: The aim of the study was to evaluate the early colonization of non‐submerged implants over a 6‐month period in partially edentulous patients treated for advanced aggressive periodontal disease. In ...22 patients treated for advanced aggressive periodontitis and in a supportive maintenance program for a period between 12 and 240 months at implant surgery, a total of 68 non‐submerged dental implants were installed. Patients had a plaque score below 20%, and less than 20% of the pockets around the teeth were bleeding on probing (BOP). Using DNA‐probes (micro‐IDent®), the presence and concentration of five periodontal pathogens (Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythensis (Tf) and Treponema denticola (Td)) were determined in the five deepest pockets of the rest dentition pre‐operatively and after 6 months as well as five places around each implant 10 days, 1 month, 3 months and 6 months after surgery. In each patient, a test to determine the genotype interleukin‐1 (IL‐1) was performed (PST – micro‐IDent®). After 6 months, no difference in microbial composition as compared with baseline was found around the teeth in five patients, in 12 minute differences and in five patients important differences were observed. Ten days after surgery, three patients had a complete similar bacterial composition between teeth and implants. In 14 patients, the composition was fairly similar, while large differences in composition and concentration occurred in five patients. This microbiota around the implants remained almost unchanged over a 6‐month period and did not hamper the clinical and radiographic osseointegration and did not lead to peri‐implantitis, mucositis or initiation of bone destruction.
summary One hundred and seventy‐two fixed reconstructions (317 prosthetic units), made on 283 ITI implants in 105 patients (age range 25–86 years) with a minimum follow‐up period of 40 months, were ...taken into the study to analyse technical complication rate, complication type and costs for repair. The mean evaluation time was 62·5 ± 25·3 months. Eighty were single crowns and 92 different types of fixed partial dentures (FPDs). In 45 cases the construction was screw retained and in 127 cases cemented with zinc phosphate cement or an acrylic‐based cement. Complications occurred after a minimum period of 2 months and a maximum period of 100 months (mean: 35·9 ± 21·4 months). Fifty‐five prosthetic interventions were needed on 44 constructions (25%) of which 88% in the molar/premolar region. The lowest percentage of complications occurred in single crowns (25%), the highest in 3–4 unit FPDs (35%) and in FPDs with an extension (44%). Of the necessary clinical repair, 36% was recementing and 38% tightening the screws. Of all interventions, 14% were classified as minor (no treatment or <10 min chair time), 70% as moderate (>10 min but <60 min chair time) and 14% as major interventions (>60 min and additional costs for replacement of parts and/or laboratory). For seven patients the additional costs ranged from €28 to €840. Bruxing seemed to play a significant role in the frequency of complications. Longer constructions seemed to be more prone to complications. The relatively high occurrence of technical complications should be discussed with the patient before the start of the treatment.
Objectives: This prospective clinical study investigates long‐term survival and clinical parameters of non‐submerged implants with large buccal dehiscences treated with a deproteinized bovine bone ...mineral xenograft and a non‐resorbable membrane in a one‐stage approach.
Material and methods: Sixteen consecutive non‐submerged implants (ITI Straumann) were installed in narrow alveolar ridges in 13 patients (age range: 25–61 years). All patients were non‐smokers. On the buccal site the bone dehiscence ranged between 3 and 9 mm. Primary stability was achieved in all but one implant. The exposed threads were covered with a xenograft (Bio‐Oss®) and a non‐resorbable expanded polytetrafluoroethylene membrane. The flap was sutured leaving the implant head non‐submerged. The membrane was removed when (1) the membrane became exposed or (2) after a maximum of 24 weeks. All implants received singular cemented crowns. The implants were followed for a period ranging from 12 to 114 months. Whole‐mouth plaque index (Pl), the % of bleeding on probing (BOP), probing depth and signs of peri‐implantitis were recorded. Every year periapical radiographs were taken using a long cone technique.
