Systemic conditions and treatments as risks for implant therapy

PURPOSE: To evaluate whether systemic diseases with/without systemic medication increase the risk of implant failure and therefore diminish success and survival rates of dental implants. MATERIALS AND METHODS: A MEDLINE search was undertaken to find human studies reporting implant survival in subjects treated with osseointegrated dental implants who were diagnosed with at least one of 12 systemic diseases. RESULTS: For most conditions, no studies comparing patients with and without the condition in a controlled setting were found. For most systemic diseases there are only case reports or case series demonstrating that implant placement, integration, and function are possible in affected patients. For diabetes, heterogeneity of the material and the method of reporting data precluded a formal meta-analysis. No unequivocal tendency for subjects with diabetes to have higher failure rates emerged. The data from papers reporting on osteoporotic patients were also heterogeneous. The evidence for an association between osteoporosis and implant failure was low. Nevertheless, some reports now tend to focus on the medication used in osteoporotic patients, with oral bisphosphonates considered a potential risk factor for osteonecrosis of the jaws, rather than osteoporosis as a risk factor for implant success and survival on its own. CONCLUSIONS: The level of evidence indicative of absolute and relative contraindications for implant therapy due to systemic diseases is low. Studies comparing patients with and without the condition in a controlled setting are sparse. Especially for patients with manifest osteoporosis under an oral regime of bisphosphonates, prospective controlled studies are urgently needed.

Ridge preservation techniques for implant therapy

PURPOSE: The aim of this review was to evaluate the techniques and outcomes of postextraction ridge preservation and the efficacy of these procedures in relation to subsequent implant placement. MATERIALS AND METHODS: A MEDLINE/PubMed search was conducted and the bibliographies of reviews from 1999 to March 2008 were assessed for appropriate studies. Randomized clinical trials, controlled clinical trials, and prospective/retrospective studies with a minimum of five patients were included. RESULTS: A total of 135 abstracts were identified, from which 53 full-text articles were further examined, leading to 37 human studies that fulfilled the search criteria. Many different techniques, methodologies, durations, and materials were presented in the publications reviewed, making direct comparison difficult. CONCLUSIONS: Despite the heterogeneity of the studies, it was concluded that ridge preservation procedures are effective in limiting horizontal and vertical ridge alterations in postextraction sites. There is no evidence to support the superiority of one technique over another. There is also no conclusive evidence that ridge preservation procedures improve the ability to place implants.

Clinical and esthetic outcomes of implants placed in postextraction sites

PURPOSE: The aim of this review was to evaluate the clinical outcomes for the different time points of implant placement following tooth extraction. MATERIALS AND METHODS: A PubMed search and a hand search of selected journals were performed to identify clinical studies published in English that reported on outcomes of implants in postextraction sites. Only studies that included 10 or more patients were accepted. For implant success/survival outcomes, only studies with a mean follow-up period of at least 12 months from the time of implant placement were included. The following outcomes were identified: (1) change in peri-implant defect dimension, (2) implant survival and success, and (3) esthetic outcomes. RESULTS AND CONCLUSIONS: Of 1,107 abstracts and 170 full-text articles considered, 91 studies met the inclusion criteria for this review. Bone augmentation procedures are effective in promoting bone fill and defect resolution at implants in postextraction sites, and are more successful with immediate (type 1) and early placement (type 2 and type 3) than with late placement (type 4). The majority of studies reported survival rates of over 95%. Similar survival rates were observed for immediate (type 1) and early (type 2) placement. Recession of the facial mucosal margin is common with immediate (type 1) placement. Risk indicators included a thin tissue biotype, a facial malposition of the implant, and a thin or damaged facial bone wall. Early implant placement (type 2 and type 3) is associated with a lower frequency of mucosal recession compared to immediate placement (type 1).

