A retrospective analysis of patients referred for implant placement to a specialty clinic: indications, surgical procedures, and early failures

Purpose: This retrospective study analyzed the pool of patients referred for treatment with dental implants over a 3-year period in a referral specialty clinic. Materials and Methods: All patients receiving dental implants between 2002 and 2004 in the Department of Oral Surgery and Stomatology, University of Bern, were included in this retrospective study. Patients were analyzed according to age, gender, indications for implant therapy, location of implants, and type and length of implants placed. A cumulative logistic regression analysis was performed to identify and analyze potential risk factors for complications or failures. Results: A total of 1,206 patients received 1,817 dental implants. The group comprised 573 men and 633 women with a mean age of 55.2 years. Almost 60% of patients were age 50 or older. The most frequent indication for implant therapy was single-tooth replacement in the maxilla (522 implants or 28.7%). A total of 726 implants (40%) were inserted in the esthetically demanding region of the anterior maxilla. For 939 implants (51.7%), additional bone-augmentation procedures were required. Of these, ridge augmentation with guided bone regeneration was performed more frequently than sinus grafting. Thirteen complications leading to early failures were recorded, resulting in an early failure rate of 0.7%. The regression analysis failed to identify statistically significant failure etiologies for the variables assessed. Conclusions: From this study it can be concluded that patients referred to a specialty clinic for implant placement were more likely to be partially edentulous and over 50 years old. Single-tooth replacement was the most frequent indication (> 50%). Similarly, additional bone augmentation was indicated in more than 50% of cases. Adhering to strict patient selection criteria and a standardized surgical protocol, an early failure rate of 0.7% was experienced in this study population

Implant therapy in a surgical specialty clinic: an analysis of patients, indications, surgical procedures, risk factors, and early failures

PURPOSE The aim of this study was to analyze the patient pool referred to a specialty clinic for implant surgery over a 3-year period. MATERIALS AND METHODS All patients receiving dental implants between 2008 and 2010 at the Department of Oral Surgery and Stomatology were included in the study. As primary outcome parameters, the patients were analyzed according to the following criteria: age, sex, systemic diseases, and indication for therapy. For the inserted implants, the type of surgical procedure, the types of implants placed, postsurgical complications, and early failures were recorded. A logistic regression analysis was performed to identify possible local and systemic risk factors for complications. As a secondary outcome, data regarding demographics and surgical procedures were compared with the findings of a historic study group (2002 to 2004). RESULTS A total of 1,568 patients (792 women and 776 men; mean age, 52.6 years) received 2,279 implants. The most frequent indication was a single-tooth gap (52.8%). Augmentative procedures were performed in 60% of the cases. Tissue-level implants (72.1%) were more frequently used than bone-level implants (27.9%). Regarding dimensions of the implants, a diameter of 4.1 mm (59.7%) and a length of 10 mm (55.0%) were most often utilized. An early failure rate of 0.6% was recorded (13 implants). Patients were older and received more implants in the maxilla, and the complexity of surgical interventions had increased when compared to the patient pool of 2002 to 2004. CONCLUSION Implant therapy performed in a surgical specialty clinic utilizing strict patient selection and evidence-based surgical protocols showed a very low early failure rate of 0.6%.

Objective evaluation of shoulder function using body-fixed sensors: a new way to detect early treatment failures?

