Clinical and radiographic assessment of circular versus triangular cross-section neck implants in the posterior maxilla: Five-year follow-up of a randomized controlled trial.

OBJECTIVES: Dental implants with a triangular neck design have been developed in order to maintain peri-implant bone. The primary aim of this randomized controlled trial (RCT) was to assess after 5 years the peri-implant bone stability and the peri-implant soft tissue conditions with this new triangular implant neck design compared to a conventional round neck implant design. MATERIAL AND METHODS: This is a secondary evaluation of a RCT including 34 patients. Patients were recalled after 1, 3, and finally 5 years to assess implant survival and peri-implant bone levels using standardized radiographs. Peri-implant soft tissue health was also evaluated by recording probing depth, plaque index and Bleeding on Probing. Patient Reported Outcome Measures (PROMs) and the Pink Esthetic Score were also assessed. RESULTS: No implant loss occurred during the 5-year follow up period. The mean ± SD proximal bone remodeling after 5 years reached 0.38 ± 0.39 mm for the circular design and 0.29 ± 0.58 mm for the triangular design (p = .49). Peri-implant soft tissue health parameters and PROMs were found to be comparable. Altogether, 80% of implants presented peri-implant mucositis whereas one implant (4%) displayed sings of peri-implantitis. CONCLUSION: The 5-year evaluation of the triangular neck implants showed similar results to the circular neck implants.

Clinical and radiographic assessment of circular versus triangular cross-section neck Implants in the posterior maxilla: A 1-year randomized controlled trial.

OBJECTIVES: Implants with a triangular neck were recently introduced to limit peri-implant bone loss. The primary objective of this randomized controlled trial was to compare peri-implant bone changes of circular versus triangular cross-section neck implants 1 year after loading. The secondary objectives were to assess buccal hard tissue thickness changes, Pink Esthetic Score (PES), and patient satisfaction. MATERIAL AND METHODS: Thirty four patients requiring replacement of the single, intercalated missing tooth of healed site for at least 4 months in the posterior maxilla were randomized into 2 groups according to the type of implant. Immediately after surgery and 1 year after final restoration, a cone beam CT (CBCT) was performed to assess proximal bone remodeling and buccal bone thickness. Peri-implant soft tissue health, PES, and patient-reported outcome measures (PROMs) were recorded. RESULTS: No implant loss occurred within the follow-up period. The mean ± SD peri-implant proximal bone loss 1 year after loading was 0.22 ± 0.30 mm for triangular and 0.42 ± 0.67 mm for circular implants necks (p = .25). Peri-implant bone loss exceeding 2 mm was observed in a single implant in the circular neck group. Buccal bone thickness remained stable and did not differ different between the 2 groups. The peri-implant soft tissue health, PES, and patient satisfaction were also comparable. CONCLUSIONS: Within the limitations of the present study, patient clinical and radiographic outcomes did not differ between triangular and circular cross-section neck implants in the posterior maxilla.

Patient Eligibility for Standardized Treatment of the Edentulous Mandible: A Retrospective CBCT-Based Assessment of Mandibular Morphology.

The aim of the study was to evaluate the proportion of patients recommended for full-arch mandibular restoration that would be eligible for treatment with a recently developed premanufactured full-arch prosthesis (Trefoil™, Nobel Biocare) based on the morphology of their lower jaw. Anonymized cone beam computed tomography (CBCT) data from 100 partially and fully edentulous patients referred for full-arch mandibular restoration were retrospectively collected from an imaging center database. Using custom-built software, CBCTs of mandibles were registered to a reference CBCT of a patient treated previously with a premanufactured full-arch prosthesis to determine if patients had adequate horizontal width and vertical height for implant placement. Bone height and thickness around simulated implants and distances to the incisive canal were evaluated. Mandibular arch width and semi-automated volume calculations were also performed. Using the system-specific 5.0 mm diameter implants with lengths of 13 and 11.5 mm, 85% and 86% of patients, respectively, were eligible for treatment with the standardized prosthesis. Eligibility was higher for men than women (odds ratio = 3.9, p = 0.045) due to increased bone volume. Based on mandibular morphology, our results suggest that the standardized treatment concept could serve a large percentage of patients with edentulous mandibles or failing dentition in the mandible.

Cross-Sectional Assessment of Achievement of Therapeutic Goals in a Canadian Multidisciplinary Clinic for Patients With Advanced Chronic Kidney Disease.

