Background: Long‐term studies worldwide indicate that peri‐implant inflammation is a frequent finding and that the prevalence of peri‐implantitis correlates with loading time. Implant loss, although ...less frequent, has serious oral health and economic consequences. An understanding of predictive factors for peri‐implant disease and implant loss would help providers and patients make informed decisions.
Methods: A cross‐sectional study was performed on 96 patients with 225 implants that were placed between 1998 and 2003. Implant placement data were collected from patient records, and patients presented for a clinical and radiographic follow‐up examination. Implant status and periodontal status were determined, the data were analyzed to determine the prevalence of peri‐implant disease or implant loss, and a predictive model was tested.
Results: The mean follow‐up time for the patients was 10.9 years. The implant survival rate was 91.6%. Peri‐implant mucositis was found in 33% of the implants and 48% of the patients, and peri‐implantitis occurred in 16% of the implants and 26% of the patients. Individuals with peri‐implantitis were twice as likely to report a problem with an implant as individuals with healthy implants. Peri‐implantitis is associated with younger ages and diabetes at the time of placement and with periodontal status at the time of follow‐up. Implant loss is associated with diabetes, immediate placement, and larger‐diameter implants.
Conclusions: One in four patients and one in six implants have peri‐implantitis after 11 years. The data suggest that periodontal and diabetes status of the patient may be useful for predicting implant outcomes.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Aim
The purpose of this study was to determine whether restoration emergence angle was associated with peri‐implantitis.
Materials and Methods
A data set consisting of 96 patients with 225 implants ...(mean follow‐up: 10.9 years) was utilized. Implants were divided into bone‐level and tissue‐level groups, and radiographs were analysed to determine the restoration emergence angles, as well as restoration profiles (convex or concave). Peri‐implantitis was diagnosed based on probing depth and radiographic bone loss. Associations between peri‐implantitis and emergence angles/profiles were assessed using generalized estimating equations.
Results
Eighty‐three patients with 168 implants met inclusion criteria. The prevalence of peri‐implantitis was significantly greater in the bone‐level group when the emergence angle was >30 degrees compared to an angle ≤30 degrees (31.3% versus 15.1%, p = .04). In the tissue‐level group, no such correlation was found. For bone‐level implants, when a convex profile was combined with an angle of >30 degrees, the prevalence of peri‐implantitis was 37.8% with a statistically significant interaction between emergence angle and profile (p = .003).
Conclusions
Emergence angle of >30 degrees is a significant risk indicator for peri‐implantitis and convex profile creates an additional risk for bone‐level implants, but not for tissue‐level implants.
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Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including
We report on a method used ...to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR
infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an
isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the
infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted.
Failure of dental restorations is a major concern in dental practice. Replacement of failed restorations constitutes the majority of operative work. Clinicians should be aware of the longevity of, ...and likely reasons for the failure of, direct posterior restorations. In a long-term, randomized clinical trial, the authors compared the longevity of amalgam and composite. SUBJECTS, METHODS AND MATERIALS: The authors randomly assigned one-half of the 472 subjects, whose age ranged from 8 through 12 years, to receive amalgam restorations in posterior teeth and the other one-half to receive resin-based composite restorations. Study dentists saw subjects annually to conduct follow-up oral examinations and take bitewing radiographs. Restorations needing replacement were failures. The dentists recorded differential reasons for restoration failure.
Subjects received a total of 1,748 restorations at baseline, which the authors followed for up to seven years. Overall, 10.1 percent of the baseline restorations failed. The survival rate of the amalgam restorations was 94.4 percent; that of composite restorations was 85.5 percent. Annual failure rates ranged from 0.16 to 2.83 percent for amalgam restorations and from 0.94 to 9.43 percent for composite restorations. Secondary caries was the main reason for failure in both materials. Risk of secondary caries was 3.5 times greater in the composite group.
Amalgam restorations performed better than did composite restorations. The difference in performance was accentuated in large restorations and in those with more than three surfaces involved.
Use of amalgam appears to be preferable to use of composites in multisurface restorations of large posterior teeth if longevity is the primary criterion in material selection.
BACKGROUND:Antiarrhythmic drugs have not proven to significantly improve overall survival after out-of-hospital cardiac arrest from shock-refractory ventricular fibrillation/pulseless ventricular ...tachycardia. How this might be influenced by the route of drug administration is not known.
