This document summarizes a clinical study on the outcomes of dental implants in patients with type 2 diabetes mellitus. The study included 41 patients who received a total of 141 dental implants to support overdentures. The success rates after 1 and 5 years were 97.2% and 94.4%, respectively. Most patients reported improved function with the new treatment. A high correlation was found between good mucosal health and improved function, but no correlation was found between failed implants and glucose levels. The results suggest that dental implants can provide satisfactory outcomes for selected patients with well-controlled type 2 diabetes.
This document reports a case study of a 64-year-old female patient who developed late onset tracheal stenosis after receiving an 125Iodine seed esophageal stent to treat advanced esophageal carcinoma. The patient experienced progressive stenosis of the lower trachea at 6, 26, and 47 days post-operatively. The causes of stenosis are believed to include direct pressure from the stent, tumor proliferation, pressure from the aortic arch, and complications from other therapies such as radiation treatment. Due to its short clinical use, 125Iodine seed stents may present some fatal complications, and more study is needed on their long-term efficacy.
This meta-analysis compared onlay and sublay mesh repair techniques for open ventral incisional hernias using data from 7 randomized controlled trials involving 954 patients. The analysis found that sublay mesh repair resulted in significantly fewer wound infections and seromas compared to onlay repair, but no significant difference in hematomas. Regarding hernia recurrence, there was no statistical difference between the techniques, but heterogeneity was high and meta-regression showed sublay repair was superior in reducing recurrence. Overall, the meta-analysis indicates sublay mesh repair provides better outcomes than onlay repair for open ventral incisional hernias.
1) The study examined the effect of tempeh extract in promoting callus growth in patients with femoral fractures over 16 days.
2) 28 subjects with femoral fractures were divided into two groups - 14 received 50ml tempeh extract daily and 14 did not receive the extract.
3) Analysis found the group receiving tempeh extract had higher rates of positive callus growth (39.3%) compared to the control group (14.3%), indicating tempeh extract significantly promotes fracture healing.
Efficacy,and safety of intravenous zoledronic acid in treatment+of+pediatric+...Abdulmoein AlAgha
Zoledronic acid is an effective treatment for pediatric osteoporosis. A 13-year study of 131 children with primary or secondary osteoporosis found that intravenous zoledronic acid significantly reduced fractures, bone pain, and bone turnover markers. While acute side effects like fever and hypocalcemia occurred after the first infusion, no chronic adverse events were reported. Zoledronic acid should be considered as an important treatment for improving outcomes in pediatric osteoporosis.
This document discusses the management of appendicular lumps. It notes that appendicular lumps are inflammatory tumors consisting of the inflamed appendix and surrounding tissues. Treatment options include emergency surgery, conservative management followed by interval surgery, or totally conservative management without interval surgery. Conservative treatment is associated with a risk of missing hidden pathologies. Emergency surgery carries a high risk of complications while interval surgery risks appendicular abscess or perforation during the waiting period. Randomized controlled trials have found that conservative treatment without interval surgery appears to be the best approach for appendicular masses and abscesses. The document examines factors to consider in decision making and presents cases studies from a tertiary care center.
This study examined 406 microsurgical tissue transfer cases in the head and neck region over a 13-year period. The overall flap survival rate was approximately 92%. Primary reconstructions had a significantly higher success rate than secondary reconstructions. Defect location also significantly impacted survival, with more caudal locations associated with better outcomes. Neither anticoagulation regimen nor recipient vessel system choice influenced survival rates. Microsurgical tissue transfer is a reliable reconstruction method for maxillofacial defects when aware of success factors.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
This document reports a case study of a 64-year-old female patient who developed late onset tracheal stenosis after receiving an 125Iodine seed esophageal stent to treat advanced esophageal carcinoma. The patient experienced progressive stenosis of the lower trachea at 6, 26, and 47 days post-operatively. The causes of stenosis are believed to include direct pressure from the stent, tumor proliferation, pressure from the aortic arch, and complications from other therapies such as radiation treatment. Due to its short clinical use, 125Iodine seed stents may present some fatal complications, and more study is needed on their long-term efficacy.
This meta-analysis compared onlay and sublay mesh repair techniques for open ventral incisional hernias using data from 7 randomized controlled trials involving 954 patients. The analysis found that sublay mesh repair resulted in significantly fewer wound infections and seromas compared to onlay repair, but no significant difference in hematomas. Regarding hernia recurrence, there was no statistical difference between the techniques, but heterogeneity was high and meta-regression showed sublay repair was superior in reducing recurrence. Overall, the meta-analysis indicates sublay mesh repair provides better outcomes than onlay repair for open ventral incisional hernias.
1) The study examined the effect of tempeh extract in promoting callus growth in patients with femoral fractures over 16 days.
2) 28 subjects with femoral fractures were divided into two groups - 14 received 50ml tempeh extract daily and 14 did not receive the extract.
3) Analysis found the group receiving tempeh extract had higher rates of positive callus growth (39.3%) compared to the control group (14.3%), indicating tempeh extract significantly promotes fracture healing.
Efficacy,and safety of intravenous zoledronic acid in treatment+of+pediatric+...Abdulmoein AlAgha
Zoledronic acid is an effective treatment for pediatric osteoporosis. A 13-year study of 131 children with primary or secondary osteoporosis found that intravenous zoledronic acid significantly reduced fractures, bone pain, and bone turnover markers. While acute side effects like fever and hypocalcemia occurred after the first infusion, no chronic adverse events were reported. Zoledronic acid should be considered as an important treatment for improving outcomes in pediatric osteoporosis.