Results: All but one implant integrated successfully. At the time of membrane removal, all previously exposed threads were completely covered with richly vascularized tissue except for two implants where the coverage reached 63% and 87%, respectively. The whole‐mouth plaque score and BOP remained low in all patients during the observation period. None of the implants had plaque and, except for one implant BOP never occurred. All implants were stable and in function. Swelling, redness or purulence was never observed. On the periapical radiographs no bone resorption was observed on the mesial and distal site except for one implant in one patient with a mesial and distal bone resorption of 2 and 3 mm. Probing depth was never higher than 3 mm except for one patient where the implant was placed deeply subgingival for esthetical reasons.
Conclusion: This prospective long‐term study shows that with the use of non‐submerged transmucosal implants, large bony dehiscences can be treated in a one‐stage approach using a stiff non‐resorbable membrane combined with a xenograft.
Résumé
Cette étude clinique prospective a examiné les paramètres cliniques et de survie à long terme d'implants non‐enfouis avec des déhiscences vestibulaires larges traitées par une xénogreffe minérale d'os bovin déprotéiné et une membrane non‐résorbable en une approche en une étape. Seize implants ITI Straumann ont été insérés dans des rebords alvéolaires étroits chez treize patients de 25 à 61 ans. Tous ces derniers étaient non‐fumeurs. En vestibulaire, la déhiscence osseuse s'étalait de 3 à 9 mm. La stabilité primaire a été assurée au niveau de tous les implants sauf un. Les filetages exposés étaient recouverts d'une xénogreffe (Bio‐Oss®) et d'une membrane en téflon non‐résorbable. Le lambeau a été suturé en laissant la tête de l'implant en dehors de la gencive. La membrane a été enlevée lorsque 1) elle était exposée ou 2) après un maximum de 24 semaines. Tous les implants ont reçu des couronnes cémentées uniques. Les implants ont été suivis durant une période de douze à 114 mois. L'indice de plaque général (Pli), le pourcentage de saignement au sondage (BOP), la profondeur au sondage et les signes de paroïmplantite ont été notés. Chaque année des radiographies périapicales ont été prises en utilisant la technique du long cône. Tous les implants sauf un se sont intégrés avec succès. Lors de l'enlèvement de la membrane, tous les filetages précédement exposés étaient complètement recouverts avec un tissu richement vascularisés sauf pour deux implants où le recouvrement était respectivement de 63% et 87%. Pli et BOP restaient bas chez tous les patients durant la période d'observation. Aucun des implants n'avaient de plaque et excepté pour un implant, le saignement au sondage n'est jamais apparu. Tous les implants étaient stables et fonctionnels. Tuméfaction, rougeurs et purulence n'ont pas été observés. Sur les radiographies périapicales aucune résorption osseuse n'a été observée en mésial et distal sauf pour un implant chez un patient avec une résorption osseuse mésiale et distale de 2 et 3 mm. La profondeur au sondage n'était jamais supérieure à 3 mm sauf chez un patient où l'implant était placé en profondeur en sous‐gingival pour des raisons esthétiques. Cette étude prospective à long terme montre qu'avec l'utilisation des implants transmuqueux non‐enfouis, de larges déhiscences peuvent être traitées par une approche en une étape en utilisant une membrane non‐résorbable et rigide combinée à une xénogreffe.
Zusammenfassung
Ziel: Diese klinische Langzeitstudie untersucht die längerfristige Überlebensrate und die klinischen Parameter von transmukosal eingeheilten Implantaten, deren grossflächigen buccalen Dehiszenzen gleichzeitig bei der Implantation mit einem Xenotransplantat aus entproteinisiertem Rinderknochenmineral und einer nichtresorbierbaren Membran gedeckt worden waren.
Material und Methode: Bei 13 Patienten mit schmalem Alveolarknochen (Alter zwischen 25 und 61 Jahren) wurden in der Folge 16 transmukosal einheilende Implantate (ITI Straumann) eingesetzt. Alle Patienten waren Nichtraucher. Auf der buccalen Seite variierten die Dehiszenzen zwischen 3 und 9 mm. Die primäre Stabilität konnte ausser bei einem Implantat immer erreicht werden. Die exponierten Schraubenwindungen deckte man mit einem Xenotransplantat (Bio‐Oss®) und einer nicht resorbierbaren e‐PTFE‐Membran ab. Der Lappen wurde so vernäht, dass der Implantathals transmukosal einheilte. Die Membran wurde entfernt, wenn sie (1) exponiert war oder (2) spätestens nach 24 Wochen. Alle Implantate erhielten zementierte Einzelkronen. Danach überwachte man sie während einer Zeitspanne von 12 bis 114 Monaten. Man beurteilte dabei den Plaqueindex im ganzen Mund (Pl), das prozentuale Bluten auf Sondieren (BOP), die Sondierungstiefen und die Anzeichen für eine Periimplantitis. Jedes Jahr wurden zusätzlich mit der Longcone‐Technik periapikale Röntgenaufnahmen hergestellt.