Background: Variable definitions of outcome (Constant score, Simple Shoulder Test [SST]) have been used to assess outcome after shoulder treatment, although none has been accepted as the universal standard. Physicians lack an objective method to reliably assess the activity of their patients in dynamic conditions. Our purpose was to clinically validate the shoulder kinematic scores given by a portable movement analysis device, using the activities of daily living described in the SST as a reference. The secondary objective was to determine whether this device could be used to document the effectiveness of shoulder treatments (for glenohumeral osteoarthritis and rotator cuff disease) and detect early failures.Methods: A clinical trial including 34 patients and a control group of 31 subjects over an observation period of 1 year was set up. Evaluations were made at baseline and 3, 6, and 12 months after surgery by 2 independent observers. Miniature sensors (3-dimensional gyroscopes and accelerometers) allowed kinematic scores to be computed. They were compared with the regular outcome scores: SST; Disabilities of the Arm, Shoulder and Hand; American Shoulder and Elbow Surgeons; and Constant.Results: Good to excellent correlations (0.61-0.80) were found between kinematics and clinical scores. Significant differences were found at each follow-up in comparison with the baseline status for all the kinematic scores (P < .015). The kinematic scores were able to point out abnormal patient outcomes at the first postoperative follow-up.Conclusion: Kinematic scores add information to the regular outcome tools. They offer an effective way to measure the functional performance of patients with shoulder pathology and have the potential to detect early treatment failures.Level of evidence: Level II, Development of Diagnostic Criteria, Diagnostic Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.

Pääomasijoittamisen tehostaminen suomalaisen pkt-sektorin kehittämisessä

Tutkimuksen tavoitteena oli kehittää systemaattinen toimintamalli sekä luoda suorituskyvyn esi-merkkimittaristo pääomasijoittajan toiminnan tehostamiseksi. Pääomasijoittajan tärkein tehtävä on pyrkiä kasvattamaan sijoituskohdeyrityksen osakkeiden ja siten omistaja-arvoa keskipitkällä aika-jänteellä. Strategioiden kehittämistä ja toteuttamista on tutkittu sangen laajasti, mutta käytännölli-sempi lähestymiskulma hallitustyöskentelyn vaikutuksista sekä strategioiden toteutuksen varmis-tamisesta on jäänyt näissä aikaisemmissa tutkimuksissa vähemmälle huomiolle. Varsinainen perusta omistaja-arvolle ja sen kasvattamiselle suomalaisen pkt-yrityksen pääomasi-joittamisessa luodaan hyvien ja tulevaisuuden kasvupotentiaalia omaavien kohdeyritysten etsimisellä, riittävän tarkalla analysoinnilla sekä sijoitushetken kohtuullisella arvostuksella. Sijoitusaikana ei enää pystytä korjaamaan mahdollisia alkuvaiheen epäonnistumisia. Kun kohdeyhtiöön on valittu ammattitaitoinen ja motivoitunut hallitus, tulee pääomasijoittajan panostaa valittujen strategioiden toteuttamiseen havainnollisilla ja tehokkailla työkaluilla. Ne mahdollistavat kohdeyrityksen visioiden ja arvojen jakamisen edelleen helpommin ymmärrettäviksi avainmittareiksi ja –tavoitteiksi kaikille organisaatiotasoille. Suorituskyvyn mittaamisen ja analysoinnin päätehtävä sekä suurissa että pienissäkin yrityksissä on yritysjohdon päätöksenteon tukeminen luotettavan, säännöllisen ja riittävän tarkan informaation tuottamisella huolellisesti valituista mittauskohteista. Suorituskyvyn analysointi auttaa myös hahmottamaan paremmin kokonaisnäkemystä yrityksen menestykseen vaikuttavista tekijöistä sekä niiden välisistä syy-yhteyksistä. Alunperin suuryritysten tarpeisiin kehitetyt suorituskyvyn analysointi- ja mittausmenetelmät ovat poikkeuksetta liian monimutkaisia ja raskaita vastatakseen pienempien yritysten vaatimuksia. Liiketoiminnan seuraamisessa ja ohjaamisessa pkt-yrityksen hallituksen tulee ottaa perinteisten taloudellisten mittareiden lisäksi mukaan myös keskeisimpiä, ei-taloudellisia seurattavia asioita, joiden avulla muodostuu ajantasaisempi kuva kohdeyhtiön kilpailukyvystä sekä menestyksestä. Pääomasijoittajan toimintamallissa esitellään kansainvälisesti käytössä olevia menetelmiä strategian jalkauttamiseen, yrityksen liiketoimintamallin kehittämiseen sekä suorituskyvyn johtamisen tukemiseen. Pkt-yrityksille pyrittiin luomaan yksinkertainen mallimittaristo suorituskyvyn analysointiin ja yrityksen johtamisen tueksi. Sijoituskohdeyritysten hallituksilla on jo tällä hetkellä käytettävissään erilaisia kuukausittaisia taloudellisia tunnuslukuja sekä tilikauden tuloksestakin jotain ennakkotietoa. Näiden pohjalle olisi varsin yksinkertaista rakentaa myös yrityksen sisäisiä prosesseja, asiakkuustyöskentelyä, myyntiä ja markkinointia sekä toiminnan yleistä systemaattisuutta kuvaavia mittareita.