This document discusses the management of appendicular lumps. It notes that appendicular lumps are inflammatory tumors consisting of the inflamed appendix and surrounding tissues. Treatment options include emergency surgery, conservative management followed by interval surgery, or totally conservative management without interval surgery. Conservative treatment is associated with a risk of missing hidden pathologies. Emergency surgery carries a high risk of complications while interval surgery risks appendicular abscess or perforation during the waiting period. Randomized controlled trials have found that conservative treatment without interval surgery appears to be the best approach for appendicular masses and abscesses. The document examines factors to consider in decision making and presents cases studies from a tertiary care center.
This study examined 406 microsurgical tissue transfer cases in the head and neck region over a 13-year period. The overall flap survival rate was approximately 92%. Primary reconstructions had a significantly higher success rate than secondary reconstructions. Defect location also significantly impacted survival, with more caudal locations associated with better outcomes. Neither anticoagulation regimen nor recipient vessel system choice influenced survival rates. Microsurgical tissue transfer is a reliable reconstruction method for maxillofacial defects when aware of success factors.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
Colonoscopic localisation accuracy for colorectal resectionsDamian Ianno
This document discusses a study assessing the accuracy of colonoscopic localization of colorectal lesions prior to surgical resection. The study found that colonoscopic localization was incorrect in 20.8% of cases, and in 4% of cases this resulted in changes to the planned surgical procedure. Incomplete colonoscopies were a significant factor in incorrect localization. While CT scans provided additional information, they could not reliably localize lesions on their own. The study concludes that emphasis on precise localization during colonoscopy training is important to optimize patient outcomes for colorectal resections.
This presentation explains the various controversies in different topics in periodontics. Discusses the controversies in Classification of periodontal diseases,
Diagnosis of periodontal diseases,
Prognosis,
Tooth mobility & splinting,
Gingival curettage one stage full-mouth disinfection versus quadrant SRP,
Systemic antimicrobials in periodontal therapy, Non-surgical versus surgical periodontal therapy,
Postsurgical antimicrobial medication,
Periodontal pack,
Periodontal-endodontic relationship,
Periodontal and systemic diseases,
Implant therapy in periodontally compromised patients.
Hip fractures are common and debilitating injuries among the elderly that can result in loss of independence and mortality. This study compared functional recovery outcomes between elderly patients treated surgically with either a dynamic hip screw (DHS) or proximal femoral nail (PFN) for intertrochanteric hip fractures. The study found that while functional recovery scores were similar between the DHS and PFN groups at 1-year post-surgery, patients treated with a DHS had significantly reduced function at 3 and 6 months compared to their pre-operative levels, whereas PFN patients did not experience this loss of function in the early months of recovery.
This document reviews the use of open lung biopsy (OLB) in critically ill patients and those with respiratory failure. OLB is considered the gold standard for diagnosing parenchymal lung disease, but its use in intensive care unit patients is controversial due to risks. The document analyzes 22 studies on OLB outcomes in critically ill patients. It finds that OLB frequently results in specific diagnoses in over 50% of cases, sometimes 100%, and leads to significant changes in treatment in the majority of cases. However, OLB also carries risks of complications. More research is needed to determine the risks and benefits of OLB for critically ill respiratory failure patients.
This study analyzed 200 cases of typhoid intestinal perforation (TIP) in children seen over a 10-year period at a teaching hospital in Nigeria. The researchers found that TIP accounted for 35.7% of pediatric surgeries during this period, with most cases occurring in males aged 6-15 years old. Common presenting symptoms were fever, abdominal pain, and distension. Surgical findings typically included a single perforation in the terminal ileum. The most common procedure was primary closure of the perforation. Post-operative complications and a mortality rate of 8.5% highlighted that TIP remains a significant problem in developing countries due to poor sanitation and access to clean water.
Despitetheroutineuseofprophylacticsystemicantibiotics,sternalwoundin- fection still occurs in 5% or more of cardiac surgical patients and is associated with signifi- cant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, ran- domized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
Comparison between mesh hernioplasty and simple sutureAlexander Decker
This document compares mesh hernioplasty and simple suture repair for treating paraumbilical hernias. A study of 215 patients found that the mesh hernioplasty group had a lower recurrence rate of 2.27% compared to 10.71% for the simple suture repair group. The mesh group also had fewer postoperative complications like hematomas and seromas. However, the infection rate was higher in the mesh group at 12% compared to 10% for simple suture repair. While mesh hernioplasty gave better clinical outcomes, it was more expensive than simple suture technique.
The document discusses a prospective study that compares the incidence of incisional hernia in 134 patients undergoing gastric bypass surgery who received either primary fascial closure or closure with a prophylactic biological mesh. The results showed a significantly lower incidence of incisional hernia in patients who received the biological mesh (2.3% vs 17.7%), though these patients experienced a higher rate of seroma formation. After adjusting for risk factors, prophylactic mesh placement was found to be protective against hernia development while smoking increased hernia risk. The study provides evidence that prophylactic biological mesh may reduce incisional hernia rates in high-risk patients.
