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J Prosthet Dent ; 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33454116


An oral prosthesis can help maintain a sense of normalcy by preserving psychosocial and physiologic function in the aftermath of a maxillary resection. Rehabilitating the resulting defect in a timely manner requires strategic choices in treatment sequencing and prosthetic design. This clinical report describes the process of fabricating a series of removable and implant-retained prostheses to minimize a patient's time without the restoration of critical craniofacial structures.

J Prosthodont ; 29(8): 725-729, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32794594


Amyloidosis of the tongue can result in significant and irreversible alterations of tooth position and function due to prolonged application of imbalanced force on the teeth by the enlarged tongue. Due to the rarity of this oral form of systemic disease, little has been elucidated on management of the resulting impaired oral function. While surgery can address the size of the tongue, it carries significant morbidities, enlargement can recur, and does not address adverse tooth positioning. Prosthetic rehabilitation can more aptly restore oral function but it also needs to be tailored based on the patient's expectations and goals as well as biologic and mechanical parameters of treatment. This report discusses an effective and noninvasive application of a tooth-supported, removable prosthesis with an onlay occlusal design to restore occlusion, speech, and esthetics in a patient with tongue-based amyloidosis.

Amiloidosis , Estética Dental , Enfermedades de la Lengua , Amiloidosis/complicaciones , Oclusión Dental , Humanos , Lengua/cirugía
Am J Prev Med ; 57(1): 41-50, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31128953


INTRODUCTION: Many type 2 diabetes patients show insufficient levels of physical activity and are often unmotivated to change physical activity behaviors. This study investigated whether a newly developed smartphone game delivering individualized exercise and physical activity promotion through an elaborate storyline can generate sustained improvements in daily physical activity (steps/day). STUDY DESIGN: Thirty-six participants were enrolled in this 24-week RCT between August 2016 and April 2018. After baseline assessment, participants were randomized in equal numbers to the intervention or control condition. Data analysis was performed in May-June 2018. SETTING/PARTICIPANTS: Inactive, overweight type 2 diabetes patients, aged 45-70 years, were recruited through advertising and from hospitals and diabetes care centers in the Basel, Switzerland, metropolitan area. INTERVENTION: Participants were instructed to play the innovative smartphone game (intervention group) or to implement the recommendations from the baseline lifestyle counseling (control group) autonomously during the 24-week intervention period. MAIN OUTCOME MEASURES: Primary outcomes were changes in daily physical activity (steps/day); changes in aerobic capacity, measured as oxygen uptake at the first ventilatory threshold; and changes in glycemic control, measured as HbA1c. RESULTS: Daily physical activity increased by an average of 3,998 (SD=1,293) steps/day in the intervention group and by an average of 939 (SD=1,156) steps/day in the control group. The adjusted difference between the two groups was 3,128 steps/day (95% CI=2,313, 3,943, p<0.001). The increase in daily physical activity was accompanied by an improved aerobic capacity (adjusted difference of oxygen uptake at the first ventilatory threshold of 1.9 mL/(kg·min), 95% CI=0.9, 2.9, p<0.001). Glycemic control (HbA1c) did not change over the course of the intervention. CONCLUSIONS: A novel, self-developed smartphone game, delivering multidimensional home-based exercise and physical activity promotion, significantly increases daily physical activity (steps/day) and aerobic capacity in inactive type 2 diabetes patients after 24 weeks. The ability of the game to elicit a sustained physical activity motivation may be relevant for other inactive target groups with chronic diseases. TRIAL REGISTRATION: This study is registered at NCT02657018.

Diabetes Mellitus Tipo 2/terapia , Ejercicio Físico , Motivación , Conducta Sedentaria , Teléfono Inteligente , Terapia Conductista , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suiza
J Prosthodont ; 28(6): 623-633, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30350385