La responsabilidad del Estado por el hecho del legislador

Analizar el fenómeno de la responsabilidad del Estado causada por los hechos del legislador ha sido un trabajo desarrollado tanto por la doctrina como por la jurisprudencia internacional a mediados del siglo xx. En Francia, por ejemplo, se presentó el primer antecedente jurisprudencial en el año de 1934. En España, su estudio empezó a gestionarse con la promulgación de la Constitución de 1978, dándose el primer fallo judicial en elaño de 1993. Para el caso colombiano, la Constitución de 1991 introdujo en su artículo 90 el fundamento constitucional de la responsabilidad patrimonial del Estado, sin que esto significase que la jurisprudencia del Consejo de Estado encontrase las bases de esta responsabilidad en diferentes disposiciones de la Constitución de 1886, tales como los artículos 2º, 16 y 30, que consagró el principio de legalidad del Estado para proteger la vida, honra y bienes de los ciudadanos, y garantizar la propiedad privada y los demás derechos adquiridos con el título de derecho. Sin embargo, los primeros fallos relacionados con este título de imputación en Colombia fueron emitidos por el máximo Tribunal de lo Contencioso Administrativo colombiano en el año de 1998 y por la Corte Constitucional a través de la Sentencia C-038 de 2006, providencia judicial que estableció algunas de las características que posee esta figura jurídica.

Analysis of failed commercially pure titanium dental implants: A scanning electron microscopy and energy-dispersive spectrometer X-ray study

Background: the failure of osseointegration in oral rehabilitation has gained importance in current literature and in clinical practice. The integration of titanium dental implants in alveolar bone has been partly ascribed to the biocompatibility of the implant surface oxide layer. The aim of this investigation was to analyze the surface topography and composition of failed titanium dental implants in order to determine possible causes of failure.Methods: Twenty-one commercially pure titanium (cpTi) implants were retrieved from 16 patients (mean age of 50.33 +/- 11.81 years). Fourteen implants were retrieved before loading (early failures), six after loading (late failures), and one because of mandibular canal damage. The failure criterion was lack of osseointegration characterized as dental implant mobility. Two unused implants were used as a control group. All implant surfaces were examined by scanning electron microscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) to element analysis. Evaluations were performed on several locations of the same implant.Results: SEM showed that the surface of all retrieved implants consisted of different degrees of organic residues, appearing mainly as dark stains. The surface topography presented as grooves and ridges along the machined surface similar to control group. Overall, foreign elements such as carbon, oxygen, sodium, calcium, silicon, and aluminum were detected in failed implants. The implants from control group presented no macroscopic contamination and clear signs of titanium.Conclusion: These preliminary results do not suggest any material-related cause for implant failures, although different element composition was assessed between failed implants and control implants.