Surgical Treatment of Haglund Triad by Using Complete Detachment and Reattach...skisnfeet
This study evaluated the surgical outcome of treating the Haglund triad, which includes retrocalcaneal exostosis, insertional Achilles tendinosis, and retrocalcaneal bursitis, using a standardized approach of complete detachment and reattachment of the Achilles tendon. Seventeen patients underwent this surgery and reported significant pain reduction, high satisfaction rates, and good functional outcomes post-operatively based on questionnaires and clinical scoring systems. Complications were few and minor in most cases.
Encapsulate peritoneal dialysis after short term peritoneal dialysisNakisa Hooman
Encapsulated Peritoneal Sclerosis (EPS) is a devastating complication of long term CAPD. The diagnosis is based on structural and functional aspects of intestinal obstruction. The total imaging score at the time of diagnosis of EPS did not correlate with the clinical outcome. It is important to differentiate simple peritoneal sclerosis from EPS.The incidence increases from zero to 18% with time on peritoneal dialysis for 5-8 years. The risk of EPS increases exponentially when PD continues beyond 3 years. The other potential risk factors are high strength glucose exposure, icodextrin, young age, inflammation, chemical exposure, genetic factors, acidic PD fluid. Peritoneal injury and subsequent peritoneal inflammation are two hit hypothesis for EPS. But episodes of peritonitis, intense or repeated hemoperitoneaum, abdominal surgery, stopped PD, and genetic predisposition could be the potential risk factors. There is no authentic screening tool for early diagnosis. The combination of Ca-125<33 U/min and IL-6>350 pg/min with UFF suggest the possibility to identify patients at risk. High levels of cytokines in peritoneal effluent correlate with alteration peritoneal membrane transport status. The pathophysiology of EPS consists of inflammation, fibrin deposition and fibrinolysis, epithelial-mesenchymal transition, and growth factors. Ultrafiltration failure and high average transport status are very common in EPS. High awareness to detect the earliest stage of EPS might help to improve survival. Discontinuation of PD, nutritional support, immunosuppressive therapy, tamoxifen and surgery are medical options. There is no strategy to prevent EPS. In the case of PD catheter removal, dry peritoneum might lead to new fibrin deposition and accelerate sclerosing process. Periodic irrigation of peritoneal cavity for 6-12 months after cessation of PD therapy might prevent intestinal adhesion.
This case report describes a 35-year-old male patient who presented with chronic periodontitis and bilateral supernumerary premolars in the mandibular arch. Clinical examination and radiographs revealed generalized bone loss, deep pockets, and the extra premolars lingual to the normal premolars. The supernumerary premolars and infected teeth were extracted, and the patient underwent scaling, antibiotics, and flap surgery. While the association between periodontitis and supernumerary teeth is debated, managing the extra teeth and infection resolved the periodontitis in this case.
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
This document discusses several studies on urological injuries and conditions:
1. A study of 25 female patients with urethral and bladder neck injuries from pelvic fractures, finding many required surgical repair and long-term urinary and sexual dysfunction for some.
2. A study of 8 girls with pelvic fracture urethral strictures, finding 1-stage repair and substitution urethroplasty had 100% success rates and advocating early cystostomy drainage and deferred reconstruction when needed.
3. An editorial comment on female urethral injuries from pelvic fractures, noting they require high suspicion to diagnose and advocating early repair of urethral and vaginal injuries to
1) Inguinal hernias have traditionally been repaired surgically due to beliefs that complications like bowel obstruction are likely if left untreated and that surgical repair is low risk. However, recent randomized controlled trials have questioned these beliefs.
2) Two randomized controlled trials compared watchful waiting to surgical repair and found low rates of complications like bowel obstruction for untreated hernias, with rates under 2 events per 1000 patients per year. Patients reported similar pain levels and quality of life whether they had immediate repair or watchful waiting.
3) The trials provide new evidence that watchful waiting may be a reasonable option for asymptomatic or minimally symptomatic inguinal hernias, challenging traditional views that all hernias require immediate
Research article no needle no suture vmmcDeepak Kabbur
This study evaluated a new single-visit adult male circumcision technique called Unicirc that uses a disposable plastic instrument and tissue adhesive. In a trial of 110 men across 3 sites in South Africa, the procedure took a median of 9 minutes with minimal blood loss and pain. There was a 6.3% rate of moderate complications like bleeding and infection but no serious adverse events. Nearly all wounds were fully healed by 4 weeks with high patient satisfaction and excellent cosmetic results, demonstrating the potential for this technique to safely scale up circumcision programs with one visit and without injections.
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving sw...Veera Bagu
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving swallowing ability among Cerebrovascular Accident patients with dysphagia at selected Hospital, Erode
This document describes a case report of a rare congenital anomaly called ulnar dimelia in a 1.5 year old male patient. Ulnar dimelia is characterized by double ulnae in the forearm, polydactyly, absence of the radius and thumb. The patient presented with restricted elbow and wrist movement and an unacceptable cosmetic appearance. Management would require multiple staged surgeries but the parents neglected further treatment after the initial visit. Ulnar dimelia results from imbalanced signals during embryonic development leading to abnormalities in the forearm, hand and digits. Surgical management aims to improve function and cosmesis but often requires several procedures and long-term follow up.
Dental implants in patients with type 2 diabetes - CoverEitan Koniarski
This document discusses a clinical study on the use of dental implants in patients with type 2 diabetes mellitus. The study found that:
1) The success rate of implants was 97.3% after 1 year and 94.4% after 5 years, showing satisfying outcomes.
2) Most patients reported improved function following treatment with implant-retained overdentures.
