Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

Anterior Tooth Rehabilitation With Frozen Homogenous Bone Graft and Immediately Loaded Titanium Implant Using Computer-Guided Surgery

Computed tomographic scanning is a precise, noinvasive surveying technique that enables the professionals to improve the precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of anterior tooth rehabilitation with frozen homogenous bone graft and immediately loaded titanium implant using computer-guided surgery. A multislice computed tomography was realized, and a prototype was built. All the procedures were previously realized in the prototype before started in the patient. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.

Patients' Satisfaction After Surgical Facial Reconstruction or After Rehabilitation With Maxillofacial Prosthesis

The matching of the aesthetic, functional, and psychosocial results of a facial deformity may produce devastating effects in its carriers, especially if the lesion is extensive or the treatment is aggressive. Because of this, the objective of the present article was to evaluate patient's satisfaction rating after surgical facial reconstruction or rehabilitation with oral and maxillofacial prosthesis, by means of reviewing the literature.

Patient satisfaction with maxillofacial prosthesis. Literature review

Obturators and facial prostheses are important not only in rehabilitation and aesthetics, but also in patient re-socialisation. The level of reintegration is directly related to the degree of satisfaction with rehabilitation. So, the maxillofacial prosthetics must provide patient satisfaction during treatment. This study aimed to search information in database and conduct a literature review on patient satisfaction with maxillofacial prosthesis. The problems experienced by these patients may decrease when specialists keep the patient on regular inspection. Rehabilitation through alloplasty or prosthetic restoration provides satisfactory conditions in aesthetics and well-being and reinstates individuals in familial and social environment. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Rehabilitation with ear prosthesis linked to osseointegrated implants

Background: The absence of an ear, which can be the result of a congenital malformation, surgical tumour resection or traumatic injury, is a significant aesthetic problem. Attachment of ear prostheses with adhesives can cause local irritation for the wearer and affect the colour of the prostheses. Use of implants in craniofacial reconstruction can improve the retention and stability of prostheses giving to patient greater comfort and security relative to adhesive attachment.Objective: The aim of this report was to present a clinical case of a mutilated patient who was rehabilitated by means of installing an ear prosthesis fixed through osseointegrated implants.Materials and methods: The patient had two implants installed in the mastoid region that were linked by a bar, and a clip-type system was used. The ear prosthesis was constructed from medical-use silicone, pigmented to match the patient's skin colour and linked to the retention system.Conclusion: The patient's rehabilitation was satisfactory from both a functional and an aesthetic point of view, making it possible for the patient to return to a normal social life and regain lost self-esteem.

Oral Rehabilitation After Surgical Removal of Pleomorphic Adenoma

Although tumors of minor salivary glands are rare, the pleomorphic adenoma is the most common pathology among the benign neoplasm and can be found with high prevalence in the junction between hard palate and soft palate. The treatment of choice for most of maxillary tumors is surgical through either a total or partial maxillectomy. However, surgical defects caused by such type of treatment lead to both clinical and psychologic disorders for the patient. The immediate oral rehabilitation using interim palate obturator after maxillectomy provides optimization on the healing process, recovers the stomatognathic functions after surgery, and avoids psychosocial sequelae for the patients. This clinical report aimed to present the rehabilitation with immediate palate obturator of a patient who underwent a partial maxillectomy due to a hard palate pleomorphic adenoma of minor salivary glands. We report the clinical importance of the prosthetic rehabilitation and the improvements on both quality of life and stomatognathic functions of this patient. It can be concluded that the immediate rehabilitation of the patient after partial maxillectomy by using an interim palate obturator was a great option and provided clinical benefits in the immediate postoperative period, improving the patient's quality of life, allowing the patient's reinsertion into society, and reducing the surgical treatment sequelae.

Obturator for Rehabilitation of Cleft Palate With Implant-Supported Retention System

Objective: Surgical reconstruction and prosthetic obturation are alternatives for the treatment of cleft in the soft palate.Design: The present case reports the rehabilitation of a patient presenting cleft palate with obturator prosthesis associated with implant-supported retention system.Conclusions: The use of ball attachment system improved speech, masticatory efficiency, swallowing, and social behavior of the patient.