Probabilidade de falha de coroas com infraestrutura em zircônia com diferentes geometrias

Pós-graduação em Odontologia Restauradora - ICT

Mass transport in polymers

The study of mass transport in polymeric membranes has grown in importance due to its potential application in many processes such as separation of gases and vapors, packaging, controlled drug release. The diffusion of a low molecular weight species in a polymer is often accompanied by other phenomena like swelling, reactions, stresses, that have not been investigated in all their aspects yet. Furthermore, novel materials have been developed that include inorganic fillers, reactive functional groups or ions, that make the scenery even more complicated. The present work focused on the experimental study of systems where the diffusion is accompanied by other processes; suitable models were also developed to describe the particular circumstances in order to understand the underlying concepts and be able to design the performances of the material. The effect of solvent-induced deformation in polymeric films during sorption processes was studied since the dilation, especially in constrained membranes, can cause the development of stresses and therefore early failures of the material. The bending beam technique was used to test the effects of the dilation and the stress induced in the polymer by penetrant diffusion. A model based on the laminate theory was developed that accounts for the swelling and is able to predict the stress that raise in the material. The addition of inorganic fillers affects the transport properties of polymeric films. Mixed matrix membranes based on fluorinated, high free volume matrices show attractive performances for separation purposes but there is a need for deeper investigation of the selectivity properties towards gases and vapors. A new procedure based on the NELF model was tested on the experimental data; it allows to predict solubility of every penetrant on the basis of data for one vapor. The method has proved to be useful also for the determination of the diffusion coefficient and for an estimation of the permeability in the composite materials. Oxygen scavenging systems can overcome lack of barrier properties in common polymers that forbids their application in sensitive applications as food packaging. The final goal of obtaining a membrane almost impermeable to oxygen leads to experimental times out of reach. Hence, a simple model was developed in order to describe the transport of oxygen in a membrane with also reactive groups and analyze the experimental data collected on SBS copolymers that show attractive scavenging capacity. Furthermore, a model for predicting the oxygen barrier behavior of a film formed as a blend of OSP in a common packaging material was built, considering particles capable of reactions with oxygen embedded in a non-reactive matrix. Perfluorosulphonic acid ionomers (PFSI) are capturing attention due to a high thermal and chemical resistance coupled with very peculiar transport properties, that make them appropriate to be used in fuel cells. The possible effect of different formation procedure was studied together with the swelling due to water sorption since both water uptake and dilation can dramatically affect the fuel cells performances. The water diffusion and sorption was studied with a FTIR-ATR spectrometer that can give deeper information on the bonds between water molecules and the sulphonic hydrophilic groups and, therefore, on the microstructure of the hydrated ionomer.

Algorithms for scheduling parallel batch processing machines with non-identical job ready times

This research is motivated by a practical application observed at a printed circuit board (PCB) manufacturing facility. After assembly, the PCBs (or jobs) are tested in environmental stress screening (ESS) chambers (or batch processing machines) to detect early failures. Several PCBs can be simultaneously tested as long as the total size of all the PCBs in the batch does not violate the chamber capacity. PCBs from different production lines arrive dynamically to a queue in front of a set of identical ESS chambers, where they are grouped into batches for testing. Each line delivers PCBs that vary in size and require different testing (or processing) times. Once a batch is formed, its processing time is the longest processing time among the PCBs in the batch, and its ready time is given by the PCB arriving last to the batch. ESS chambers are expensive and a bottleneck. Consequently, its makespan has to be minimized. ^ A mixed-integer formulation is proposed for the problem under study and compared to a formulation recently published. The proposed formulation is better in terms of the number of decision variables, linear constraints and run time. A procedure to compute the lower bound is proposed. For sparse problems (i.e. when job ready times are dispersed widely), the lower bounds are close to optimum. ^ The problem under study is NP-hard. Consequently, five heuristics, two metaheuristics (i.e. simulated annealing (SA) and greedy randomized adaptive search procedure (GRASP)), and a decomposition approach (i.e. column generation) are proposed—especially to solve problem instances which require prohibitively long run times when a commercial solver is used. Extensive experimental study was conducted to evaluate the different solution approaches based on the solution quality and run time. ^ The decomposition approach improved the lower bounds (or linear relaxation solution) of the mixed-integer formulation. At least one of the proposed heuristic outperforms the Modified Delay heuristic from the literature. For sparse problems, almost all the heuristics report a solution close to optimum. GRASP outperforms SA at a higher computational cost. The proposed approaches are viable to implement as the run time is very short. ^