3) There was a correlation between good mucosal health and improved function, but no correlation between failed implants and glucose level.
4) The results suggest that dental implants can be a good option for selected patients with well-controlled type 2 diabetes, but more long-term studies are needed.
This study evaluated the clinical outcomes and properties of periodontal ligament progenitor cells (PDLPs) for the treatment of periodontitis. Three patients with intrabony periodontal defects were treated by transplantation of autologous PDLPs cultured on a bone graft material. Clinical measurements over 32-72 months showed reduced probing depths and clinical attachment gains, indicating potential therapeutic benefits. In vitro analysis found that PDLPs showed characteristics similar to periodontal ligament stem cells (PDLSCs), including proliferation, mesenchymal surface marker expression, and multipotent differentiation, but lacked expression of the tendon marker scleraxis. This provides preliminary evidence that PDLP transplantation may be an effective and safe approach for periodontitis
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
Colonoscopic localisation accuracy for colorectal resectionsDamian Ianno
This document discusses a study assessing the accuracy of colonoscopic localization of colorectal lesions prior to surgical resection. The study found that colonoscopic localization was incorrect in 20.8% of cases, and in 4% of cases this resulted in changes to the planned surgical procedure. Incomplete colonoscopies were a significant factor in incorrect localization. While CT scans provided additional information, they could not reliably localize lesions on their own. The study concludes that emphasis on precise localization during colonoscopy training is important to optimize patient outcomes for colorectal resections.
This presentation explains the various controversies in different topics in periodontics. Discusses the controversies in Classification of periodontal diseases,
Diagnosis of periodontal diseases,
Prognosis,
Tooth mobility & splinting,
Gingival curettage one stage full-mouth disinfection versus quadrant SRP,
Systemic antimicrobials in periodontal therapy, Non-surgical versus surgical periodontal therapy,
Postsurgical antimicrobial medication,
Periodontal pack,
Periodontal-endodontic relationship,
Periodontal and systemic diseases,
Implant therapy in periodontally compromised patients.
Hip fractures are common and debilitating injuries among the elderly that can result in loss of independence and mortality. This study compared functional recovery outcomes between elderly patients treated surgically with either a dynamic hip screw (DHS) or proximal femoral nail (PFN) for intertrochanteric hip fractures. The study found that while functional recovery scores were similar between the DHS and PFN groups at 1-year post-surgery, patients treated with a DHS had significantly reduced function at 3 and 6 months compared to their pre-operative levels, whereas PFN patients did not experience this loss of function in the early months of recovery.
This document reviews the use of open lung biopsy (OLB) in critically ill patients and those with respiratory failure. OLB is considered the gold standard for diagnosing parenchymal lung disease, but its use in intensive care unit patients is controversial due to risks. The document analyzes 22 studies on OLB outcomes in critically ill patients. It finds that OLB frequently results in specific diagnoses in over 50% of cases, sometimes 100%, and leads to significant changes in treatment in the majority of cases. However, OLB also carries risks of complications. More research is needed to determine the risks and benefits of OLB for critically ill respiratory failure patients.
This study analyzed 200 cases of typhoid intestinal perforation (TIP) in children seen over a 10-year period at a teaching hospital in Nigeria. The researchers found that TIP accounted for 35.7% of pediatric surgeries during this period, with most cases occurring in males aged 6-15 years old. Common presenting symptoms were fever, abdominal pain, and distension. Surgical findings typically included a single perforation in the terminal ileum. The most common procedure was primary closure of the perforation. Post-operative complications and a mortality rate of 8.5% highlighted that TIP remains a significant problem in developing countries due to poor sanitation and access to clean water.
Despitetheroutineuseofprophylacticsystemicantibiotics,sternalwoundin- fection still occurs in 5% or more of cardiac surgical patients and is associated with signifi- cant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, ran- domized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
Comparison between mesh hernioplasty and simple sutureAlexander Decker
This document compares mesh hernioplasty and simple suture repair for treating paraumbilical hernias. A study of 215 patients found that the mesh hernioplasty group had a lower recurrence rate of 2.27% compared to 10.71% for the simple suture repair group. The mesh group also had fewer postoperative complications like hematomas and seromas. However, the infection rate was higher in the mesh group at 12% compared to 10% for simple suture repair. While mesh hernioplasty gave better clinical outcomes, it was more expensive than simple suture technique.
The document discusses a prospective study that compares the incidence of incisional hernia in 134 patients undergoing gastric bypass surgery who received either primary fascial closure or closure with a prophylactic biological mesh. The results showed a significantly lower incidence of incisional hernia in patients who received the biological mesh (2.3% vs 17.7%), though these patients experienced a higher rate of seroma formation. After adjusting for risk factors, prophylactic mesh placement was found to be protective against hernia development while smoking increased hernia risk. The study provides evidence that prophylactic biological mesh may reduce incisional hernia rates in high-risk patients.
Surgical Treatment of Haglund Triad by Using Complete Detachment and Reattach...skisnfeet
This study evaluated the surgical outcome of treating the Haglund triad, which includes retrocalcaneal exostosis, insertional Achilles tendinosis, and retrocalcaneal bursitis, using a standardized approach of complete detachment and reattachment of the Achilles tendon. Seventeen patients underwent this surgery and reported significant pain reduction, high satisfaction rates, and good functional outcomes post-operatively based on questionnaires and clinical scoring systems. Complications were few and minor in most cases.