Mechanical and technical risks in implant therapy

PURPOSE: To systematically appraise the impact of mechanical/technical risk factors on implant-supported reconstructions. MATERIAL AND METHODS: A MEDLINE (PubMed) database search from 1966 to April 2008 was conducted. The search strategy was a combination of MeSH terms and the key words: design, dental implant(s), risk, prosthodontics, fixed prosthodontics, fixed partial denture(s), fixed dental prosthesis (FDP), fixed reconstruction(s), oral rehabilitation, bridge(s), removable partial denture(s), overdenture(s). Randomized controlled trials, controlled trials, and prospective and retrospective cohort studies with a mean follow-up of at least 4 years were included. The material evaluated in each study had to include cases with/without exposure to the risk factor. RESULTS: From 3,568 articles, 111 were selected for full text analysis. Of the 111 articles, 33 were included for data extraction after grouping the outcomes into 10 risk factors: type of retentive elements supporting overdentures, presence of cantilever extension(s), cemented versus screw-retained FDPs, angled/angulated abutments, bruxism, crown/implant ratio, length of the suprastructure, prosthetic materials, number of implants supporting an FDP, and history of mechanical/technical complications. CONCLUSIONS: The absence of a metal framework in overdentures, the presence of cantilever extension(s) > 15 mm and of bruxism, the length of the reconstruction, and a history of repeated complications were associated with increased mechanical/technical complications. The type of retention, the presence of angled abutments, the crown-implant ratio, and the number of implants supporting an FDP were not associated with increased mechanical/technical complications. None of the mechanical/technical risk factors had an impact on implant survival and success rates.

Implant loading protocols for partially edentulous maxillary posterior sites

PURPOSE: To evaluate early and immediate loading of implants in the posterior maxilla and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, including marginal bone level changes. MATERIALS AND METHODS: A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers. RESULTS: Twelve papers were identified on early loading (two randomized controlled clinical trials [RCTs] and 10 prospective case series studies). Six papers were found on immediate loading (one RCT, four prospective case series, and one retrospective study). CONCLUSIONS: Under certain circumstances it is possible to successfully load dental implants in the posterior maxilla early or immediately after their placement in selected patients. The success rate appears to be technique sensitive, although no study has directly assessed this. A high degree of primary implant stability (high value of insertion torque) and implant surface characteristics play an important role. It is not possible to draw evidence-based conclusions concerning contraindications, threshold values for implant stability, bone quality and quantity needed, or impact of occlusal loading forces. As for the impact of the surgical technique on implant outcome in different bone densities, no studies prove significant superior results with one technique over another. Well-designed RCTs with a large number of patients are necessary to make early/immediate loading protocols in posterior maxilla evidence based, but ethical and practical considerations may limit the real possibility of such studies in the near future.

Response surface modeling of the interaction between propofol and sevoflurane

BACKGROUND: Propofol and sevoflurane display additivity for gamma-aminobutyric acid receptor activation, loss of consciousness, and tolerance of skin incision. Information about their interaction regarding electroencephalographic suppression is unavailable. This study examined this interaction as well as the interaction on the probability of tolerance of shake and shout and three noxious stimulations by using a response surface methodology. METHODS: Sixty patients preoperatively received different combined concentrations of propofol (0-12 microg/ml) and sevoflurane (0-3.5 vol.%) according to a crisscross design (274 concentration pairs, 3 to 6 per patient). After having reached pseudo-steady state, the authors recorded bispectral index, state and response entropy and the response to shake and shout, tetanic stimulation, laryngeal mask airway insertion, and laryngoscopy. For the analysis of the probability of tolerance by logistic regression, a Greco interaction model was used. For the separate analysis of bispectral index, state and response entropy suppression, a fractional Emax Greco model was used. All calculations were performed with NONMEM V (GloboMax LLC, Hanover, MD). RESULTS: Additivity was found for all endpoints, the Ce(50, PROP)/Ce(50, SEVO) for bispectral index suppression was 3.68 microg. ml(-1)/ 1.53 vol.%, for tolerance of shake and shout 2.34 microg . ml(-1)/ 1.03 vol.%, tetanic stimulation 5.34 microg . ml(-1)/ 2.11 vol.%, laryngeal mask airway insertion 5.92 microg. ml(-1) / 2.55 vol.%, and laryngoscopy 6.55 microg. ml(-1)/2.83 vol.%. CONCLUSION: For both electroencephalographic suppression and tolerance to stimulation, the interaction of propofol and sevoflurane was identified as additive. The response surface data can be used for more rational dose finding in case of sequential and coadministration of propofol and sevoflurane.

