A Prospective Single-Cohort Multicenter Study of an Innovative Prefabricated Three-Implant-Supported Full-Arch Prosthesis for Treatment of Edentulous Mandible: 1-year Report.

PURPOSE: To clinically evaluate a recently developed, standardized, three-implant-supported full-arch treatment concept for fully edentulous mandibles. MATERIALS AND METHODS: This ongoing multinational prospective cohort study is evaluating the performance of the treatment concept over 5 years in patients who were fully edentulous or had failing dentition of the mandible. The primary outcome was the cumulative survival rate of implants (CSRI). Secondary outcomes included the cumulative survival rate of the prostheses (CSRP), marginal bone level change, soft tissue outcomes, impact on quality of life, and patient and clinician satisfaction. The 1-year report is presented here. RESULTS: In total, 110 patients (330 implants) were included. Prostheses underwent immediate loading in 76.4% of cases and early loading in 23.6% of cases. The mean surgical time was 1.60 ± 0.78 hours, and the mean laboratory time was 3.99 ± 1.74 hours. At 1 year, eight implants and three prostheses failed, yielding an implant-level CSRI of 97.5% and a CSRP of 97.3%. All prosthetic failures were due to loss of two implants in the patient. The mean marginal bone level change at 1 year was -0.62 ± 1.39 mm. Among soft tissue outcomes, the Bleeding Index improved significantly between the 6-month and 1-year follow-up, and 242 implants (75%) were surrounded by keratinized mucosa by the 6-month follow-up. Patients reported a significant improvement in quality of life between prosthesis placement and the 6-month follow-up based on the Oral Health Impact Profile for Edentulous 21 questionnaire. Both patient and clinician satisfaction with function and esthetics were high throughout treatment. CONCLUSION: This novel treatment concept using a passively fitting standardized framework with simplified surgical and prosthetic workflow demonstrated high survival and excellent outcomes at 1 year while reducing chair and fabrication time. This concept may offer patients a safe and efficient option for full-arch mandibular prostheses.

An Innovative Implant-Supported Treatment for the Edentulous Mandible: Case Report.

When surveyed, edentulous patients commonly state that they would prefer an implant-supported restoration to conventional removable dentures. However, acceptance of implant-supported restorations remains low, primarily due to the high cost of available solutions. To reduce cost and treatment time for patients with an edentulous mandible or failing mandibular dentition, an innovative treatment concept consisting of a standardized framework and time-efficient surgical and restorative protocols was developed. The prefabricated titanium framework is supported on three implants using an adaptive fixation mechanism that compensates for surgical misalignment of the implants to achieve passive fit. The definitive fixed, full-arch mandibular prosthesis can be delivered within 24 hours of implant placement. This patient presentation demonstrates the treatment of a man 82 years of age with complete edentulism. The entire treatment time from surgery to definitive placement was 3 hours over a single business day. After 2 years of function with immediate loading, the patient displayed favorable hard and soft tissue outcomes. Initial results indicate that treatment with this premanufactured device could potentially provide patients with a fixed full-arch implant-supported mandibular restoration with reduced clinical treatment time compared with other implant-supported treatments.

Passivity of Fit of a Novel Prefabricated Implant-Supported Mandibular Full-Arch Reconstruction: A Comparative In Vitro Study.

PURPOSE: To quantify the strain development of a new prefabricated implant-supported mandibular full-arch reconstruction. MATERIALS AND METHODS: Five resin models reflecting edentulous mandibles were each restored with three interforaminal implants and prefabricated frameworks with a novel compensation mechanism, cast frameworks, and computer-aided design/computer-assisted manufacturing (CAD/CAM)-fabricated frameworks. Strains were recorded during superstructure fixation. Statistical analyses (analysis of variance, t tests; α = .05) were based on level of misfit and distribution of misfit. RESULTS: Cast restorations showed significantly higher levels of misfit and a significantly more uneven distribution of misfit compared to prefabricated and CAD/CAM restorations (P < .05 for all comparisons). Prefabricated and CAD/CAM frameworks showed a similar low level and distribution of misfit (P = .24145 and P = .2837, respectively). CONCLUSION: The compensation mechanism of the prefabricated frameworks provides a level of fit comparable to CAD/CAM superstructures.

Genetic suppression analysis in novel vacuolar processing enzymes reveals their roles in controlling sugar accumulation in tomato fruits.