Resultate: Ausser einem Implantat osseointegrierten alle. Zum Zeitpunkt der Membranentfernung waren, abgesehen von zwei Implantaten (Bedeckungsgrad von 63% und 87%), alle zu Beginn entblössten Schraubenwindungen vollständig und mit gut vaskularisiertem Gewebe bedeckt. Der Plaqueindex und der BOP waren bei allen Patienten über die ganze Beobachtungszeit tief. Auf keinem der Implantate lag Plaque und mit Ausnahme eines Implantates trat nie ein positiver BOP auf. Alle Implantate waren fest und in funktioneller Okklusion. Schwellung, Rötung oder Eiter mussten nie registriert werden. Auf den periapicalen Röntgenbildern musste mesial und distal ausser an einem Implantat (mesial 2 mm und distal 3 mm) keine Resorptionen des Alveolarknochens festgestellt werden. Die Sondierungstiefen waren nie grösser als 3 mm, es sei denn das Implantat ist, wie bei einem Patienten, aus ästhetischen Gründen tief subgingival gesetzt worden.
Zusammenfassung: Diese Langzeitstudie zeigt, dass man mit Hilfe einer steiffen nichtresorbierbaren Membran und einem Xenotransplantat auch grosse Knochendehiszenzen bei transmukosal einheilenden Implantaten mit einem einzigen chirurgischen Eingriff behandeln kann.
Resumen
Objetivos: Este estudio clínico prospectivo investiga la supervivencia a largo plazo y los parámetros clínicos de implantes no sumergidos con grandes dehiscencias vestibulares tratadas con un xenoinjerto de mineral óseo bovino desproteinizado y una membrana no reabsorbible con un enfoque de una sola fase.
Material y método: Se colocaron dieciséis implantes (ITI Straumann) consecutivos no sumergidos en las crestas alveolares estrechas de 13 pacientes (rango de edad: 25 a 61 años). Ningún paciente era fumador. En el lado vestibular la dehiscencia ósea varió entre 3 a 9 mm.Se logró la estabilidad primaria en todos salvo en un implante. Las roscas expuestas se cubrieron con un xenoinjerto (Bio‐Oss®) y una membrana no‐reabsorbible de e‐PTFE. El colgajo se suturó dejando la cabeza del implante no sumergida. La membrana se retiró cuando (1) se expuso o (2) tras un máximo de 24 semanas. Todos los implantes recibieron coronas unitarias cementadas. Los implantes se siguieron durante un periodo que varió desde 12 a 114 meses. Se registró el índice de placa de toda la boca (Pl), el % de sangrado al sondaje (BOP), profundidad de sondaje y signos de periimplantitis. Cada año se tomaron radiografías periapicales usando una técnica de cono largo.
Resultados: Todos excepto un implante se integraron con éxito. En el momento de retirar la membrana todas las roscas previamente expuestas estaban completamente cubiertas con un tejido ricamente vascularizado, a excepción de 2 implantes en los que la cobertura alcanzó el 63% y el 87% respectivamente. Los valores de placa de toda la boca y el sangrado al sondaje permanecieron bajos durante el periodo de observación. Ningún implante tuvo placa y, a excepción de un implante, ninguno sangró al sondaje. Todos los implantes estaban estables y en función. Nunca se observó, enrojecimiento o fluido purulento. En las radiografías periapicales no se observó reabsorción ósea en los lados mesial y distal a excepción de un implante en un paciente con reabsorción ósea mesial y distal de 2 y 3 mm. La profundidad de sondaje nunca fue superior a los 3 mm excepto para un paciente en el que el implante se colocó profundamente subgingival por razones estéticas.
