Improvements in Implant Dentistry over the Last Decade: Comparison of Survival and Complication Rates in Older and Newer Publications

Purpose: The objective of this systematic review was to assess and compare the survival and complication rates of implant-supported prostheses reported in studies published in the year 2000 and before, to those reported in studies published after the year 2000. Materials and Methods: Three electronic searches complemented by manual searching were conducted to identify 139 prospective and retrospective studies on implant-supported prostheses. The included studies were divided in two groups: a group of 31 older studies published in the year 2000 or before, and a group of 108 newer studies published after the year 2000. Survival and complication rates were calculated using Poisson regression models, and multivariable robust Poisson regression was used to formally compare the outcomes of older and newer studies. Results: The 5-year survival rate of implant-supported prostheses was significantly increased in newer studies compared with older studies. The overall survival rate increased from 93.5% to 97.1%. The survival rate for cemented prostheses increased from 95.2% to 97.9%; for screw-retained reconstruction, from 77.6% to 96.8%; for implant-supported single crowns, from 92.6% to 97.2%; and for implant-supported fixed dental prostheses (FDPs), from 93.5% to 96.4%. The incidence of esthetic complications decreased in more recent studies compared with older ones, but the incidence of biologic complications was similar. The results for technical complications were inconsistent. There was a significant reduction in abutment or screw loosening by implant-supported FDPs. On the other hand, the total number of technical complications and the incidence of fracture of the veneering material was significantly increased in the newer studies. To explain the increased rate of complications, minor complications are probably reported in more detail in the newer publications. Conclusions: The results of the present systematic review demonstrated a positive learning curve in implant dentistry, represented in higher survival rates and lower complication rates reported in more recent clinical studies. The incidence of esthetic, biologic, and technical complications, however, is still high. Hence, it is important to identify these complications and their etiology to make implant treatment even more predictable in the future.

Is dosing of therapeutic immunoglobulins optimal? A review of a three-decade long debate in europe.

The consumption of immunoglobulins (Ig) is increasing due to better recognition of antibody deficiencies, an aging population, and new indications. This review aims to examine the various dosing regimens and research developments in the established and in some of the relevant off-label indications in Europe. The background to the current regulatory settings in Europe is provided as a backdrop for the latest developments in primary and secondary immunodeficiencies and in immunomodulatory indications. In these heterogeneous areas, clinical trials encompassing different routes of administration, varying intervals, and infusion rates are paving the way toward more individualized therapy regimens. In primary antibody deficiencies, adjustments in dosing and intervals will depend on the clinical presentation, effective IgG trough levels and IgG metabolism. Ideally, individual pharmacokinetic profiles in conjunction with the clinical phenotype could lead to highly tailored treatment. In practice, incremental dosage increases are necessary to titrate the optimal dose for more severely ill patients. Higher intravenous doses in these patients also have beneficial immunomodulatory effects beyond mere IgG replacement. Better understanding of the pharmacokinetics of Ig therapy is leading to a move away from simplistic "per kg" dosing. Defective antibody production is common in many secondary immunodeficiencies irrespective of whether the causative factor was lymphoid malignancies (established indications), certain autoimmune disorders, immunosuppressive agents, or biologics. This antibody failure, as shown by test immunization, may be amenable to treatment with replacement Ig therapy. In certain immunomodulatory settings [e.g., idiopathic thrombocytopenic purpura (ITP)], selection of patients for Ig therapy may be enhanced by relevant biomarkers in order to exclude non-responders and thus obtain higher response rates. In this review, the developments in dosing of therapeutic immunoglobulins have been limited to high and some medium priority indications such as ITP, Kawasaki' disease, Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, myasthenia gravis, multifocal motor neuropathy, fetal alloimmune thrombocytopenia, fetal hemolytic anemia, and dermatological diseases.

Characteristics of Consecutive Esophageal Motility Diagnoses After a Decade of Change

BACKGROUND AND AIMS Combined multichannel intraluminal impedance and esophageal manometry (MII-EM) measures concomitantly bolus transit and pressure changes allowing determination of the functional impact of esophageal motility abnormalities. Ten years ago our laboratory reported MII-EM results in 350 consecutive patients. Since then high-resolution impedance manometry (HRIM) became available and the definitions of ineffective esophageal motility (IEM) and nutcracker esophagus were revised. The aim of this study was to assess the impact of these developments on esophageal function testing. METHODS From August 2012 through May 2013, HRIM was performed in 350 patients referred for esophageal function testing. Each patient received 10 liquid and 10 viscous swallows. While taking advantage of the new technology and revised criteria, HRIM findings were classified according to the conventional criteria to allow more appropriate comparison with our earlier analysis. RESULTS Compared with the study performed 10 years ago, the prevalence of normal manometry (36% vs. 35%), achalasia (7% vs. 8%), scleroderma (1% vs. 1%), hypertensive lower esophageal sphincter (LES) (7% vs. 7%), and hypotensive LES (1% vs. 2%) remained the same, whereas the prevalence of distal esophageal spasm (9% vs. 3%), nutcracker esophagus (9% vs. 3%), and poorly relaxing LES (10% vs. 3%) decreased and the prevalence of IEM increased (20% vs. 31%) significantly. Compared with the early study, normal liquid bolus transit was significantly different in patients with hypertensive LES (96% vs. 57%) and poorly relaxing LES (55% vs. 100%). CONCLUSIONS This study brings to light the increase in prevalence of IEM. In addition, it suggests that the hypertensive LES and poorly relaxing LES may each affect bolus transit in about half of these patients.

The Treatment Action Campaign's First Decade: Success Achieved?

South Africa is known to have the largest HIV epidemic in the world with 5.7 million people currently living with HIV, according to UNAIDS. In light of the crisis, South Africa's Treatment Action Campaign (TAC) has led the social movement for increased treatment access for people living with HIV through lobbying the government, multinational pharmaceutical companies, and grassroots campaigning. Since it's founding a decade ago, TAC has been highly acclaimed both regionally and internationally for its success. In order to determine the success of this social movement organization, social movement theories, such as mobilization potential, external political opportunity structure, and framing of the social context of issues will be examined. The assessment of TAC's success will be made based on two outcomes: political outcome and social/cultural outcome. The assessment of TAC's success, using this framework has shown that TAC is a successful social movement organization overall.

Decade Wind and Wave Data for NW Iberia, Cabo Sillerio

Seafloor sediment mobilization on the inner Northwest Iberian continental shelf is caused largely by ocean surface waves. The temporal and spatial variability in the wave height, wave period, and wave direction has a profound effect on local sediment mobilization, leading to distinct sediment mobilization scenarios. Six grain-size specific sediment mobilization scenarios, representing seasonal average and storm conditions, were simulated with a physics-based numerical model. Model inputs included meteorological and oceanographic data in conjunction with seafloor grain-size and the shelf bathymetric data. The results show distinct seasonal variations, most importantly in wave height, leading to sediment mobilization, specifically on the inner shelf shallower than 30 m water depth where up to 49% of the shelf area is mobilized. Medium to severe storm events are modeled to mobilize up to 89% of the shelf area above 150 m water depth. The frequency of each of these seasonal and storm-related sediment mobilization scenarios is addressed using a decade of meteorological and oceanographic data. The temporal and spatial patterns of the modeled sediment mobilization scenarios are discussed in the context of existing geological and environmental processes and conditions to assist scientific, industrial and environmental efforts that are directly affected by sediment mobilization. Examples, where sediment mobilization plays a vital role, include seafloor nutrient advection, recurrent arrival of oil from oil-spill-laden seafloor sediment, and bottom trawling impacts.