In plant cells, many vacuolar proteins are synthesized as precursors in the endoplasmic reticulum and are subsequently transported to the vacuole. These precursors are subject to post-translational modifications to allow the active mature forms to be produced. Vacuolar processing enzyme (VPE) has been identified as a family of cysteine proteases involved in protein maturation in the vacuole. In this study, novel VPE genes were isolated from tomato (Solanum lycopersicum), and they were designated SlVPE1-SlVPE5. Phylogenic analysis suggested that SlVPE1 and SlVPE2 were categorized as the seed coat type, SlVPE4 was categorized as the seed type, and both SlVPE3 and SlVPE5 were categorized as the vegetative type. Expression analysis demonstrated that these genes were expressed during fruit development, and that their expression profiles agreed with this classification. High VPE enzyme activity was observed during tomato fruit development; the enzyme activity was correlated with the SlVPE mRNA levels, indicating that the SlVPE encoded active VPE proteins. The total sugar content was higher in RNA interference (RNAi) lines compared with the control plants, suggesting negative roles for SlVPE in sugar accumulation. The quantitative expression analysis of each SlVPE gene in the RNAi lines suggested that the suppression of SlVPE5 probably had the strongest effect on the sugar accumulation observed. The suppression of SlVPE did not influence the total amino acid content, suggesting that the molecular targets of SlVPE were mainly involved in sugar accumulation.

Lowering intercellular melatonin levels by transgenic analysis of indoleamine 2,3-dioxygenase from rice in tomato plants.

Melatonin exists in numerous living organisms including vertebrates, insects, fungi, bacteria, and plants. Extensive studies have been conducted on the physiological roles of melatonin in various plant species. In plants, melatonin seems to act in antioxidant protection, as a growth promoter, and in photoperiodism. However, the mechanisms by which melatonin carries out these roles remain unclear. We manipulated the endogenous melatonin content in tomato plants by modifying the metabolic enzyme indoleamine 2,3-dioxygenase (IDO). The OsIDO gene was isolated from rice (Oryza sativa) and characterized using 3-D homology modeling and reverse genetic approaches. The amino acid sequence of OsIDO showed high homology to the Ustilago maydis IDO. The 3-D model structure of OsIDO is composed of a small and a large domain. Transgenic tomato plants constitutively expressing the OsIDO gene exhibited a decrease in their melatonin content. Moreover, the number of lateral leaflets decreased in transgenic plants. Protein extracts taken from these plants showed activity degradation, demonstrating the function of OsIDO. These results suggest the involvement of IDO in plant melatonin metabolism and a possible role in plant leaf development.

Cloning and characterization of a Chlamydomonas reinhardtii cDNA arylalkylamine N-acetyltransferase and its use in the genetic engineering of melatonin content in the Micro-Tom tomato.

Melatonin is found in a wide variety of plant species. Several investigators have studied the physiological roles of melatonin in plants. However, its role is not well understood because of the limited information on its biosynthetic pathway. To clarify melatonin biosynthesis in plants, we isolated a cDNA-coded arylalkylamine N-acetyltransferase (AANAT), a possible limiting enzyme for melatonin biosynthesis, from Chlamydomonas reinhardtii (designated as CrAANAT). The predicted amino acid sequence of CrAANAT shares 39.0% homology to AANAT from Ostreococcus tauri and lacks cAMP-dependent protein kinase phosphorylation sites in the N- and C-terminal regions that are conserved in vertebrates. The enzyme activity of CrAANAT was confirmed by in vitro assay using Escherichia coli. Transgenic plants constitutively expressing the CrAANAT were produced using Micro-Tom, a model cultivar of tomato (Solanum lycopersicum L.). The transgenic Micro-Tom exhibited higher melatonin content compared with wild type, suggesting that melatonin was synthesized from serotonin via N-acetylserotonin in plants. Moreover, the melatonin-rich transgenic Micro-Tom can be used to elucidate the role of melatonin in plant development.

Clinical evaluation of the zygoma implant: 3-year follow-up at 16 clinics.