Conclusión: Este estudio prospectivo a largo plazo muestra que con el uso de implantes transmucosos no‐sumergidos, se pueden tratar grandes dehiscencias óseas con un enfoque de una sola fase utilizando una membrana rígida no‐reabsorbible combinada con un xenoinjerto.
Objectives: To evaluate the implant survival rate, periodontal and radiographic parameters of non‐submerged screw implants with two different surfaces (TPS and SLA) in periodontally non‐susceptible ...patients (NSP) and in patients with chronic adult periodontitis (CAP) or with generalized aggressive periodontitis (GAP).
Material and methods: In 110 healthy partially edentulous subjects, 68 patients with CAP and 16 patients with GAP, a total of 513 implants were installed and followed for on average 48.1±25.9 months. Only fixed partial dentures were used as suprastructures. All patients were offered a supportive periodontal maintenance program. Smoking habits, health impairment, plaque score, bleeding on probing (BOP), type of surface, bone score, bone loss on radiographs and the number of failed implants were noted.
Results: Implant survival in the NSP and CAP group was 98% and 96% after 140 months (NS), but only 80% after 100 months in the GAP group (P=0.0026). The overall rate of implant loss was 4.7%, but 15.25% in the GAP group (6/16 patients). The average marginal bone loss for all implants was 0.12±0.71 mm on the mesial side and 0.11±0.68 mm on the distal side. Bone loss/year was 0.08±0.31 and 0.07±0.3 mm in the NSP group, but 0.17±0.2 and 0.17±0.19 mm in the GAP group. Only in the GAP group, was bone loss significantly related to BOP, age, inflammation, presence of plaque, probing depth. Implants with a TPS surface had a lower survival than implants with an SLA surface (93% vs. 97%; P=0.06), especially in the GAP group (80% vs. 83%; P=0.005). Smoking habits had a significant influence on implant survival only in the GAP group (P=0.07), declining in current smokers to 63%, and to 78% in former smokers. Overall, impaired general health had no significant influence (P=0.85). However, impaired health further reduced implant survival in the GAP group (survival: 71%). In a statistical model to predict the chance for implant failing, only periodontal classification (P=0.012) and implant surface type (P=0.027) were significant.
Conclusion: Periodontally healthy patients and patients with CAP show no difference in peri‐implant variables and implant survival rate, but patients with GAP have more peri‐implant pathology, more marginal bone loss and a lower implant survival implant rate. SLA surface had a better prognosis than the TPS surface.
Lowering the dietary protein content can reduce N excretions and NH3 emissions from manure and increase milk N efficiency of dairy cows. However, milk yield (MY) and composition can be compromised ...due to AA deficiency. Methionine and Lys are known as first limiting EAA for dairy cows, and recently His is also mentioned as limiting, especially in grass-based or low-protein diets. To examine this, a trial was conducted with a 3-wk pre-experimental adaptation period (diet 16.5% crude protein), followed by a depletion period of 4 wk, in which 39 cows (average ± standard deviation: 116 ± 29.3 d in milk, 1.8 ± 1.2 lactations, 638 ± 73.2 kg of body weight, and 32.7 ± 5.75 kg MY/d) received a low-protein diet (CTRL) (14.5% crude protein). Then, taking into account parity, His plasma concentration, and MY, cows were randomly assigned to 1 of 3 treatment groups during the rumen-protected (RP) AA period of 7 wk; (1) CTRL; (2) CTRL + RP-Met + RP-Lys (MetLys); (3) CTRL + RP-Met + RP-Lys + RP-His (MetLysHis). Products were dosed, assuming requirements for digestible (d) Met, dLys, and dHis being, respectively, 2.4%, 7.0%, and 2.4% of intestinal digestible protein. In the cross-back period of 5 wk, all cows received the CTRL diet. During the last week of each period, a N balance was conducted by collecting total urine and spot samples of feces. Total feces production was calculated using the inert marker TiO2. Statistical analysis was performed with a linear mixed model with cow as random effect and data of the last week of the pre-experimental period used as covariate for the animal performance variables. No effect of supplementing RP-Met and RP-Lys nor RP-Met, RP-Lys, and RP-His on feed intake, milk performance, or milk N efficiency was observed. However, the plasma AA profile indicated additional supply of dMet, dLys, and dHis. Nevertheless, evaluation of the AA uptake relative to the cow's requirements showed that most EAA (exclusive Arg and Thr) were limiting over the whole experiment. Only dHis was sufficiently supplemented during the RP-AA period due to an overestimation of the diet's dMet and dLys supply in the beginning of the trial. The numerically increased milk urea N and urinary N excretion when RP-Met, RP-Lys, and RP-His were added to the low-protein diet suggest an increased catabolism of the excess His.