METHODS:In this prespecified analysis of a randomized, placebo-controlled clinical trial, we compared the differences in survival to hospital discharge in adults with shock-refractory ventricular fibrillation/pulseless ventricular tachycardia out-of-hospital cardiac arrest who were randomly assigned by emergency medical services personnel to an antiarrhythmic drug versus placebo in the ALPS trial (Resuscitation Outcomes Consortium Amiodarone, Lidocaine or Placebo Study), when stratified by the intravenous versus intraosseous route of administration.
RESULTS:Of 3019 randomly assigned patients with a known vascular access site, 2358 received ALPS drugs intravenously and 661 patients by the intraosseous route. Intraosseous and intravenous groups differed in sex, time-to-emergency medical services arrival, and some cardiopulmonary resuscitation characteristics, but were similar in others, including time-to-intravenous/intrasosseous drug receipt. Overall hospital discharge survival was 23%. In comparison with placebo, discharge survival was significantly higher in recipients of intravenous amiodarone (adjusted risk ratio, 1.26 95% CI, 1.06–1.50; adjusted absolute survival difference, 5.5% 95% CI, 1.5–9.5) and intravenous lidocaine (adjusted risk ratio, 1.21 95% CI, 1.02–1.45; adjusted absolute survival difference, 4.7% 95% CI, 0.7–8.8); but not in recipients of intraosseous amiodarone (adjusted risk ratio, 0.94 95% CI, 0.66–1.32) or intraosseous lidocaine (adjusted risk ratio, 1.03 95% CI, 0.74–1.44). Survival to hospital admission also increased significantly when drugs were given intravenously but not intraosseously, and favored improved neurological outcome at discharge. There were no outcome differences between intravenous and intraosseous placebo, indicating that the access route itself did not demarcate patients with poor prognosis. The study was underpowered to assess intravenous/intraosseous drug interactions, which were not statistically significant.
CONCLUSIONS:We found no significant effect modification by drug administration route for amiodarone or lidocaine in comparison with placebo during out-of-hospital cardiac arrest. However, point estimates for the effects of both drugs in comparison with placebo were significantly greater for the intravenous than for the intraosseous route across virtually all outcomes and beneficial only for the intravenous route. Given that the study was underpowered to statistically assess interactions, these findings signal the potential importance of the drug administration route during resuscitation that merits further investigation.
In life, genetic and epigenetic networks precisely coordinate the expression of genes—but in death, it is not known if gene expression diminishes gradually or abruptly stops or if specific genes and ...pathways are involved. We studied this by identifying mRNA transcripts that apparently increase in relative abundance after death, assessing their functions, and comparing their abundance profiles through postmortem time in two species, mouse and zebrafish. We found mRNA transcript profiles of 1063 genes became significantly more abundant after death of healthy adult animals in a time series spanning up to 96 h postmortem. Ordination plots revealed non-random patterns in the profiles by time. While most of these transcript levels increased within 0.5 h postmortem, some increased only at 24 and 48 h postmortem. Functional characterization of the most abundant transcripts revealed the following categories: stress, immunity, inflammation, apoptosis, transport, development, epigenetic regulation and cancer. The data suggest a step-wise shutdown occurs in organismal death that is manifested by the apparent increase of certain transcripts with various abundance maxima and durations.
Clinical trials have shown very modest short-term improvements in glycemic control among participants with diabetes after periodontitis treatment. Few longitudinal studies suggest that periodontitis ...may be related to prediabetes/diabetes risk.
We evaluated 1206 diabetes free participants in the San Juan Overweight Adults Longitudinal Study (SOALS) and 941 with complete 3-year follow-up data were included. The National Health and Nutrition Examination Survey (NHANES) methods were used to assess periodontitis. Diabetes and prediabetes were classified using American Diabetes Association cutoffs for fasting and 2-hour post-load glucose and HbA1c. We used Poisson regression adjusting for baseline age, gender, smoking, education, family history of diabetes, physical activity, waist circumference, and alcohol intake.