BACKGROUND: The implementation of advanced chronic kidney disease (CKD) multidisciplinary clinics has now demonstrated their effectiveness in delaying and even avoiding dialysis for patients with CKD. However, very little has been documented on the management and achievement of targets for a number of parameters in this context. OBJECTIVE: Our goal was to assess our multidisciplinary clinic therapy performance in relation to the targets for hypertension, anemia, and calcium phosphate assessment. DESIGN AND SETTING: A cross-sectional descriptive study was conducted with a cohort including all patients followed up in our multidisciplinary clinic in July 2014. MEASUREMENTS: Comorbidity, laboratory, and clinical data were collected and compared with the recommendations of scientific organizations. RESULTS: The cohort included 128 patients, 37.5% of whom were women. Mean follow-up time was 26.6 ± 25.1 months and mean estimated glomerular filtration rate (eGFR) was 14.0 ± 4.7 mL/min/1.73 m2. A total of 24.2% of patients with diabetes achieved blood pressure targets of <130/80 mm Hg, while 56.5% of patients without diabetes achieved targets of <140/90 mm Hg. Hemoglobin of patients treated with erythropoiesis-stimulating agents was 100 to 110 g/L in 36.2% of the patients, below 100 for 39.7% of them, and above 110 for 24.1%, whereas 67.2% were within the acceptable limits of 95 to 115 g/L. In addition, 63.4% of patients had a serum phosphate of <1.5 mmol/L, and 90.9% of patients had total serum calcium <2.5 mmol/L. LIMITATIONS: Our study is a single center study with the majority of our patients being Caucasian. This limits the generalizability of our findings. CONCLUSION: The control rates of various parameters were satisfactory given the difficult clinical context, but could be optimized. We publish these data in the hope that they are helpful to others engaged in quality improvement in their own programs or more generally.

CONTEXTE: L'implantation de cliniques multidisciplinaires spécialisées en néphropathie chronique de stade avancé a prouvé leur efficacité à retarder ­ voire à éviter ­ le recours à la dialyse chez les patients atteints d'insuffisance rénale chronique (IRC). Cependant, il existe peu de littérature sur la gestion et l'atteinte d'objectifs propres à un tel contexte en regard de certains paramètres. OBJECTIF DE L'ÉTUDE: Nous avons voulu évaluer l'efficacité thérapeutique de notre clinique multidisciplinaire par rapport aux paramètres suivants : l'hypertension, l'anémie et le taux de phosphate de calcium. CADRE ET TYPE D'ÉTUDE: Une étude descriptive transversale a été menée auprès d'une cohorte constituée de tous les patients suivis à notre clinique multidisciplinaire en juillet 2014. MESURES: On a colligé les comorbidités, les résultats de laboratoire et les données cliniques des patients. Ces données ont ensuite été comparées aux valeurs recommandées par la communauté scientifique. RÉSULTATS: La cohorte comptait 128 patients, 37,5 % étaient des femmes. La durée moyenne du suivi était de 26,6 ± 25,1 mois et le DFGe moyen des participants était de 14,0 ± 4,7 mL/min/1,73 m2. Seuls 24,2 % des patients diabétiques présentaient une tension artérielle inférieure à 130/80 mm Hg, soit la valeur cible pour ce groupe de patients, alors que 56,5 % des non-diabétiques ont maintenu leur tension artérielle sous la valeur cible de 140/90 mm Hg. Le taux d'hémoglobine des patients traités avec des agents stimulant l'érythropoïèse se situait entre 100 et 110 g/L dans 36,2 % des cas; 39,7 % présentaient un taux d'hémoglobine inférieur à 100 g/L, et 24,1 % présentaient un taux supérieur à 110 g/L. Dans la majorité des cas (67,2 %), le taux d'hémoglobine se situait dans les limites acceptables, soit entre 95 et 115 g/L. Enfin, 63,4 % des participants à l'étude présentaient des valeurs de phosphate sérique inférieures à 1,5 mmol/L et un total de 90,9 % des patients présentaient des valeurs de calcium sérique inférieures à 2,5 mmol/L. LIMITES DE L'ÉTUDE: Notre étude s'est tenue dans un seul établissement et auprès d'une population à majorité caucasienne, ce qui limite la généralisation de nos résultats. CONCLUSION: Compte tenu du contexte clinique difficile, nous considérons les taux de contrôle pathologique atteints pour les paramètres étudiés comme satisfaisants, quoiqu'ils puissent encore être améliorés. Nous publions ces résultats dans l'espoir qu'ils serviront notamment à l'amélioration de programmes mis sur pied par d'autres équipes.