The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes.
Lowering dietary protein content is a promising ...strategy to reduce N excretions in cattle but it requires improved N utilization by the animal. Feed enzymes (e.g., exogenous α-amylase) and plant extracts (e.g., essential oils EO) are 2 additives that may enhance rumen function and possibly also microbial protein yield. This may increase fat- and protein-corrected milk yield (MY) and milk nitrogen efficiency and thus lower N losses from dairy cows. Both types of additives were studied in an experiment including 39 Holstein cows that had (average ± SD) 40.7 ± 7.95 kg/d MY, 89 ± 43 DIM, 2.7 ± 1.5 lactations, and 677 ± 68.6 kg of BW, consisting of a covariate (4 wk) and treatment period (5 wk). During the whole experiment cows were fed a typical Benelux diet (CTRL), supplemented with concentrates to meet individual requirements for energy and MP, which were fulfilled for 100% and 101%, respectively. The total diet was low in CP (15.5%) and relatively high in starch (22.6% and 6.6% rumen bypass starch). Cows were balanced for parity, DIM, MY, and roughage intake and randomly assigned to one of 3 groups, which received the following treatments in the treatment period: (1) CTRL (n = 13); (2) CTRL + 14 g/cow per day Ronozyme RumiStar α-amylase enzyme (AMEZ, n = 13; DSM); and (3) CTRL + 2.5 g/cow per day Crina Protect, a blend of EO components (ESOL, n = 13; DSM). Animal performance, ruminal pH, and enteric gas emissions were monitored throughout the experiment. During the last week of the covariate and treatment periods, nitrogen balances were conducted, total-tract nutrient digestibility was determined, and urinary allantoin and uric acid were determined as indicators for microbial N production. The statistical model applied to these variables contained group and DIM during treatment period as fixed effects and the values from the covariate period as covariate. Post hoc Dunnet-corrected comparisons between each treatment group and the control group were explored. The α-amylase enzyme tended to increase apparent total-tract starch digestibility and increased milk lactose concentration. The EO blend tended to increase MY and increased milk N output, milk nitrogen efficiency, and feed efficiency. Therefore, when feeding reduced dietary protein levels, EO have potential to improve the N-use efficiency in cattle, whereas the α-amylase enzyme might increase starch digestibility and milk lactose. However, additional research is necessary to substantiate our findings.
Statement of problem. Older temporomandibular disorder patients with more general complications and health problems may have a different clinical profile and be likely to react less favorably to ...conservative treatment.
Purpose. This retrospective study compared the clinical profiles of a young (20 to 30 years) and an older (50 to 70 years) group of patients with pain and dysfunction in the temporomandibular region and to analyze treatment outcomes.
Methods. Clinical profiles and treatment outcomes were studied with a standardized protocol and the Helkimo Pain and Dysfunction Index up to 1 year after initial examination.
Results. Younger and older patients with temporomandibular disorder differed only in pain intensity at initial examination, but the outcome of conservation treatment was equally successful.
Conclusion. Conservative treatment resulted in a significant alleviation of pain and dysfunction in almost 85% of patients. Both the younger and the older patient groups benefitted from this treatment protocol and therefore can be treated in the same fashion. (J Prosthet Dent 1999;81:312-7.)