Over the 3-year follow-up, 69 (7.3%) of the 941 individuals developed type 2 diabetes, and 142 (34.9%) of the 407 with normal glycemia at baseline developed prediabetes. In multivariable models, greater mean pocket depth and mean attachment loss at baseline were associated with lower risk of developing prediabetes/diabetes over the follow-up (IRR = 0.81; 95% CI: 0.67–0.99, and IRR = 0.86; 95% CI: 0.74–0.99, respectively). Increase in periodontal attachment loss from baseline to follow-up was associated with higher prediabetes/diabetes risk (multivariate IRR = 1.25; 95% CI: 1.09–1.42), and increase in pocket depth was associated with >20% fasting glucose increase (multivariate IRR = 1.43; 95% CI: 1.14–1.79). The inverse associations persisted after additionally adjusting for baseline income, sugar-sweetened beverages, number of teeth, oral hygiene, glycemia, or previous periodontal therapy.
There is no association between periodontitis and risk of prediabetes/diabetes in this longitudinal study.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
In this trial, patients with out-of-hospital cardiac arrest received amiodarone, lidocaine, or placebo for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. There were ...no significant between-group differences in survival to hospital discharge.
Out-of-hospital cardiac arrest is responsible for more than 300,000 deaths each year in North America.
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Many out-of-hospital cardiac arrests are attributable to ventricular fibrillation or pulseless ventricular tachycardia. Although ventricular fibrillation or pulseless ventricular tachycardia is regarded as the most treatable presentation of out-of-hospital cardiac arrest because of its responsiveness to shock,
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most defibrillation attempts do not result in sustained return of spontaneous circulation.
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Ventricular fibrillation or pulseless ventricular tachycardia commonly persists or recurs after shock, and there is a significant inverse relationship between the duration of ventricular fibrillation or pulseless ventricular tachycardia, or the frequency of acute recurrences, and . . .
Analysis of energy expenditure (EE) in mice is essential to obesity research. Since EE varies with body mass, comparisons between lean and obese mice are confounded unless EE is normalized to account ...for body mass differences. We 1) assessed the validity of ratio-based EE normalization involving division of EE by either total body mass (TBM) or lean body mass (LBM), 2) compared the independent contributions of LBM and fat mass (FM) to EE, and 3) investigated whether leptin contributes to the link between FM and EE.
We used regression modeling of calorimetry and body composition data in 137 mice to estimate the independent contributions of LBM and FM to EE. Subcutaneous administration of leptin or vehicle to 28 obese ob/ob mice and 32 fasting wild-type mice was used to determine if FM affects EE via a leptin-dependent mechanism.
Division of EE by either TBM or LBM is confounded by body mass variation. The contribution of FM to EE is comparable to that of LBM in normal mice (expressed per gram of tissue) but is absent in leptin-deficient ob/ob mice. When leptin is administered at physiological doses, the plasma leptin concentration supplants FM as an independent determinant of EE in both ob/ob mice and normal mice rendered leptin-deficient by fasting.
The contribution of FM to EE is substantially greater than predicted from the metabolic cost of adipose tissue per se, and the mechanism underlying this effect is leptin dependent. Regression-based approaches that account for variation in both FM and LBM are recommended for normalization of EE in mice.
Background: Supragingivally applied glycine powder air polishing (SupraGPAP) has been shown to remove biofilms in shallow periodontal pockets. This study assesses efficacy and safety of subgingivally ...applied glycine powder air polishing (SubGPAP) in moderate‐to‐deep periodontal pockets.
Methods: Patients with chronic periodontitis and intraoral Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia who completed initial therapy were randomly assigned to receive SubGPAP in periodontal pockets with probing depths of 4 to 9 mm, SupraGPAP in all other shallow periodontal sites, and at mucous membranes followed by removal of calculus using curets (full‐mouth GPAP) or scaling and root planing followed by coronal polishing (SRP). Patients rinsed with 0.12% chlorhexidine gluconate after debridement, and twice daily, for 2 weeks.
Results: All 30 patients enrolled completed the baseline, day 10, and day 90 visits. SubGPAP resulted in significantly lower total viable bacterial counts in moderate‐to‐deep pockets when compared to SRP immediately after debridement and at day 10 (P <0.05). Total P. gingivalis counts in the oral cavity were significantly reduced after full‐mouth GPAP compared to SRP at day 90 (P <0.05). Patients’ comfort levels were high for both treatments. There were no adverse events related to full‐mouth GPAP.
Conclusions: The results indicate that SubGPAP is more efficacious in removing subgingival biofilm in moderate‐to‐deep periodontal pockets than SRP. Furthermore, full‐mouth GPAP may result in a beneficial shift of the oral microbiota and appears to be well tolerated.
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