Importância da rugosidade da superfície implantar

Desde 1965 em que se colocaram as primeiras próteses osteointegradas sob os princípios de Brånemark, a implantologia sofreu uma constante e notória evolução e consiste, hoje, na primeira linha de tratamento em reabilitação oral. Os mecanismos que induzem a adesão óssea ou a união entre o implante e o osso, ainda não são perfeitamente conhecidos. As conclusões que se obtiveram das pesquisas, demostraram que a taxa de osteointegração dos impantes e o índice de sucesso relacionam-se com a composição química e com a rugosidade da superfície. Os implantes com rugosidades superficiais possuem maior estabilidade primária e modificam os mecanismos de interação das células com a superfície, quando comparados com os de superfície lisa. Quanto à composição química das superfícies dos implantes, as enriquecidas com cálcio e hidroxiapatite, favorecem e promovem o processo de cicatrização e de deposição óssea. Os estudos comparativos entre as superfícies modificadas por métodos de tratamento físicos e/ou químicos, quando comparados com as superfícies maquinadas, demonstram a superioridade das superfícies rugosas em muitos aspectos biomecânicos, sendo hoje um consenso entre a comunidade científica, a superioridade das superfícies modificadas. Independentemente das evidências científicas apontarem para maiores taxas de sucesso associadas ás superfícies tratadas, ainda há um longo caminho a percorrer para colmatar todas as falhas existentes na atualidade. O objetivo deste trabalho foi a realização de uma revisão bibliográfica, através da pesquisa de artigos da Pubmed, B-On, Science Direct, Scielo de forma a aprofundar conhecimentos das vantagens e desvantagens da rugosidade presente na superfície implantar, assim como alertar os médicos dentistas para a importância a ter com a rugosidade em excesso e tentar perceber qual a rugosidade dita ideal. Não se limitou o tempo de pesquisa mas deu-se relevância a referências científicas dos últimos 20 anos, publicados em língua portuguesa e inglesa.

A Irrequietude motora como expressão de uma função materna comprometida: Método Rorschach

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Lower Bounds for Achieving Synchronous Early Stopping Consensus with Orderly Crash Failures

In this paper, we discuss the consensus problem for synchronous distributed systems with orderly crash failures. For a synchronous distributed system of n processes with up to t crash failures and f failures actually occur, first, we present a bivalency argument proof to solve the open problem of proving the lower bound, min (t + 1, f + 2) rounds, for early-stopping synchronous consensus with orderly crash failures, where t < n - 1. Then, we extend the system model with orderly crash failures to a new model in which a process is allowed to send multiple messages to the same destination process in a round and the failing processes still respect the order specified by the protocol in sending messages. For this new model, we present a uniform consensus protocol, in which all non-faulty processes always decide and stop immediately by the end of f + 1 rounds. We prove that the lower bound of early stopping protocols for both consensus and uniform consensus are f + 1 rounds under the new model, and our proposed protocol is optimal.

Minority quasispecies of drug-resistant HIV-1 that lead to early therapy failure in treatment-naive and -adherent patients.

