Immediate Implant Placement, Immediate Load With Same-Day Fully Digital Fabrication of a Screw-Retained Provisional Implant Prosthesis.

This article describes the use of technology capable of converting a failed dentition to a full-arch screw-retained implant-supported provisional restoration in one day using a fully digital restorative protocol. With this expedited digital treatment, the transition to a restored dentition is completed without the need for any physical impressions. Predicated on facially driven virtual smile designs, sophisticated engineering designs, complex algorithms, artificial intelligence, and novel laboratory and clinical workflows, the protocol allows for streamlined, same-day digital delivery of an in-house 3D-printed provisional prosthesis after implant placement surgery.

Benchmark for Tooth Replacement: Immediate Implant With Immediate Provisional Restoration. Outcome Analytics From 29 Years of Documentation.

This article focuses on evidence-based documentation of immediate implant surgery with immediate provisional restoration. Since 1988 the author has documented 14,946 implant surgical sites as to protocol, size of implant, regenerative regimen, outcome, and long-term follow-up. There were 8,319 immediate implant sites: 2,493 were immediate implant/immediate provisional restorations (IIIPR), and 5,826 were immediate implant/no restoration (IINR). The cumulative success rate of IIIPR was 95.1%, while IINR was 94.5%. Patients and dentists were canvassed as to outcome satisfaction of the procedure and final esthetics. The author concludes that IIIPR compares favorably to IINR; IIIPR were reproducible in diverse clinical situations, produced a steady state of bone and soft tissue under loading, and provided high patient satisfaction.

Clinical and Radiographic Evaluation of Brånemark Implants with an Anodized Surface following Seven-to-Eight Years of Functional Loading.

The aim of this study was to evaluate the clinical and radiographic long-term outcomes of dental implants with an anodized TiUnite surface, placed in routine clinical practice. Two clinical centers participated in the study. One hundred and seven implants (80 in the maxilla and 27 in the mandible) in 52 patients were followed in the long term. Both one- and two-stage techniques were used for 38 and 69 implants, respectively. Thirty-eight single tooth restorations and 22 fixed partial prostheses were delivered, according to a delayed loading protocol, within 4 to 12 months since implant placement. All implants were stable at insertion and at the long-term follow-up visit, which occurred between 7 and 8 years of functional loading. The mean followup was 7.33 ± 0.47 years. The mean marginal bone level change at the long-term followup as compared to baseline was 1.49 ± 1.03 mm. No implant failure occurred. Healthy peri-implant mucosa was found around 95% of implants, whereas 91% of implants showed no visible plaque at the implant surfaces at the long-term followup. The study showed that dental implants with the TiUnite anodized surface demonstrate excellent long-term clinical and radiographic outcomes.

Improving the appropriateness of laboratory submissions for urinalysis from general practice.

BACKGROUND: Urine is the most common microbiology laboratory specimen. Submissions increase annually by 5-10%, and many specimens may be unnecessary. OBJECTIVES: To assess the impact of guidance, implemented by interactive workshops and reinforced with modified request forms, on specimen submission. METHODS: This was a prospective randomized controlled study with modified Zelen design. The study population comprised five primary care trusts (PCTs) in Gloucestershire/County Durham/Darlington, containing 82 general practices in six geographical clusters. The six clusters were randomly assigned to urine workshop covering submission in the elderly, adults and children or a control workshop. Within these groups, half the practices were randomized to receive modified laboratory forms emphasizing the workshop messages. Practices were not aware of the study. RESULTS: Workshops lead to a 12% reduction in urine submissions from 16- to 64-year olds, which persisted for the 15 months but had no effect on bacteriuria rate. Workshops had no significant effect in the elderly or children. Modified forms were not associated with any reduction in submissions but were associated with an 11% reduction in detection of significant bacteriuria in 16- to 64-year olds. CONCLUSIONS: The 12% decrease in urine submissions from 16- to 64-year olds, attained with workshops, may help counter relentlessly rising test submissions. Modified forms are currently not worth pursuing. When educational workshops are used across PCTs to change practice, the change in test submission is smaller than attained in educational initiatives involving volunteers. Workshops may be more effective if they also discuss urine submissions from asymptomatic patients and are directed at high testing practices and care homes.

Interactive workshops increase chlamydia testing in primary care--a controlled study.

BACKGROUND: Primary care clinicians suggest that staff education is needed to increase chlamydia testing appropriately. OBJECTIVES: To determine if interactive workshops and modified laboratory request forms could increase testing and case detection. STUDY DESIGN: Prospective cluster randomized controlled study, using modified Zelen's design, examining the effect of workshops and modified request forms on primary care clinicians' chlamydia specimen submission and case positivity rate. STUDY POPULATION: 82 general practices in six geographical clusters within five primary care trusts (PCTs) in Gloucestershire and County Durham and Darlington. INTERVENTION: Practices within geographical clusters were randomly assigned to workshops on chlamydia or a control consisting of comparable workshops on the management of urinary symptoms, held in PCT-protected learning time. Half the practices were randomized to receive modified laboratory request forms. Staff were unaware that they were part of a study. RESULTS: Interactive workshops increased chlamydia testing in 16- to 24-year-old women by 33% in intervention practices compared to controls with effect persisting at 10 months (P = 0.003). No associated rise in the number of chlamydia infections was detected (P = 0.91), suggesting that increased testing may have occurred in a lower risk population. Modified forms did not change test submission (P = 0.75). CONCLUSIONS: Interactive workshops for general practices can be used to successfully increase chlamydia-testing rates. Chlamydia detection rates will need to be monitored as this type of educational programme may not increase absolute numbers of chlamydia infections detected, if patients at lower risk of infection are inappropriately tested. Other interventions may need to be combined with the workshops, to reach sufficiently high chlamydia screening rates to significantly reduce prevalence of chlamydial infection.

