , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Conformacional de Fita Simples , Porphyromonas , RNA Bacteriano/genética , Análise de Sequência de DNA , Streptococcus , VeillonellaRESUMO
The clinical implementation of percutaneous implants is still limited owing to infections at the side of the stoma. In our concept, this issue is addressed by designing copolymer surface coatings possessing biocompatibility and antimicrobial activity to improve the maintenance of a physiological skin seal at the skin-implant interface. Different copolymers with surface-active phosphonate and antimicrobial cationic groups were designed. Thus, coated titanium samples were cultured with bacterial strains or fibroblasts, respectively. Antimicrobial impact was evaluated by imaging the reduction of bacterial adherence. Biocompatibility was displayed by fibroblast proliferation and morphology. A variety of copolymers of 4-vinylpyridine with vinylbenzylphosphonate or dimethyl(2-methacryloyloxy-ethyl) phosphonate were prepared by free radical polymerization. The optimized polymer coating (copolymer D) showed a reduction of adherent bacteria up to 95%, with only a slight reduction in the adherence of human fibroblasts compared with blank titanium controls. In this study, we demonstrate in vitro that polymer surface coatings can be simultaneously antimicrobial and biocompatible. We consider this to be a promising technology for the realization of a permanent aseptic percutaneous passage as needed for the advancement of osseointegrated limb prosthesis.
Assuntos
Anti-Infecciosos/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Materiais Revestidos Biocompatíveis/síntese química , Materiais Revestidos Biocompatíveis/farmacologia , Contaminação de Equipamentos/prevenção & controle , Prótese Articular/microbiologia , Osseointegração/fisiologia , Anti-Infecciosos/química , Análise de Falha de Equipamento , Teste de Materiais , Osseointegração/efeitos dos fármacos , Desenho de PróteseRESUMO
The long-term success of osseointegrated oral implants is endangered by inflammation of peri-implant hard and soft tissues caused by bacterial biofilms that may have been initiated by bacterial transmission from the adjacent dentition. The present study aimed to compare the bacterial communities at inflamed implant and tooth sites by broad-range PCR techniques to evaluate the etiological processes of peri-implant and periodontal diseases and potential future therapeutic strategies. Eighteen samples of peri-implant and periodontal microflora were collected from nine partially edentulous patients with implant-retained crowns or bridges revealing clinical signs of gingivitis or mucositis. The clinical parameters plaque index (PI), probing depth (PD), and bleeding on probing were recorded. Amplified fragments of bacterial 16S rRNA genes were separated by use of single-strand conformation polymorphism analysis, and sequences were determined to identify the predominant bacterial genera. The clinical parameters PI and PD were significantly different at implants (PI = 0.4 ± 0.7, PD = 3.1 ± 0.6 mm) compared with teeth (PI = 1.8 ± 0.8, PD = 2.5 ± 0.2 mm). A total of 20 different genera were found at the inflamed tooth and implant sites. The microbial diversity of the microflora surrounding the remaining dentition (12.0 ± 3.8) was significantly higher (p = 0.01) than the diversity of the peri-implant microflora at implant-retained crowns or bridges (6.3 ± 2.3). Within the limitations of the present study, the microbial diversity of the investigated implants and teeth with clinical signs of mucositis or gingivitis exhibits substantial differences, demonstrating that transmission of the complete bacterial microflora from teeth to implants could be excluded. Furthermore, broad-range molecular biological detection methods specify bacterial genera and species in the peri-implant and periodontal microflora which were not in the focus of research interests so far.