Encapsulate peritoneal dialysis after short term peritoneal dialysisNakisa Hooman
Encapsulated Peritoneal Sclerosis (EPS) is a devastating complication of long term CAPD. The diagnosis is based on structural and functional aspects of intestinal obstruction. The total imaging score at the time of diagnosis of EPS did not correlate with the clinical outcome. It is important to differentiate simple peritoneal sclerosis from EPS.The incidence increases from zero to 18% with time on peritoneal dialysis for 5-8 years. The risk of EPS increases exponentially when PD continues beyond 3 years. The other potential risk factors are high strength glucose exposure, icodextrin, young age, inflammation, chemical exposure, genetic factors, acidic PD fluid. Peritoneal injury and subsequent peritoneal inflammation are two hit hypothesis for EPS. But episodes of peritonitis, intense or repeated hemoperitoneaum, abdominal surgery, stopped PD, and genetic predisposition could be the potential risk factors. There is no authentic screening tool for early diagnosis. The combination of Ca-125<33 U/min and IL-6>350 pg/min with UFF suggest the possibility to identify patients at risk. High levels of cytokines in peritoneal effluent correlate with alteration peritoneal membrane transport status. The pathophysiology of EPS consists of inflammation, fibrin deposition and fibrinolysis, epithelial-mesenchymal transition, and growth factors. Ultrafiltration failure and high average transport status are very common in EPS. High awareness to detect the earliest stage of EPS might help to improve survival. Discontinuation of PD, nutritional support, immunosuppressive therapy, tamoxifen and surgery are medical options. There is no strategy to prevent EPS. In the case of PD catheter removal, dry peritoneum might lead to new fibrin deposition and accelerate sclerosing process. Periodic irrigation of peritoneal cavity for 6-12 months after cessation of PD therapy might prevent intestinal adhesion.
This case report describes a 35-year-old male patient who presented with chronic periodontitis and bilateral supernumerary premolars in the mandibular arch. Clinical examination and radiographs revealed generalized bone loss, deep pockets, and the extra premolars lingual to the normal premolars. The supernumerary premolars and infected teeth were extracted, and the patient underwent scaling, antibiotics, and flap surgery. While the association between periodontitis and supernumerary teeth is debated, managing the extra teeth and infection resolved the periodontitis in this case.
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
This document discusses several studies on urological injuries and conditions:
1. A study of 25 female patients with urethral and bladder neck injuries from pelvic fractures, finding many required surgical repair and long-term urinary and sexual dysfunction for some.
2. A study of 8 girls with pelvic fracture urethral strictures, finding 1-stage repair and substitution urethroplasty had 100% success rates and advocating early cystostomy drainage and deferred reconstruction when needed.
3. An editorial comment on female urethral injuries from pelvic fractures, noting they require high suspicion to diagnose and advocating early repair of urethral and vaginal injuries to
1) Inguinal hernias have traditionally been repaired surgically due to beliefs that complications like bowel obstruction are likely if left untreated and that surgical repair is low risk. However, recent randomized controlled trials have questioned these beliefs.
2) Two randomized controlled trials compared watchful waiting to surgical repair and found low rates of complications like bowel obstruction for untreated hernias, with rates under 2 events per 1000 patients per year. Patients reported similar pain levels and quality of life whether they had immediate repair or watchful waiting.
3) The trials provide new evidence that watchful waiting may be a reasonable option for asymptomatic or minimally symptomatic inguinal hernias, challenging traditional views that all hernias require immediate
Research article no needle no suture vmmcDeepak Kabbur
This study evaluated a new single-visit adult male circumcision technique called Unicirc that uses a disposable plastic instrument and tissue adhesive. In a trial of 110 men across 3 sites in South Africa, the procedure took a median of 9 minutes with minimal blood loss and pain. There was a 6.3% rate of moderate complications like bleeding and infection but no serious adverse events. Nearly all wounds were fully healed by 4 weeks with high patient satisfaction and excellent cosmetic results, demonstrating the potential for this technique to safely scale up circumcision programs with one visit and without injections.
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving sw...Veera Bagu
Effectiveness of Chin Tuck Against Resistance (CTAR) exercise in improving swallowing ability among Cerebrovascular Accident patients with dysphagia at selected Hospital, Erode
This document describes a case report of a rare congenital anomaly called ulnar dimelia in a 1.5 year old male patient. Ulnar dimelia is characterized by double ulnae in the forearm, polydactyly, absence of the radius and thumb. The patient presented with restricted elbow and wrist movement and an unacceptable cosmetic appearance. Management would require multiple staged surgeries but the parents neglected further treatment after the initial visit. Ulnar dimelia results from imbalanced signals during embryonic development leading to abnormalities in the forearm, hand and digits. Surgical management aims to improve function and cosmesis but often requires several procedures and long-term follow up.
Dental implants in patients with type 2 diabetes - CoverEitan Koniarski
This document discusses a clinical study on the use of dental implants in patients with type 2 diabetes mellitus. The study found that:
1) The success rate of implants was 97.3% after 1 year and 94.4% after 5 years, showing satisfying outcomes.
2) Most patients reported improved function following treatment with implant-retained overdentures.
3) There was a correlation between good mucosal health and improved function, but no correlation between failed implants and glucose level.
4) The results suggest that dental implants can be a good option for selected patients with well-controlled type 2 diabetes, but more long-term studies are needed.
