Meta-analysis of Failure and Survival Rate of Implant-supported Single Crowns, Fixed Partial Denture, and Implant Tooth-supported Prostheses.

BACKGROUND: Dental implants have become the most viable option for rehabilitation. Although, many studies report the success of these reconstructions using implants, a cumulative data about the various studies and the failure rate still remain unaddressed. Therefore, the purpose of this systematic review was to analyze these data and to derive the cumulative survival rate of different implant-supported prosthesis. MATERIALS AND METHODS: Manual searches followed by a MEDLINE search were conducted to select prospective and retrospective cohort studies on single crowns (SCs), fixed partial denture (FPD), and tooth implant connected prostheses with a mean follow-up time of minimum of 5 years. Random-effects Poisson's regression models have been used to obtain summary estimates for implant failure and survival rates. RESULTS: Data were extracted from the final selected 63 studies. In a meta-analysis of these studies, the survival rate of SCs supported by implants (95% CI) was 96.363%, for FPDs was 94.525% and implant tooth-supported prostheses was 91.27% after 5 years of function. The cumulative failure rate per 100 FPD years of the SCs, FPDs, and implant tooth-supported prostheses were 0.684, 0.881, and 1.514, respectively. CONCLUSION: The study concludes high survival rates for implant-supported SCs followed by implant-supported FPDs can be expected over an observation period of 5 years. However, tooth implant-supported prostheses can be provided if there are certain limitations prohibiting the completely implant-supported prostheses.

Effect of Post Material and Length on Fracture Resistance of Endodontically Treated Premolars: An In-Vitro Study.

BACKGROUND: Endodontically treated teeth with posts are more prone to fracture. Hence, the purpose of this study was to investigate the in-vitro fracture resistance of devitalized teeth and mode of failure restored with posts of different materials and different lengths. MATERIALS AND METHODS: Sixty freshly extracted human mandibular premolars were endodontically treated and then restored with 1 of 2 prefabricated posts: Stainless-steel (SS) and glass-fiber (fiber posts [FP]) with intraradicular lengths of 4, 5 or 10 mm (n = 10). Following core restoration, a static compressive load was applied perpendicular to the long-axis of the teeth. Initial failure of each specimen was recorded in Newton. The mode of failure was also determined radiographically. The data were analyzed using two-way ANOVA and Tukey's post-hoc analysis with Bonferroni adjustment. RESULTS: Analysis indicated significant differences (P < 0.001) among the groups. Among the SS posts, SS/7 (246 N) exhibited the highest failure load and SS/4 (122 N) the lowest. FP/10 (140.5 N) exhibited the highest failure load among the FP and FP/4 (68.5 N) the lowest. SS posts showed post pull out, followed by core fracture while FP showed core debonding, followed by core fracture as the primary mode of failure. CONCLUSION: Fracture resistance of the teeth proportionately increased with increase in the length of FP while it decreased with that of metal post. SS posts showed greater fracture resistance than FP when 90° load was applied.

Rehabilitation of an Orbital Defect: A Simplified Technique.

Loss of tissue, whether congenital or traumatic or resulting from malignancy or radical surgery, is accompanied by esthetic and psychologic effects. This loss is more pronounced when the affected part is the eye and all orbital contents, resulting in gross mutilation. Success in maxillofacial prosthetics depends on the full cognizance of the principles that underlie facial harmony, color matching, anchorage and retention, weight bearing and leverage, durability and strength of materials used, tissue compatibility and tolerance. The restoration of orbital defects presents a challenge in maxillofacial prosthetics. Many variations exist in techniques and materials for fabricating orbital prostheses. Careful positioning of the ocular portion of the orbital prosthesis is one of the requirements for a successful esthetic result. A change of this position, which may occur during fabrication or may be due to distortion of the prosthetic housing or loss of retention of the prosthesis, may result in an unsatisfactory appearance. This article presents a simplified technique for fabricating an orbital prosthesis.

Comparative Evaluation of Push Out Bond Strength of a Fiber Post System using Four Different Resin Cements: An In-Vitro Study.

BACKGROUND: Debonding is one of the frequent causes of failure experienced in fiber-reinforced composite posts, and establish along post space-dentin adhesive interface. The purpose of this study was to assess push-out bond strength of a fiber-reinforced post system using four different resin cements. MATERIALS AND METHODS: In this in-vitro study 40 mandibular premolars were decoronated, and roots were treated endodontically. Following the post space preparation, the roots were grouped into four groups of 10 specimens each. Fiber-reinforced composite posts were cemented with four resin cement systems: (a) Multilink Speed, (b) Rely X Unicem, (c) Calibra, and (d) Permaflo DC. Three sections of each root, with a thickness of 3 mm, were prepared. The push-out test was with a universal testing machine at a crosshead speed of 1 mm/min, and bond strength values were evaluated. The data were analyzed with using multivariate analysis of variance (MANOVA) and post-hoc Scheffe test. RESULT: The mean push-out bond strength was highest for Rely X Unicem (18.0 ± 1.81), followed by Multilink Speed (13.1 ± 0.75) and Permaflo DC (12.8 ± 0.95). The lowest mean push-out bond strength was seen with Calibra (11.8 ± 0.69). There were statistically significant differences seen in the push-out bond strength of resin cement in different root canal regions using MANOVA and post-hoc Scheffe test. CONCLUSION: Mean push-out bond strength was highest for Rely X Unicem, followed by Multilink Speed and Permaflo DC. Lowest mean push-out bond strength was seen with respect to Calibra.

Clinical and anatomic outcomes after carotid endarterectomy.