PURPOSE: Systematic monitoring of important clinical outcomes is increasingly important for health-care decision making, especially in the context of continuous quality improvement. Dental implant failure within the first year (early failure) has been previously shown to be more common than subsequent failure. The purpose of this study was to identify associations between early implant failure and patient factors, surgical manipulations, and systemic conditions. MATERIALS AND METHODS: The authors retrospectively identified the records of consecutive adult patients with dental implants seen between 2000 and 2014 in the Department of Dental Specialties, at the Mayo Clinic. Demographic, surgical, and medical data were extracted from the database and individual medical records to determine time to first implant failure. Cox proportional hazards regression models were used to assess associations of demographic, surgical, and systemic conditions with implant failure during the first year post-implantation, summarized as hazard ratio (HR) (95% confidence interval [CI]). RESULTS: Among 8540 implants identified during the study period, 362 (4.2%) failed within the first year of placement at a mean (SD) of 129 (96) days after placement. On univariate analysis, most candidate predictors were not shown to influence first-year failure. Preplacement surgical manipulations associated with increased early implant failure were bone augmentation only (HR, 1.45; 95% CI, 1.02-2.05; p = 0.04), socket preservation (HR, 2.67; 95% CI, 1.33-5.38; p = 0.006), and xenogenic material (HR, 2.12; 95% CI, 1.11-4.04; p = 0.02). Alveoloplasty only at placement was associated with decreased early implant failure (HR, 0.33; 95% CI, 0.17-0.65; p = 0.001). Overall, 318 implants (3.7%) had surgical complications within the first year of placement at a mean (SD) of 110 (114) days after placement; any surgical complication was significantly associated with early implant failure (hazard ratio, 15.84; 95% CI, 11.10-22.61; p < 0.001). After adjustment for age, sex, and implant era, no single or multiple medical condition(s) and no single or multiple medication(s) increased patient risk of implant failure in the first year after placement. CONCLUSIONS: These findings support a targeted effort to reduce the incidence of surgical complications to reduce early failure of dental implants.

Implantación Dental Endoósea , Implantes Dentales , Adulto , Fracaso de la Restauración Dental , Humanos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos
J Prosthodont ; 28(1): 30-35, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30484925


PURPOSE: To identify associations between early implant failure and prosthodontic characteristics that could be used to guide subsequent continuous quality improvement efforts of patient care. MATERIALS AND METHODS: An implant-level analysis was performed in which data were abstracted from a prospective clinical database of all adult patients treated with implants and followed up from January 2000 through December 2014 at the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. These data were used to determine time to implant failure. Associations between prosthodontic characteristics and early implant failure were evaluated with Cox proportional hazards regression models and summarized with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Among 8762 implants in 2787 patients, 395 (4.5%) failed within the first year of placement at a mean (SD) of 127 (97) days (range, 2-364 days). Univariable analysis showed no associations between early implant failure and use of a cover screw, prosthesis, or definitive or provisional prosthesis at implant placement. Three of 25 single crowns failed, and use of a single crown was significantly associated with early implant failure (HR, 3.94; 95% CI, 1.08-14.35; P = 0.04). This study identified no significant associations between prosthodontic characteristics identified after implant placement and early implant failure. CONCLUSIONS: Use of a prosthesis at implant placement, use of a definitive or provisional prosthesis, and early mechanical complications were not associated with increased risk of early implant failure. Quality improvement efforts should focus on aspects of decision making that aim to decrease surgical complications.

Implantes Dentales/efectos adversos , Fracaso de la Restauración Dental/estadística & datos numéricos , Adulto , Anciano , Coronas/efectos adversos , Diseño de Implante Dental-Pilar/efectos adversos , Implantes Dentales de Diente Único/efectos adversos , Prótesis Dental de Soporte Implantado/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Factores de Tiempo
Am J Obstet Gynecol ; 207(5): 416.e1-6, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22959831


OBJECTIVE: The objective of the study was to compare the stress response and pain expression of newborns (NBs) in the early postpartum period. STUDY DESIGN: This was a prospective study with 280 NBs enclosed at 3 Swiss university hospitals. Stress response and pain reaction were analyzed according to the mode of delivery: elective cesarean section (ELCS), spontaneous vaginal delivery, and assisted vaginal delivery by vacuum extraction (VE). Saliva cortisol and clinical pain expression were evaluated after delivery and before and after heel prick for metabolic screening. RESULTS: Significant differences were evident during the first 72 hours postpartum with highest nominations in the VE group. Meconium-stained amniotic fluid was the only intrapartum stress factor with an impact on clinical pain expression. CONCLUSION: NBs delivered vaginally show a higher incidence of stress response and pain expression than infants of the ELCS group. The long-term impact of these findings remains to be determined.

Parto Obstétrico/efectos adversos , Percepción del Dolor , Estrés Fisiológico , Líquido Amniótico , Cesárea/efectos adversos , Parto Obstétrico/métodos , Femenino , Humanos , Hidrocortisona/análisis , Recién Nacido , Masculino , Meconio , Periodo Posparto , Embarazo , Estudios Prospectivos , Saliva/química , Extracción Obstétrica por Aspiración/efectos adversos