This study evaluated the clinical outcomes and properties of periodontal ligament progenitor cells (PDLPs) for the treatment of periodontitis. Three patients with intrabony periodontal defects were treated by transplantation of autologous PDLPs cultured on a bone graft material. Clinical measurements over 32-72 months showed reduced probing depths and clinical attachment gains, indicating potential therapeutic benefits. In vitro analysis found that PDLPs showed characteristics similar to periodontal ligament stem cells (PDLSCs), including proliferation, mesenchymal surface marker expression, and multipotent differentiation, but lacked expression of the tendon marker scleraxis. This provides preliminary evidence that PDLP transplantation may be an effective and safe approach for periodontitis
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
Dental Implant 1 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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This study summarizes the results of a major ambulatory oral surgery program using general inhalational anesthesia on 112 disabled patients from 2006-2007. The majority (75%) of patients had coexisting medical issues. Common procedures included restorations, extractions, sealants and root canals. The average surgery time was 72.69 minutes. The replacement and suspension rates were low at 100% and 1.92% respectively. Postoperative complications like bleeding requiring readmission occurred in 1.92% of patients. The rehospitalization rate was 3.84%. Overall, the program resulted in a low number of medical incidents despite the high comorbidity of patients.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 31st publication IJAR 1st name
Managements of medication-induced gingival hyperplasia 4.pptxMohammadEissaAhmadi
This document summarizes a systematic review of treatment options for medication-induced gingival hyperplasia (MIGH). The review included 22 studies published between 1988-2017. The studies evaluated non-surgical treatments like scaling and root planing, oral hygiene instructions, and antimicrobial mouthwashes/gels. Surgical resection was used for severe cases. Most studies found that non-surgical treatments combined with strict oral hygiene helped reduce gingival inflammation and size. However, recurrence was still reported in some cases requiring additional treatment.
This study examined the effectiveness and efficiency of early treatment versus late treatment for Class II malocclusions. The researchers conducted a randomized controlled trial comparing early treatment using headgear or functional appliances to a control group receiving no early treatment. Results showed that while early treatment produced small changes to jaw growth, this initial advantage was not sustained. There were no differences found between the groups in final skeletal or dental measurements, need for extractions, treatment time, or quality of dental occlusion after treatment. Therefore, the study concluded that early treatment was generally no more effective than conventional late treatment for most cases of Class II malocclusion.
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
The document discusses two approaches to treatment planning for patients with severe periodontitis - a reconstructive approach and an adaptive approach. The reconstructive approach favors early extraction of questionable teeth to place dental implants, while the adaptive approach aims to retain natural teeth through nonsurgical and surgical periodontal therapy. The case study presented illustrates an adaptive approach, where periodontally hopeless teeth were extracted but other teeth were retained through nonsurgical therapy, surgery, and periodic maintenance. Over time, some retained teeth were later extracted and replaced with implants due to increased mobility.
Treatment of gingival recession using coronally advanced flapShruti Maroo
This document describes a case study evaluating the efficacy of the coronally advanced flap technique for treating gingival recession. A 27-year old male patient presented with Miller's Class I gingival recession on teeth 22 and 23, along with sensitivity. The coronally advanced flap procedure was performed, involving incisions and elevation of a partial-thickness flap. One month and three months post-operatively, the patient showed uneventful healing and 100% root coverage, with reduction in sensitivity and no probing defects. The coronally advanced flap technique alone can successfully treat gingival recession when residual gingiva is thick and wide, resulting in good esthetic and functional outcomes.
Managements of medication-induced gingival hyperplasia (2).pptxMohammadEissaAhmadi
1) Multiple studies evaluated non-surgical treatment options for medication-induced gingival hyperplasia (MIGH) including scaling and root planing, oral hygiene instructions, and various antimicrobial therapies.
2) Some studies found improvements in gingival inflammation and reductions in gingival tissue volume with nonsurgical periodontal treatment alone, while others saw limited or no effect.
3) The efficacy of systemic or locally delivered azithromycin and metronidazole was inconsistent between studies, with some demonstrating short-term reductions in gingival enlargement but not complete resolution of MIGH.
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching H...Crimsonpublisherssmoaj
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching Hospital by Si Ching Lim*, Peter Chow, Peter CL Chow, Fuyin Li, Swee Sim Hiew, Lau Soy Soy and Zhang Di in Crimson Publishers: Surgical Medicine Open Access Journal
The elderly patients admitted under surgery have longer lengths of stay and develop multiple complications during their hospital stay particularly with delirium, medical complications and functional decline. A Geriatrician’s input was helpful to identify incident and postop delirium early and put in measures to improve outcome, together with better nursing care and pharmacist’s input to reduce harm from medications.
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Journal Club on The clinical and radiographical characteristics of zygomatic ...Dr Bhavik Miyani
This document summarizes a study that compared the clinical outcomes of patients who underwent surgery to treat zygomatic complex fractures and were treated either surgically or non-surgically. The study found that extraoral steps, intraoral steps, and malar depression were significantly more common in surgically treated patients. While non-surgically treated patients also sometimes had displaced fractures, studying this group could provide insight into developing better methods for determining appropriate treatment. The study recommends further research on non-surgically treated patients with zygomatic complex fractures.