Assuntos
Gengivite/microbiologia , Arcada Parcialmente Edêntula/microbiologia , Metagenoma/genética , Peri-Implantite/microbiologia , Periodonto/microbiologia , Adulto , Idoso , Biodiversidade , Biofilmes , Implantes Dentários/microbiologia , Índice de Placa Dentária , Prótese Dentária Fixada por Implante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Mucosite/microbiologia , Polimorfismo Conformacional de Fita Simples , Estatísticas não ParamétricasRESUMO
The aim of the present in vivo study was to examine the effect of polytetrafluoroethylene (PTFE) surfaces on biofilm formation on dental implant abutments in comparison to titanium surfaces. Fifteen modified abutments with incorporated PTFE plates were inserted in 10 patients for 14 days. Scanning electron microscopy techniques were used to examine biofilm formation on different surfaces and to determine the percentage of surface coverage. Significantly less biofilm was detected on PTFE surfaces than on titanium surfaces. The results of this study reveal that PTFE surfaces reduce biofilm formation to a minimum on dental implant abutments. Int J Prosthodont 2011;24:373-375.
Assuntos
Implantes Dentários , Titânio , Biofilmes , Humanos , Politetrafluoretileno , Propriedades de SuperfícieRESUMO
OBJECTIVE: To test the null hypothesis that stainless steel and ceramic brackets show no differences in biofilm adhesion. MATERIALS AND METHODS: Twenty adolescents (6 boys, 14 girls) who had received fixed orthodontic therapy for 18.9 ± 3.2 months were divided into a metal and a ceramic bracket group. Thirty brackets per group were taken from central incisors, canines, and second premolars and quantitatively analyzed for biofilm coverage with the Rutherford backscattering detection method. Five micrographs were obtained per bracket with views from the buccal, mesial, distal, gingival, and occlusal aspects, resulting in a total of 300 images. Biofilm formation between groups was compared using the Mann-Whitney U-test (α = .05). RESULTS: Total biofilm formation was 12.5% ± 5.7% (3.3 ± 1.6 mm(2)) of the surface on metal and 5.6% ± 2.4% (1.5 ± 0.6 mm(2)) on ceramic brackets. Differences between groups were statistically significant (P < .05). A pairwise comparison of biofilm formation revealed significantly lower biofilm formation on ceramic brackets with respect to intraoral location (central incisor, canine, second premolar) and bracket surface (buccal, mesial, distal). CONCLUSIONS: The hypothesis was rejected. The results indicate that ceramic brackets exhibit less long-term biofilm accumulation than metal brackets.
Assuntos
Biofilmes/crescimento & desenvolvimento , Cerâmica/química , Ligas Dentárias/química , Braquetes Ortodônticos/microbiologia , Aço Inoxidável/química , Adolescente , Aderência Bacteriana , Dente Pré-Molar/microbiologia , Dente Canino/microbiologia , Índice de Placa Dentária , Feminino , Seguimentos , Hemorragia Gengival/classificação , Humanos , Processamento de Imagem Assistida por Computador , Incisivo/microbiologia , Estudos Longitudinais , Masculino , Microscopia Eletrônica de Varredura , Índice Periodontal , Bolsa Periodontal/classificação , Espectrometria por Raios X , Propriedades de SuperfícieRESUMO
BACKGROUND: Infections after prosthetic replacement of the aorta remain a serious and life-threatening complication. The only appropriate treatment is the surgical removal of the infected prosthesis. Accordingly, there is a need for new procedures to prevent the infection of vascular prostheses. This in vitro experiment investigated the effect of the pretreatment of vascular prostheses with antibiotics (daptomycin or baneocin) and the effect of antibiotics combined with fibrin sealant as possible prophylaxis of perioperative graft infection. METHODS: Untreated prostheses served as controls. Pretreated prostheses of double woven velour vascular grafts were contaminated with Staphylococcus epidermidis, and colony-forming units were counted each day (CFU/mL). RESULTS: The period of sterility differed significantly as a function of the pretreatment. Uncoated prostheses were immediately non-sterile and exhibited 2.63 ± 0.61 × 10(5) CFU/mL. Baneocin pretreatment resulted in sterility for 1.7 ± 0.6 (95% confidence interval (CI) 1.0-2.4) d before we detected 2.14 ± 0.57 × 10(5) CFU/mL on the prostheses. Pretreatment with daptomycin yielded 2.9 ± 0.4 (CI 2.6-3.2) and fibrin sealant/baneocin compound yielded 3.1 ± 0.3 (CI 2.9-3.3) d of sterility, after which 1.81 ± 0.86 × 10(5) CFU/mL and 1.04 ± 0.77 × 10(5) CFU/mL were recorded. Finally, pretreatment with fibrin sealant/daptomycin led to sterility for 7.1 ± 0.3 (CI 6.9-7.3) d, after which 0.77 ± 0.60 × 10(5) CFU/mL were observed on the prostheses. CONCLUSIONS: The risk of vascular graft infection is reduced by pretreating the prostheses with antibiotics. The antibiotic/fibrin compound exhibited an effect of delayed antibiotic release. Vascular prostheses should therefore be pretreated with antibiotic solution to reduce bacterial adhesion. This procedure might be an effective prophylaxis for perioperative vascular graft infection and provides suitable protection for the prosthetic material.