Albiglutide is a glucagon-like peptide-1 (GLP-1) mimetic generated by genetic fusion of a dipeptidyl peptidase-IV-resistant GLP-1 dimer to human albumin. Albiglutide was designed to retain the ...therapeutic effects of native GLP-1 while extending its duration of action. This study was conducted to determine the pharmacokinetics and initial safety/tolerability profile of albiglutide in non-diabetic volunteers. In this single-blind, randomized, placebo-controlled trial, 39 subjects (18-60 years, body mass index 19.9-35.0 kg/m²) received placebo (n = 10) or escalating doses of albiglutide (n = 29) on days 1 and 8 in the following sequential cohorts: cohort 1: 0.25 + 1 mg; cohort 2: 3 + 6 mg; cohort 3: 16 + 24 mg; cohort 4: 48 + 60 mg; and cohort 5: 80 + 104 mg. Dose proportionality was evaluated based on area under the plasma drug concentration versus time curve area under the curve (AUC₍₀₋₇ days₎) and maximum plasma drug concentration (Cmax) for cohorts 2-5 during week 1. Albiglutide had a terminal elimination half-life (T₁/₂) of 6-8 days and time to maximum observed plasma drug concentration (Tmax) of 3-4 days. A greater-than-dose proportional increase in albiglutide exposure was observed. Albiglutide demonstrated a dose-dependent trend in reductions of glucose weighted mean AUC and fructosamine levels in healthy subjects. The incidence and severity of adverse events (AEs) was similar between placebo and albiglutide groups. Headache was the most frequent drug-related AE, followed by constipation, flatulence and nausea. Albiglutide has a half-life that favours once weekly or less frequent dosing with an acceptable safety/tolerability profile in non-diabetic subjects.
The chemical composition and the energy and protein value of five batches of condensed distillers solubles (CDS) originating from wheat were determined. The net energy for lactation (NEL) was derived ...from digestion coefficients obtained with sheep. The true protein digested in the small intestine (DVE) and the rumen degradable protein balance (OEB) were based on the rumen degradation rate (kdD), the rumen undegradable fraction (U) and intestinal digestibility of undegraded protein (%DVBE) predicted by regression equations derived from a data set of 28 protein feeds with kdD, U and %DVBE determined in situ. The CDS is a by-product with a high, but very variable CP content (238 to 495 g/kg DM). The CP contained on average 81% amino acids, with glutamine as main component (on average 21.8% of CP) and a relatively good lysine proportion (3.0%). Further, CDS contains quite a lot of crude fat (mean±SD: 71±14 g/kg DM), glycerol (95±52 g/kg DM) and sugars (123±24 g/kg DM) resulting in a high organic matter digestibility (88.6±3.0%) and high NEL content (8.3±0.4 MJ/kg DM). The protein value showed a large variation, with DVE ranging from 122 to 244 g/kg DM and OEB from 50 to 204 g/kg DM. Wheat CDS is a rich source of minerals and trace elements with exception of calcium.
Not all patients with chronic obstructive pulmonary disease (COPD) experience similar benefits after pulmonary rehabilitation (PR). This pre-post PR study used a large sample of patients with COPD to ...determine whether PR-induced changes of oxygen uptake (V˙O2) kinetics and exercise responses of V˙O2, carbon dioxide output (V˙CO2), minute ventilation (V˙E), V˙E/V˙CO2, breathing frequency, and tidal volume differed between responders and nonresponders to PR.
Responders to PR were defined as patients with a minimal clinically important increase in endurance time of 105 s. Isotime (=180 s) values of V˙O2, V˙CO2, V˙E, V˙E/V˙CO2, breathing frequency, and tidal volume; gains of V˙O2, V˙CO2, and V˙E; and V˙O2 mean response time of 183 patients with COPD (forced expiratory volume in 1 s: 56% ± 19% predicted) were compared between pre- and post-PR constant work rate tests.
After PR, only the group of responders significantly decreased V˙O2 mean response time (P < 0.05), V˙CO2 gain, V˙E gain, and isotime values of V˙CO2, V˙E, and V˙E/V˙CO2 (all, P < 0.001), while also improving their breathing pattern (e.g., decreased breathing frequency isotime value; P < 0.0001). These changes were not observed in the group of nonresponders. Changes in physiological exercise responses were correlated with changes in physical performance (e.g., correlation between changes in V˙O2 mean response time and endurance time: P = 0.0002, r = -0.32).
PR-induced changes in physiological exercise responses differed between responders and nonresponders. Physiological changes are relevant to explain the variable improvements of physical performance after PR in patients with COPD.
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