BACKGROUND: Early virological failure of antiretroviral therapy associated with the selection of drug-resistant human immunodeficiency virus type 1 in treatment-naive patients is very critical, because virological failure significantly increases the risk of subsequent failures. Therefore, we evaluated the possible role of minority quasispecies of drug-resistant human immunodeficiency virus type 1, which are undetectable at baseline by population sequencing, with regard to early virological failure. METHODS: We studied 4 patients who experienced early virological failure of a first-line regimen of lamivudine, tenofovir, and either efavirenz or nevirapine and 18 control patients undergoing similar treatment without virological failure. The key mutations K65R, K103N, Y181C, M184V, and M184I in the reverse transcriptase were quantified by allele-specific real-time polymerase chain reaction performed on plasma samples before and during early virological treatment failure. RESULTS: Before treatment, none of the viruses showed any evidence of drug resistance in the standard genotype analysis. Minority quasispecies with either the M184V mutation or the M184I mutation were detected in 3 of 18 control patients. In contrast, all 4 patients whose treatment was failing had harbored drug-resistant viruses at low frequencies before treatment, with a frequency range of 0.07%-2.0%. A range of 1-4 mutations was detected in viruses from each patient. Most of the minority quasispecies were rapidly selected and represented the major virus population within weeks after the patients started antiretroviral therapy. All 4 patients showed good adherence to treatment. Nonnucleoside reverse-transcriptase inhibitor plasma concentrations were in normal ranges for all 4 patients at 2 separate assessment times. CONCLUSIONS: Minority quasispecies of drug-resistant viruses, detected at baseline, can rapidly outgrow and become the major virus population and subsequently lead to early therapy failure in treatment-naive patients who receive antiretroviral therapy regimens with a low genetic resistance barrier.

Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report

Severe mucocutaneous (MCL) and diffuse (DCL) forms of American cutaneous leishmaniasis (ACL) are infrequent in Venezuela. Chemotherapy produces only transitory remission in DCL, and occasional treatment failures are observed in MCL. We have evaluated therapy with an experimental vaccine in patients with severe leishmaniasis. Four patients with MCL and 3 with early DCL were treated with monthly intradermal injections of a vaccine containing promastigotes of Leishmania (Viannia) braziliensis killed by pasteurization and viable Bacillus Calmette- Guerin. Clinical and immunological responses were evaluated. Integrity of protein constituents in extracts of pasteurized promastigotes was evaluated by gel electrophoresis. Complete remission of lesions occurred after 5-9 injections in patients with MCL or 7-10 injections in patients with early DCL. DCL patients developed positive skin reactions, average size 18.7 mm. All have been free of active lesions for at least 10 months. Adverse effects of the vaccine were limited to local reactivity to BCG at the injection sites and fever in 2 patients. Extracts of pasteurized and fresh promastigotes did not reveal differences in the integrity of protein components detectable by gel electrophoresis. Immunotherapy with this modified vaccine offers an effective, safe option for the treatment of patients who do not respond to immunotherapy with vaccine containing autoclaved parasites or to chemotherapy .

Early investigational drugs that target epidermal growth factor receptors for the treatment of head and neck cancer.

INTRODUCTION: Squamous-cell carcinoma of the head and neck (SCCHN) remains a challenging clinical problem, due to the persistent high rate of local and distant failures and the occurrence of secondary primaries. For locally advanced SCCHN, a combination of chemotherapy (CT), radiation or surgery is often used, but there are limitations, which may reduce compliance. Molecular targeted therapies, namely anti-EGFR treatments, are in development with the aim of improving clinical outcomes and mitigating treatment-related toxicities. AREAS COVERED: This review provides an overview of early investigational drugs that target EGFR for the treatment of SCCHN and discusses the ongoing trials in this domain. EXPERT OPINION: Targeted therapies are increasingly used in oncology, especially in SCCHN. Cetuximab has demonstrated a significant improvement in the treatment outcome, both as a curative treatment in combination with radiation therapy and as a palliative treatment in combination with CT; however, it failed to show any benefit in combination with concomitant chemoradiotherapy. Presently, there are many new agents, including monoclonal antibodies and small-molecule tyrosine kinase inhibitors, which are either currently under investigation for or which warrant further investigation for treating SCCHN. The discovery of predictive factors that help to identify patients most likely to respond to EGFR inhibitors as well as patient-customized therapies would help to improve patient outcomes in the future.