Assuntos
Antibacterianos/uso terapêutico , Aortite/prevenção & controle , Prótese Vascular/microbiologia , Daptomicina/uso terapêutico , Sistemas de Liberação de Medicamentos/métodos , Infecções Relacionadas à Prótese/prevenção & controle , Aortite/tratamento farmacológico , Aortite/epidemiologia , Bacitracina/uso terapêutico , Prótese Vascular/efeitos adversos , Contagem de Colônia Microbiana , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Técnicas In Vitro , Neomicina/uso terapêutico , Poliésteres , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus epidermidisRESUMO
PURPOSE: The objective of this investigation was to evaluate the influence of differently shaped preliminary cuts in combination with artificial aging on the load-bearing capacity of four-unit zirconia fixed dental prostheses (FDPs). MATERIALS AND METHODS: Forty frameworks were fabricated from white-stage zirconia blanks (InCeram YZ, Vita) by means of a computer-aided design/computer-aided manufacturing system (Cerec inLab, Sirona). Frameworks were divided into four homogeneous groups with ten specimens each. Prior to veneering, frameworks of two groups were "damaged" by defined saw cuts of different dimensions, to simulate accidental flaws generated during shape cutting. After the veneering process, FDPs, with the exception of a control group without preliminary damage, were subjected to thermal and mechanical cycling (TMC) during 200 days storage in distilled water at 36°C. Following the aging procedure, all specimens were loaded until fracture, and forces at fracture were recorded. The statistical analysis of force at fracture data was performed using two-way ANOVA, with the level of significance chosen at 0.05. RESULTS: Neither type of preliminary mechanical damage significantly affected the load-bearing capacity of FDPs. In contrast, artificial aging by TMC proved to have a significant influence on the load-bearing capacity of both the undamaged and the predamaged zirconia restorations (p < 0.001); however, even though load-bearing capacity decreased by about 20% due to simulated aging, the FDPs still showed mean load-bearing capacities of about 1600 N. CONCLUSIONS: The results of this study reveal that zirconia restorations have a high tolerance regarding mechanical damages. Irrespective of these findings, damage to zirconia ceramics during production or finishing should be avoided, as this may nevertheless lead to subcritical crack growth and, eventually, catastrophic failure. Furthermore, to ensure long-term clinical success, the design of zirconia restorations has to accommodate the decrease in load-bearing capacity due to TMC in the oral environment.