Immunogenicity of a fourth dose of Haemophilus influenzae type b (Hib) conjugate vaccine and antibody persistence in young children from the United Kingdom who were primed with acellular or whole-cell pertussis component-containing Hib combinations in infancy.

In response to the rising incidence of Haemophilus influenzae type b (Hib) disease in the United Kingdom, a national campaign to give a booster dose of single-antigen Hib conjugate vaccine to children aged 6 months to 4 years was undertaken in 2003. Children (n = 386) eligible for Hib vaccine in the campaign were recruited. Hib antibody concentrations were measured before boost and at 1 month, 6 months, 1 year, and 2 years after boost and were analyzed according to children's ages at booster dose and whether a Hib combination vaccine containing acellular pertussis (aP) or whole-cell pertussis (wP) components was given in infancy. The geometric mean antibody concentrations (GMCs) before the booster declined as the time since primary immunization increased (P < 0.001), and GMCs were threefold higher in recipients of wP-Hib than aP-Hib combination vaccines (P < 0.001). GMCs 1 month after the booster increased with age (P < 0.001) as follows: 6 to 11 months; 30 microg/ml (95% confidence interval [CI], 22 to 40); 12 to 17 months, 68 microg/ml (95% CI, 38 to 124); and 2 to 4 years, 182 microg/ml (151 to 220), with no difference according to the type of priming vaccine received. Antibody levels declined after the booster, but 2 years later, GMCs were more than 1.0 microg/ml for all age groups. By extrapolating data for the decline in antibody levels, we found the GMCs 4 years after boosting were predicted to be 0.6, 1.4, and 2.6 microg/ml for those boosted at 6 to 11 months, 12 to 17 months, and 2 to 4 years, respectively, with levels of at least 0.15 microg/ml in about 90% of individuals. A booster dose of Hib vaccine given after the first year of life should provide long-lasting protection.

Reactogenicity of meningococcal C conjugate vaccines when administered at the same time as, or a month prior to or after, tetanus and diphtheria booster vaccinations.

INTRODUCTION: This single blind study was conducted to address safety concerns regarding coadministration of diphtheria/ tetanus (DT,Td) boosters and meningococcal C conjugate (MCC) vaccines containing diphtheria or tetanus conjugate proteins. METHODS: 1754 subjects (835 preschoolers and 919 school leavers) were randomised to receive one of three MCC products a month before, after or at the same as routine DT or Td boosters. They (or their parents) completed a health diary for 10 days to record local reactions and systemic symptoms after each vaccination. The effect of antibody levels pre and post-vaccination, preexisting allergies and medication taken before and for up to ten days after vaccination on reactogenicity was assessed. RESULTS: No relationship between prevaccination antibody levels and local reactions or systemic symptoms was found. Local reactions were more common after DT/Td than MCC vaccination and were related to post-vaccination diphtheria and tetanus antibody levels in younger children and to the post-vaccination tetanus only antibody levels in older children. Preexisting allergies were not related to reactogenicity. Use of analgesics/antipyretic medication significantly reduced the incidence of local reactions and of some systemic symptoms. In the first three days after vaccination there was an excess of some systemic symptoms including fatigue/malaise and headache for all ages, and crying/ irritability for younger children and nausea/vomiting and dizziness/faintness for older subjects. Eleven serious adverse events were reported, none of which was deemed related to vaccination. CONCLUSION: MCC vaccines can be given under the above schedules and safely in the presence of raised diphtheria and tetanus antibody levels without materially altering reactogenicity profiles of either vaccine.

Influenza vaccine uptake and distribution in England and Wales using data from the General Practice Research Database, 1989/90-2003/04.

BACKGROUND: Routinely collected data from patients registered with general practices participating in the General Practice Research Database (GPRD) were used to analyse influenza vaccine uptake and distribution in England and Wales between 1989/90 and 1996/97. Major changes to influenza immunization policy were introduced in 1998 and 2000 when immunization of the elderly became age related rather than risk related. This new study examines trends in vaccine uptake for high- and low-risk patients and the impact of the policy changes on uptake in the elderly. METHODS: Between 0.5 and 2.7 million patients registered with practices participating in the GPRD from 1989 to 2004 were included. Data were examined by age group, medical risk group and evidence of vaccination per study year. RESULTS: Vaccine uptake among high-risk persons aged 65 or more increased from 36.7 per cent in 1989/90 to 72.1 per cent in 2003/04. For the same period, uptake rates for high-risk persons under 65 years increased from 10.8 to 24.3 per cent. For those at high risk, uptake by females was higher in all age groups up to 65 years. Of those that were vaccinated, a higher proportion of the 65 and over were vaccinated in October each year compared with the high risk under 65 (p < 0.001). CONCLUSIONS: Coverage among high-risk patients in younger age groups continues to fall well below satisfactory levels, especially among the youngest groups. Government policy should now focus on ways to improve uptake in these patients.

Prevention of perinatal transmission of hepatitis B to babies at high risk: an evaluation.

We aimed to determine factors associated with successful vaccination coverage and development of infection in high-risk infants born to hepatitis B infected women. Immunisation of 860/932 (92%) of babies was started within 48 h of birth and three doses of vaccination completed for 794/921 (86%). Only 543 (58%) infants were tested and 26 (4.9%) were found to have evidence of current infection. Delayed start of immunisation was significantly associated with unbooked pregnancy, maternal hepatitis B e-markers and year. Current infection in the baby was strongly associated with maternal hepatitis B e-status, ethnicity and year of vaccination. The proportion of infants developing infection declined after 1998, coinciding with the publication of national recommendations and the wider use of the accelerated schedule.