The effect of cigarette smoking and native bone heigthBerenice Gomes
This study examined the effect of cigarette smoking and residual native bone height on the survival of dental implants placed immediately in grafted sinuses. The study reviewed records of 75 patients who received 155 implants. Implant survival rates after 12 months were significantly lower for smokers (79%) compared to non-smokers (87%). Analysis also showed smoking had a more significant negative effect on implant survival when the preoperative bone height was less than 4 mm, with survival rates of 82.4% for non-smokers and 60% for smokers. The study concludes smoking should be considered a high risk factor for implants placed immediately in grafted sinuses, especially in areas of limited bone height.
Drug-Induced Gingival Overgrowth in Hypertensive Patients on Calcium Channel ...Hasanain Alani
The document describes a case-control study that assessed 103 patients taking calcium channel blockers (CCBs) for hypertension and their risk of developing drug-induced gingival overgrowth (GO). The study found that 89 patients developed GO, with 75 requiring treatment, and that the type and dosage of CCB impacted the frequency and severity of GO. The aim was to evaluate how CCB medication influences GO occurrence, treatment responses, and additional costs.
This study compared non-operative management (antibiotics only) to surgical management (appendectomy) for uncomplicated acute appendicitis in children. 102 children were enrolled and allowed to choose their treatment. At 1 year, the success rate of avoiding appendectomy with non-operative management was 75.7%, and children who received non-operative management had fewer disability days and lower healthcare costs compared to those who received surgery. Non-operative management is an effective treatment option for children with uncomplicated appendicitis that results in less morbidity and costs than surgery.
This study evaluated the effectiveness of pentoxifylline versus placebo in treating oral submucous fibrosis (OSF). 75 patients with OSF were divided into two groups - group A received placebo and group B received 400 mg of pentoxifylline daily for 7 months. Improvement was measured using symptom and sign scores. Group B showed significantly greater improvement in total scores compared to group A, indicating pentoxifylline was more effective at reducing symptoms and improving mouth opening. Pentoxifylline may help OSF by improving microcirculation and reducing inflammation. The study demonstrates pentoxifylline is superior to placebo for OSF treatment.
ABSTRACT- The treatment of carbuncle is early administration of antibiotics and surgery. The commonest surgical approach is Saucerization and Incision & Drainage (I&D). Two cases are presented here, one underwent Saucerization and then primary split thickness skin grafting. Another un-derwent I&D for her carbuncle. They were followed up for 8 weeks to assess their outcome. Saucerization produced the shortest length of hospital stay while I&D resulted in shortest wound healing. As a new modality of treatment now-a-days two new modalities gaining popularity for better cosmetic purpose: primary split thickness skin grafting & transposition of local skin/musculocutaneous flap.
Keywords: carbuncle, surgery, good glycemic control
Similar to Dental implants in patients with type 2 diabetes (20)
Oral complications in bone marrow transplantation patients recent advances. ...ssuser19a491
This document summarizes recent research on oral complications in bone marrow transplantation patients. The research found that oral infections caused by Enterobacteriaceae were responsible for many positive cultures during different stages of transplantation. Mucositis was constantly detected alongside infections and correlated with granulocytopenia and fever, improving as the immune system reconstituted. Immunoglobulin levels in patient saliva were drastically reduced by conditioning protocols but returned to normal after transplantation. Saliva also plays a role in fibrinolysis through its plasminogen activator inhibitory contents contained in oral epithelial cells.
Analysis of the gradient of sinus augmentation- histomorphometric studyssuser19a491
This study examined the gradient of new bone formation and residual graft particles at different distances from the sinus floor following maxillary sinus floor augmentation using either freeze-dried bone allografts (FDBA) or biphasic calcium phosphate (BCP) bone substitute. Biopsies were taken from 26 sites in 13 patients at implant placement 9 months after sinus augmentation. Histomorphometric analysis found that the density of new bone decreased with increasing distance from the sinus floor for both graft materials. The percentage of new bone ranged from 31-27.7% near the floor to 23.5-27.7% further away. Residual graft particle area also decreased with distance from the floor. The results support that osteogenesis initi
This article reviews literature on fracture of dental implants and presents a case report. It finds that implant fracture is a rare but severe complication with multiple potential contributing factors. These include design flaws, poor fit of superstructures, excessive occlusal forces, location in high stress areas like the posterior mandible, small implant diameter, metal fatigue, and bone resorption around implants. The case report describes a titanium implant that fractured after 4 years due to metal fatigue, which was potentially caused by bone loss facilitated by leakage of toxic nickel ions from the implant's non-precious metal crown. This suggests corrosion and ion leakage should be considered a possible risk for late implant fractures.
This study evaluated the effectiveness of multiple applications of chlorhexidine chips for the treatment of peri-implantitis. Sixty patients with peri-implantitis affecting 77 implants were randomly assigned to receive either chlorhexidine chips or placebo matrix chips every 2-6 weeks for 6 months. Probing depth reduction and clinical attachment level gains were significantly greater in the chlorhexidine chip group compared to the placebo group. Both groups experienced a reduction in bleeding on probing. The study suggests that frequent application of chlorhexidine chips may improve outcomes in the treatment of peri-implantitis.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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2. tissues in the diabetic patient is also
delayed as a result of decreased pro-
tein metabolism. It is also affected by
impaired function of the neutrophilic
leucocytes.11–13
Because of such con-
siderations, diabetes has sometimes
been considered a contraindication for
the use of dental implants.14,15
We describe our experience using
the MIS implant system (Medical Im-
plant System, Shlomi, Israel) for re-
tention of overdentures in patients
with type 2 diabetes mellitus, and pro-
vide data regarding the level of satis-
faction of the patients and improve-
ments in function, mucosal and
periimplant health, and bone level
around implants in this group.