Oral rehabilitation of severely worn dentition using an overlay for immediate re-establishment of occlusal vertical dimension

The aim of this study was to describe the treatment used in an elderly patient presenting with bruxism and dental erosion, with good gingival health and bone support, but with decreased occlusal vertical dimension (OVD). The oral rehabilitation of elderly patients presenting with bruxism in association with tooth erosion has been a great challenge for dentists. The loss of OVD, the presence of occlusal instability and the absence of an effective anterior guide due excessive dental wear, can damage stomatognathic system (SS) biology, the function and the aesthetics. In the first treatment stage, an overlay removable partial denture (ORPD) was fabricated for the immediate re-establishment of function and aesthetics. After a 2-month follow up, with the patient presenting no symptoms, a second rehabilitation stage was accomplished, with fixed and removable prostheses. Oral rehabilitation with an ORPD was able to re-establish the SS biology, but a correct diagnosis and treatment plan are essential for success. The ORPD is a non-invasive and reversible restoring modality for general dentists that allow the re-establishment of the patient's immediate aesthetics and function at low cost.

Maxillary osteosarcoma in a young patient undergoing postorthodontic treatment follow-up: The importance of ongoing oral examinations

Osteosarcoma is a common primary malignant tumor in long bones; it generally occurs in young adults. It is considered infrequent in the head and neck regions, where it is usually associated with poor outcomes and rates of survival. From a histopathologic point of view, osteosarcomas are commonly classified as osteoblastic, chondroblastic, or fibroblastic, although several unusual microscopic subtypes have also been reported. The purpose of this article was to present a case report of a maxillary chondroblastic osteosarcoma involving the maxillary sinus and the maxilla of a young woman who was diagnosed during early postorthodontic treatment follow-up. Treatment, prosthetic rehabilitation, and follow-up details are provided. Most importantly, this patient shows the importance of complete and systematic oral examinations during any routine dental treatment. (Am J Orthod Dentofacial Orthop 2011;139:845-8)

All-on-four concept and immediate loading for simultaneous rehabilitation of the atrophic maxilla and mandible with conventional and zygomatic implants

We report the simultaneous rehabilitation of an edentulous patient with a hybrid (zygomatic and conventional implants) all-on-four implant-supported prosthesis for the maxilla and a standard (conventional implants) all-on-four implant-supported prosthesis for the mandible. The transfer impression was made with a multifunctional guide and the upper and lower prostheses were placed 24 h postoperatively. Clinical and radiographic examinations showed no infection or bony resorption 2 years later. Simultaneous maxillary and mandibular rehabilitation with all-on-four immediate loading is a viable, fast and effective option for edentulous patients. (C) 2009 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.

Communication that values patient autonomy is associated with satisfaction with care: a systematic review

Question: Which communication factors used by clinicians during patient-clinician interactions are associated with satisfaction with care? Design: Systematic review with meta-analysis of studies investigating the association of verbal or nonverbal factors or interaction styles used by clinicians with patient satisfaction during an encounter between clinician and patient. Participants: Clinicians interacting with patients in primary care or rehabilitation settings. Results: Twenty-seven studies investigated 129 verbal, nonverbal, and interaction style factors. of these, 38 factors were consistently associated with satisfaction. Verbal factors concerning clinicians involving, facilitating, and supporting patients were associated with satisfaction with care. Most communication factors presented a fair correlation (r >= 0.21 but < 0.41) with satisfaction with care. Nonverbal factors such as time spent discussing prevention and time spent reading patient charts had a fair association with satisfaction with care (correlations range from 0.21 to 0.40). A moderate association was found between interaction styles such as caring (pooled r = 0.51, 95% CI 0.42 to 0.60) and satisfaction with care. Over half (58%) of the 129 identified factors never associated with satisfaction with care and the remainder associated inconsistently. Conclusion: The number of potential modifiable communication factors associated with satisfaction with care and the magnitude of their association partially support interventions to train clinicians in communication skills that value patient autonomy. [Oliveira VC, Refshauge KM, Ferreira ML, Pinto RZ, Beckenkamp PR, Negrao Filho RF, Ferreira PH (2012) Communication that values patient autonomy is associated with satisfaction with care: a systematic review. Journal of Physiotherapy 58: 215-229]