OBJECTIVE: The purpose of this study was to examine 30-day and long-term outcomes after carotid endarterectomy (CEA) in a contemporary series and to identify variables associated with stroke and death after CEA. METHODS: This was a retrospective review of patients undergoing an isolated CEA at a single institution between January 1989 and December 2005. Primary study end points were 30-day and long-term overall stroke, ipsilateral stroke, and death. Secondary end points were recurrent stenosis (>70% stenosis) and reintervention. Kaplan-Meier analysis was used to create survival curves for the long-term study end points. Multivariate models were created to identify variables associated with the study end points. RESULTS: During the study period, 3014 CEAs were performed on 2644 patients (mean age, 71.0 ± 8.9 years; 60.9% male; 33.5% symptomatic; 37% primary closure), with mean follow-up of 7.0 years. The 30-day ipsilateral stroke, death, and combined ipsilateral stroke/death rates were 1.3%, 1.1%, and 2.2%, respectively. Previous ipsilateral CEA or neck dissection for cancer (hazard ratio [HR], 3.68; P = .0081) and symptomatic disease (HR, 2.45; P = .0071) were predictive of 30-day ipsilateral stroke. Stroke-free survival was 93.8% at 4 years and 86.9% at 10 years. Diabetes (HR, 1.94; P < .0001), symptomatic disease (HR, 1.75; P < .0001), female gender (HR, 1.34; P = .035), and increasing age (HR, 1.02; P < .0001) were predictors of long-term overall stroke. Ipsilateral stroke-free survival was 97.6% at 5 years and 94.6% at 10 years, respectively. Contralateral occlusion (HR, 2.06; P = .025) and symptomatic disease (HR, 1.87; P = .003) were predictors of ipsilateral stroke, whereas antilipid therapy was protective (HR, 0.65; P = .049). Overall survival was 70.1% at 5 years and 42.2% at 10 years, with no difference between symptomatic and asymptomatic patients. Although a variety of comorbidities were associated with inferior late survival, as anticipated, female gender (HR, 0.89; P = .016) and lipid-lowering therapy (HR, 0.69; P < .0001) were protective. Reintervention was 3.4% at 5 years and 6.6% at 10 years, with primary closure (vs patch angioplasty/eversion) increasing the risk of reintervention (HR, 1.72; P = .007). CONCLUSIONS: CEA has favorable perioperative and long-term clinical and anatomic outcomes with respect to its goal of stroke prevention for symptomatic and asymptomatic patients. Adjuvant medical therapy (antilipid) has increased overall and ipsilateral stroke-free survival.

Progression of asymptomatic carotid stenosis despite optimal medical therapy.

BACKGROUND: Despite level 1 evidence in support of carotid endarterectomy vs medical therapy in selected asymptomatic patients, an alternative posture is that optimal medical therapy (OMT) has not been adequately studied and that such OMT has reduced stroke risk in asymptomatic patients to levels wherein carotid endarterectomy is no longer justified. The goal of this study was to determine the natural history of patients with asymptomatic moderate (50%-69%) carotid artery stenosis (AMCAS) in a contemporary cohort as a function of their associated medical therapy. METHODS: Patients with AMCAS determined by duplex ultrasound (DUS) from 2005-2006 were identified in our hospital database. Patients were included in the cohort if they had at least one additional DUS during the 6-year follow-up interval. Patient characteristics including medication history and lipid levels were collected. Patients were considered to have OMT if they were on aspirin and a statin with a low-density lipoprotein level that was always <100 mg/dL. Study end points included progression of carotid disease by DUS to severe stenosis (70%-100%), development of ipsilateral neurologic symptoms (INS) such as stroke or transient ischemic attack, and death. RESULTS: There were 900 carotid arteries in 794 patients in the study cohort. The average age was 72.5 years, 77.2% had hypertension, 59.6% had coronary artery disease, and 87.1% were on a statin throughout the study. The low-density lipoprotein cholesterol level was always normal (<100 mg/dL) in 37.8% and accordingly, 241 (30.3%) had OMT as defined above. The 5-year actuarial survival was 81.9% ± 1.3% with no advantage seen with OMT. Multivariate analysis of survival showed statins were protective (hazard ratio [HR], 0.50; confidence interval [CI], 0.34-0.73; P = .0004). The 5-year freedom from plaque progression was 61.2% ± 2.1% with no benefit from OMT vs the control group. Multivariate predictors of plaque progression were chronic kidney disease (HR, 2.1; CI, 1.2-3.7; P = .009), aspirin use (HR, 1.9; CI, 1.2-3.0; P = .01), and the use of calcium channel blockers (HR, 1.4; CI, 1.1-1.8; P = .007). There were 90 (11.3%) patients who developed INS during follow-up (58% of these were strokes), and the 5-year freedom from INS was 88.4% ± 1.5%. Multivariate predictors of INS were diabetes (HR, 2.3; CI, 1.5-3.6; P = .0002) and warfarin use (HR, 1.9; CI, 1.2-2.9; P = .009); while statin use (HR, 0.37; CI, 0.22-0.65; P = .0005) was protective against symptom development. CONCLUSIONS: At the 5-year of follow-up, OMT failed to prevent carotid disease progression or development of ipsilateral symptoms in 45% of patients with AMCAS.

Pseudoaneurysm of the internal carotid artery in an infant aged 8 months.

Pseudoaneurysm of the carotid artery is a potentially life-threatening complication of deep neck space infection. It clinically manifests by pulsatile neck swelling, lower cranial nerve palsy, and Horner's syndrome. There may be sentinel bleed from nose or oral cavity before the massive haemorrhage, from carotid artery rupture. We present a case of pseudoaneurysm of the internal carotid artery (ICA) following parapharyngeal and retropharyngeal space infection in an 8-month-old infant. Emergency carotid artery ligation was performed and the infant recovered well without any neurological sequelae.