PURPOSE: The purpose of this clinical investigation was to evaluate the treatment outcome with zygoma implants with regard to implant survival, patient satisfaction, and function of prosthesis replacement after 3 years. PATIENTS AND METHODS: The treatment outcome of 76 patients treated with 145 zygoma fixtures at 16 centers was evaluated with regard to implant survival. Status of peri-implant mucosa and amount of plaque were registered annually. Patients' and dentists' evaluations of the functional and esthetic outcome of the treatment were assessed at delivery of prosthesis and thereafter at each follow-up visit. RESULTS: Sixty of 76 patients were followed for 3 years after prosthetic delivery. Five of 145 placed zygoma implants failed during the course of the study resulting in an overall implant survival rate of 96.3%. At the 3-year follow-up, 75% of the implants sites were registered with normal peri-implant mucosa and 68% with no visible plaque. The patients were fully satisfied with the esthetic and functional outcome of the treatment in 86% and 71%, respectively, at the 3-year follow-up visit. All reported data from dentists scored from acceptable to excellent. CONCLUSION: The multicenter study showed a high predictability of the zygoma implant-supported rehabilitation.

Ability for basic movement as an early predictor of functioning related to activities of daily living in stroke patients.

BACKGROUND: Early functional outcomes for activities of daily living at an early stage after a stroke may enable clinicians to establish treatment-optimal training and goals. The objective of this study was to assess the relationship between the ability to perform basic movements at the bedside, which were measured using a new scale, the Ability for Basic Movement Scale, in the early stage after stroke and functional ability at discharge from the hospital. METHODS: A total of 142 stroke patients participated in this prospective study. In addition to the Ability for Basic Movement Scale score, age, limb paresis as measured by the Brunnstrom stage, and functional ability as measured by the Barthel Index were also selected as predictor variables. RESULTS: Pearson correlation coefficient analysis showed that the state of functional ability at discharge had significant positive correlations with total scores of the Ability for Basic Movement Scale and Brunnstrom stage at all stages of data collection. The results of linear stepwise regression analysis indicated that "turn over from supine position," "remain sitting," and "sit up" of the Ability for Basic Movement Scale at 10 days after onset, in addition to age at onset of stroke, the baseline Barthel Index, and the baseline Brunnstrom stage, were significant predictors (75.6%) of functional ability at discharge. CONCLUSIONS: This study provides evidence for the predictive value of the Ability for Basic Movement Scale with regard to functional ability in stroke patients.

A clinical evaluation of the Zygoma fixture: one year of follow-up at 16 clinics.

PURPOSE: To evaluate treatment outcome with Zygoma fixtures (Nobel Biocare, Göteborg, Sweden) with regard to fixture survival, patient satisfaction, and function of prosthesis replacement. MATERIALS AND METHODS: The treatment outcome of 76 patients treated with 145 Zygoma fixtures at 16 centers was evaluated. Patient's and dentist's evaluations of the functional and aesthetic outcome of the treatment were assessed at delivery of prosthesis and at the 1-year follow-up visit. At the 1-year follow-up visit, the status of the peri-implant mucosa around the abutments and the amount of plaque were registered. RESULTS: Sixty-six of the 76 patients, with 124 Zygoma fixtures supporting the prosthetic restorations, were evaluated at the 1-year follow-up. The overall survival rate for the Zygoma fixtures was 97.9% after 1-year of follow-up. Eighty percent of the patients were fully satisfied with both aesthetic and functional outcome at the time of prosthetic insertion and at the 1-year follow-up. All reported data from the dentists, with the exception of one restoration with several abutment screw loosenings, scored from acceptable to excellent for the aesthetic and functional outcome of the treatment. The status of peri-implant mucosa was recorded as normal in approximately 60% of the sites. Plaque, when present, was more often detected on the palatal surfaces compared with the buccal surfaces. CONCLUSION: This 1-year follow-up of Zygoma fixtures has shown good results with an acceptable number of minor complications and a majority of satisfied patients.

Basic Performance of a Miniature Intraventricular Axial Pump.

A miniature intraventricular axial pump for left ventricular (LV) support is under development. This pump was designed for placement in the LV cavity by insertion through the LV apex with the outlet located at the ascending aorta via the aortic valve. The basic hydro-dynamic characteristics represented as a relationship between pump head (H) and flow (Q) showed a negative linear relationship under a constant head. This characteristic was generally the same as that obtained by other axial rotation pumps. However, the actual H-Q relationship was represented as anticlockwise "loops" caused by the contraction of the natural LV. The comparative in vitro data on these H-Q loops showed that the shape of the loops was changed drastically by the connecting condition between the pump and natural cardiovascular system.