Naso-orbicular tissue necrosis by Streptococcus parasanguis in a patient with Fanconi anemia: Clinical and laboratory aspects

Fanconi anemia (FA) is a rare autosomal recessive disorder, characterized by pancytopenia and progressive hypoplasia of the bone marrow. A 23-year-old woman with FA showed severe pancytopenia and developed an abscess on the infraorbicular region on the right side of the face that progressed to phlegmon and caused tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbital region. Laboratory examination showed Streptococcus parasanguis as the etiologic agent of the phlegmon. Supportive treatment was recommended due to donor incompatibility for bone marrow transplant. The intraoral examination showed spontaneous gingival bleeding, edema of the interdental papillae, hematomas on the superior and inferior lips, bacterial and fungal infections, and adequate oral hygiene. The patient was treated with the administration of an antibiotic (imipenem), an antifungal (amphotericin B), and mouth washing with antiseptic solutions. Periodontal prophylaxis and orientation to and control of oral hygiene and diet were also used during the remission period. For functional and esthetic rehabilitation of the alar regions and nasal dorsum, an acrylic resin nasal prosthesis was made, supported by a spectacle frame.

Prosthetic rehabilitation of a bone defect with a teeth-implant supported, removable partial denture

The use of teeth-implant, mucosa-supported removable dentures for rehabilitation of partially edentulous patients involves highly complex biomechanical aspects. This type of prosthesis associates 3 kinds of support that react differently to the functional and parafunctional forces developed in the oral cavity. Although the construction of removable partial dentures may seem paradoxical when osseointegrated implants are placed, in some cases, this option is an excellent alternative to solve difficulties related to the anatomic, biologic, psychomotor, and financial conditions of the patient. This article reports on a case in which a teeth-implant, mucosa-supported removable partial denture was the option of choice for a patient with financial and anatomic limitations, having a large structural loss of the residual alveolar ridge caused by trauma by a gunshot injury at the mandible. The 5-year follow-up did not reveal any type of biomechanical or functional problem. Copyright © 2006 by Lippincott Williams and Wilkins.

Functional and esthetic rehabilitation with In-Ceram alumina and zirconia system: A multidisciplinary approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In-Ceram single crowns. Clinical significance: The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.

Cephalometric evaluation of hyoid bone position in a patient with Down syndrome: Case report

The hyoid bone contributes to the maintenance of the airway, chewing and swallowing, given to its anatomical and functional relations to the craniocervical complex. Cephalometric analysis has great importance for orthopedics, orthodontics and oral maxillary surgery. For the treatment of patients with special care needs, the cephalometric evaluation of the position of the hyoid bone should also contribute as a complementary element for dental diagnosis and the selection of the adequate treatment. The aim of this paper is to demonstrate the alteration of the hyoid position after carrying out the functional orthopedic maxillary treatment in a 9 year-old patient with Down Syndrome. Initial cephalometric analysis revealed inadequate position of hyoid bone. The association of speech therapy to dynamic functional rehabilitation of jaws showed a positive effect in occlusal relation and facial expression. After treatment, all dimensions obtained from the hyoid triangle were higher than initial ones, except the anterior-posterior value of C3-H, which suggested function improvement of stomatognathic system. Once considered its anatomical and physiological relationship with the others structures of the stomatognathic system, cephalometric analysis of hyoid bone position was helpful to the comprehension of the craniofacial abnormalities related to chromosomal anomaly, and thus is essential to the interdisciplinary dialogue.