Assuntos
Materiais Dentários/química , Prótese Parcial Fixa , Zircônio/química , Cimentação , Desenho Assistido por Computador , Dente Suporte , Porcelana Dentária/química , Falha de Restauração Dentária , Facetas Dentárias , Planejamento de Dentadura , Cimentos de Ionômeros de Vidro/química , Humanos , Óxido de Magnésio/química , Teste de Materiais , Microscopia Eletrônica de Varredura , Cimento de Policarboxilato/química , Estresse Mecânico , Propriedades de Superfície , Temperatura , Água/química , Óxido de Zinco/químicaRESUMO
INTRODUCTION: The use of medical devices, such as cardiac pacemakers, prosthetic heart valves and vascular prostheses, has become a routine treatment procedure in cardiovascular medicine. Unfortunately, bacterial infections of these devices are a serious and sometimes life-threatening for the patient, necessitating explantation. Despite implementing different prophylactic strategies to avoid contamination of the device, infections do occur. This study analysed the additional hospital costs associated with managing cardiac device infections, with special focus on cardiac pacemakers/defibrillators, prosthetic heart valves and vascular prostheses. METHODS: Out of more than 2000 operations performed in our institution in 2006, we had 462 implantations/replacements of cardiac pacemakers/implantable cardioverter defibrillators (ICDs), 577 valve replacement procedures and 613 vascular operations. Among these, we analysed all patients who received operations because of an infection of their cardiac or vascular device. Our investigations focussed on standard parameters regarding additional hospital costs, including length of stay in hospital, required time in the operating room and time in the intensive care unit. RESULTS: In 2006, we had nine cases (n=9) of prosthetic valve endocarditis in our hospital. The average length of stay in hospital for these patients was 25 days, resulting in euro72096 of additional hospital costs per case. Infection of vascular prostheses (n=6) leads to euro35506 per case and 28 days in the hospital. If an infection of cardiac pacemakers (n=7) does occur, the therapy causes a mean additional hospital cost of euro7091. CONCLUSION: Cardiac device infections are serious and sometimes life-threatening. Therapy and eradication are difficult and protracted and cause high additional hospital costs. Based on our statistical data and the mean incidence of cardiac device infections, we presume for Germany between euro38 and euro140 million in additional hospital costs per year are incurred by infections of implantable cardiovascular devices. Active surveillance and establishment of a central register with documentation of every implantation and the occurrence of any infection can only realise detailed estimates of the economic damage caused by infection of cardiovascular implants. In consideration of the economic consequences, successful strategies must be developed to reduce the incidence of infections.
Assuntos
Infecções Bacterianas/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Infecções Relacionadas à Prótese/economia , Idoso , Prótese Vascular/economia , Prótese Vascular/microbiologia , Desfibriladores Implantáveis/economia , Desfibriladores Implantáveis/microbiologia , Endocardite Bacteriana/economia , Feminino , Alemanha , Próteses Valvulares Cardíacas/economia , Próteses Valvulares Cardíacas/microbiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/economia , Marca-Passo Artificial/microbiologia , Reoperação/economiaRESUMO
PURPOSE: The aim of the present study was to establish a noninvasive method for quantitative analysis of supra- and subgingival biofilm formation on dental implants considering different surface modifications. MATERIALS AND METHODS: Patients of both sexes were included. They had to be in generally good health, partially edentulous, and the recipient of at least 1 screw-type implant with an abutment possessing supra- and subgingival areas. Healing abutments were inserted for 14 days. The abutment surfaces were divided into quadrants that were sandblasted, ground, acid-etched, and untreated (with the latter surface as a control). Biofilm formation on the healing abutments was analyzed using scanning electron microscopy, including secondary-electron and Rutherford backscattering-detection methods. Calculation of biofilm-covered surfaces was performed depending on grey-values, considering supra- and subgingival areas. After calculating absolute and relative biofilm-covered surfaces depending on localization, the influence of surface modification on biofilm formation was analyzed. RESULTS: Fifteen healing abutments were inserted in 11 patients. In all surface properties plaque adhesion in supragingival areas was significantly higher (17.3% +/- 23.1%) than in subgingival areas (0.8% +/- 1.0%). Biofilm accumulation in supragingival areas was significantly increasing by higher surface roughness, whereas this influence was not detected in subgingival areas. CONCLUSION: The described method is valuable for investigation of supra- and subgingival biofilm adhesion on surface-modified implant abutments. There was a significant influence of surface localization (supra- and subgingival) as well as surface modification on biofilm formation.