Quantifying the influence of bone density and thickness on resonance frequency analysis: an in vitro study of biomechanical test materials

PURPOSE: Resonance frequency analysis (RFA) offers the opportunity to monitor the osseointegration of an implant in a simple, noninvasive way. A better comprehension of the relationship between RFA and parameters related to bone quality would therefore help clinicians improve diagnoses. In this study, a bone analog made from polyurethane foam was used to isolate the influences of bone density and cortical thickness in RFA. MATERIALS AND METHODS: Straumann standard implants were inserted in polyurethane foam blocks, and primary implant stability was measured with RFA. The blocks were composed of two superimposed layers with different densities. The top layer was dense to mimic cortical bone, whereas the bottom layer had a lower density to represent trabecular bone. Different densities for both layers and different thicknesses for the simulated cortical layer were tested, resulting in eight different block combinations. RFA was compared with two other mechanical evaluations of primary stability: removal torque and axial loading response. RESULTS: The primary stability measured with RFA did not correlate with the two other methods, but there was a significant correlation between removal torque and the axial loading response (P < .005). Statistical analysis revealed that each method was sensitive to different aspects of bone quality. RFA was the only method able to detect changes in both bone density and cortical thickness. However, changes in trabecular bone density were easier to distinguish with removal torque and axial loading than with RFA. CONCLUSIONS: This study shows that RFA, removal torque, and axial loading are sensitive to different aspects of the bone-implant interface. This explains the absence of correlation among the methods and proves that no standard procedure exists for the evaluation of primary stability.

The use of extraoral implants for distal-extension removable dentures: a clinical evaluation up to 8 years

PURPOSE: This retrospective study reports the clinical outcome following placement of extraoral implants in severely resorbed posterior ridges to support distal-extension removable dentures. MATERIAL AND METHODS: Consecutively treated patients with partially or completely edentulous ridges, with available bone height in the posterior region of 6 mm or less, were included in the study. Implants originally intended for extraoral use (Straumann) were placed in second molar regions and allowed to heal for 4 to 6 months before abutment connection. At recall appointments, the peri-implant hard and soft tissues were evaluated. Complications with implant components, as well as mechanical and structural failures of the prostheses, were recorded. Two-year survival rates were calculated and life table analyses undertaken. RESULTS: Twenty-nine patients (19 women and 10 men; average age 61.2 years, range, 44 to 75 years) were included in the study. Forty-seven extraoral implants in 26 patients were placed in the second molar site of the mandible. Two extraoral implants in 2 patients failed during the osseointegration phase, yielding an 8-year cumulative success rate of 91.8%. The mean distance from the extraoral implants to the most distal tooth/implant was 28.1 mm (range, 16.7 to 39.2 mm). Twenty-three extraoral implants were restored with magnets, 18 with ball anchors, and 4 with conical cylinders. Replacement of abutments and retention elements was necessary in 2 patients. Four abutments in 2 patients were disconnected from the restorations. CONCLUSIONS: Within the limits of the employed research design, extraoral implants may be used successfully to provide support for distal-extension removable dentures in severely resorbed posterior alveolar ridges.

Prüftechnik für RFID bei Hochgeschwindigkeitsanwendungen im Transportwesen

Im Rahmen des Forschungsprojektes TagDrive wird die Applikation von passiven Transpondern auf 13,56 MHz-Basis untersucht, die auf der Fahrbahn befestigt und zur Spurführung und Navigation von Fahrzeugen verwendet werden. Um den Einsatz von Folientranspondern (Smart Labels) bei hohen Fahrzeuggeschwindigkeiten in Zusammenhang mit Transponderlesegeräten am Fahrzeug zu testen, wurde ein Hochgeschwindigkeitsprüfstand für Relativgeschwindigkeiten zwischen Transponder und Lesegerät von bis zu 100 km/h entwickelt und Versuche bei variierenden Leseabständen durchgeführt. Für mechanische Prüfungen der applizierten Transponder inklusive Gehäuse wurden Druckprüfungen mit Hilfe einer servohydraulischen Prüfeinrichtung durchgeführt und ein neuer pneumatischer Prüfstand entwickelt, der den Überrollvorgang durch ein Rad nachbildet. Für klimatische Tests unter anderem nach DIN EN 60068-2-67 bzw. IEC 68-2-67 wurde ein Klimaschrank verwendet.

Der Tischri-Monat

Hanover

Israelitische Lehrerbildungsanstalt Würzburg

Hanover

Na 1 Nachlass Max Horkheimer, 11 - Korrespondenzen u.a. mit Edward M. David (p. I 6, 1-183)

1 Brief von Fritz Dannenbaum an Max Horkheimer, 26.11.1935; 2 Briefe zwischen F. Darnbacher und Max Horkheimer, 24.01.1936, 22.01.1936; 3 Briefe zwischen dem Dartmouth College Hanover N.H. und Max Horkheimer, 1939-1941. 06.05.1939; 14 Briefe zwischen Edward M. David und Max Horkheimer, 1941-1942; 1 Brief von der Day Cornell University, Ithaca N.Y. an Max Horkheimer, 24.02.1939; 2 Briefe zwischen Margaret Deaner und Max Horkheimer, 01.04.1935, 04.04.1935; 1 Brief von Max Horkheimer an Hanna Deinhard, 05.01.1949; 1 Brief von Deiters an Max Horkheimer, 26.11.1935; 2 Briefe zwischen Laura Demick und Max Horkheimer, 22.12.1941, 29.12.1941; 2 Briefe zwischen Grace Dertz und Max Horkheimer, 18.10.1934, 11.10.1934; 1 Brief von Max Horkheimer an Dekan, 20.06.1940; 1 Brief von Max Dessoir an Max Horkheimer, 29.08.1937; 1 Brief von Max Horkheimer an Deutschland / deutsches Reich Minister für Wissenschaft, Kunst und Volksbildung, Berli, 21.04.1933; 4 Briefe zwischen John Dewey und Max Horkheimer, 1940-1941, 20.02.1941; 1 Brief von Max Horkheimer an Walter Strauss, 20.02.1941; 3 Briefe zwischen Frederic Dewhurst und Max Horkheimer, 1939, 08.02.1939; 5 Briefe zwischen dem Soziograph Jul Diederich und Max Horkheimer, 1934-1938; 1 Brief von Max Horkheimer an Hugo Sinzheimer, 20.10.1934; 15 Briefe zwischen William Dieterle, Charlotte Dieterle und Max Horkheimer, 1940-1944; 1 Brief von der Dillmann-Oberschule Stuttgart an Max Horkheimer, 13.12.1949; 1 Brief vonMax Horkheimer an W. R. Dittmar, 10.02.1938; 2 Briefe zwischen Sofie Doernberg, Paul Doernberg und Margot von Mendelssohn, 1942, 06.04.1942; 4 Briefe zwischen Willy Dörter und Max Horkheimer, 1936-1937, 20.02.1936; 1 Brief von Georg Glaser anMax Horkheimer; 3 Briefe zwischen Hans Venedey und Max Horkheimer, 22.01.1938, 1938; 28 Briefe sowie Zeitungsausschnitte zwischen Juliette Favez und Max Horkheimer, 1934-1938; 1 Brief von Juliette Favez ann karl Dörter, 02.10.1934; 2 Briefe von Max Horkheimer an Hans Klaus Brill, Januar 1938; 3 Briefe zwischen Karl Dörter und Max Horkheimer, 1934-1937, 12.10.1934; 4 Briefe zwischen Andrés Sternheim und Max Horkheimer, 1937, 16.06.1937; 1 Brief von Else Klee an Max Horkheimer, 13.06.1935;