MATERIALS AND METHODS
The group under investigation in-
cluded patients with well-controlled
type 2 diabetes mellitus who were re-
ferred to our clinic for insertion of
dental implants in the anterior mandi-
ble, destined to serve for retention of
overdentures. A prosthodontist deter-
mined the treatment planning, an oral
and maxillofacial surgeon examined
the patients, and these specialists then
decided whether there was an indica-
tion for implant insertion and restora-
tion as defined. Blood glucose levels
were monitored and tabulated for all
patients 1 week preoperatively, on the
day of the operation, and 1 week fol-
lowing implantation. Each patient’s
condition was managed and controlled
by their assigned family physician. Ef-
forts were made to meet the plasma
glucose levels recommended by the
American Diabetes Association (fast-
ing plasma glucose of 140 mm/dL and
2-hour postprandial glucose of 200 ml/
dL). The implants used in this study
were the MIS implant system (Medi-
cal Implant System) screw type, with a
3.75-mm diameter and ranging in
length from 10 to 16 mm. The second
stage, uncovering, was accomplished
3 months after osseointegration of im-
plants. Fabrication of the infrastruc-
tures, ball attachment, or bar-
supporting overdenture was then
started.
Periimplant health was evaluated
during the observation period 3 weeks
and 6 and 12 months after implanta-
tion in relation to periimplantitis, peri-
implant mucositis, mucosal hyperpla-
sia, and fistula formation.
Each patient completed a ques-
tionnaire related to his or her level of
satisfaction and to the improvement of
function with the new dentures. All
patients underwent standardized pan-
oramic radiography preoperatively
and at 3, 6, 12, 24, and 36 months after
implantation. All x-rays were digitized
and stored electronically using a
computer-based measurement soft-
ware (X-View Inc, Jerusalem), the
height of the alveolar bone was mea-
sured from the top of the implant to
the most apical end, all implants were
submerged.
Patients were advised to continue
taking their regular medication as pre-
scribed. Eighteen patients were in-
structed to receive 2 g amoxicillin
daily 1 day before the operation and
for 5 additional days, whereas those
who were allergic to penicillin (16 pa-
tients) received 600 mg clindamycin
daily.
Using local anesthesia, implants
were inserted in the anterior aspect of
the mandible using a standard surgical
technique. Patients were scheduled for
follow-up visits 1 and 3 weeks and 3,
6, 12, and 36 months after
implantation.
The criteria for success of the im-
plant were stable implants and super-
structures with no symptoms of pain
and without signs of inflammation and
purulent discharge, loss of no more
than 1 mm bone around the implant in
the first year, and radiolucency around
implants. For the purpose of analysis
we divided the patients into subgroups
according to age (over 65 years and 65
years and under) and to the number of
implants.
Pearson correlation coefficient
test was used for statistical analysis.
The Pearson coefficient of correlation
measures the strength of a relationship
between two variables in a population;
its values range between Ϫ1 for a neg-
ative correlation to ϩ1 for a positive
correlation.
RESULTS
The study group consisted of 41
patients (26 males and 15 females)
with type 2 diabetes mellitus who
were treated with dental implants. A
total of 141 implants were placed; ev-
ery patient received three or four im-
plants at the anterior aspect of the
mandible for retention of overdentures
(Figs. 1 and 2). Four implants failed
during the observation period; two
during the second surgical stage and
two during the 2-year period after im-
plantation and restoration. The failed
implants were mobile during the clin-
ical examination. Success rates of
97.2% and 94.4% were observed dur-
ing the first and fifth years,
respectively.
Three months after implantation,
implants were uncovered and restored;
24 patients received ball attachments
for retention of overdentures while 17
patients received bars (Fig. 3).
A gradual elevation in glucose
level occurred during the intraopera-
tive and immediate postoperative pe-
riod. One week after implantation, lev-
els returned to near-preoperative
values (Fig. 4). No correlation was
found between failed implants and
glucose levels in our study group.
The majority of patients reported
improvement of function, chewing,
and general satisfaction from the new
treatment. Only four patients (2.8%)
were completely dissatisfied with their
treatment and five patients (3.4%) re-
ported no change in function with the
new implant -retained overdenture.
Periimplant complications were ob-
served in three patients; these compli-
cations were confined to the mucosa
only, or a combination of the mucosa
and the bone. The complications ap-
peared to be due to poor adaptation of
the denture. Periimplant mucositis or
hyperplasia was observed in 1 of 26
patients (3.8%) in the In the ball
attachment-retained overdenture
group and in 2 of 15 patients (13.3%)
in the bar-retained group. A high cor-
relation was observed between muco-
sal health and satisfaction from the
treatment (R ϭ 0.933)(Fig. 4). In ad-
dition a good correlation was observed
between mucosal health and improve-
ment in function (R ϭ 0.737) and
chewing (Rϭ0.842). In the bar-
retained overdenture group a good
correlation was founded between mu-
cosal health and satisfaction from the
treatment (R ϭ 0.865) and between
mucosal health and improvement of
function (R ϭ 0.859) and chewing (R
IMPLANT DENTISTRY / VOLUME 12, NUMBER 2 2003 117
3. ϭ 0.712). A low correlation was ob-
served between glucose level and im-
provement of function. The analyses
of our results show a very good cor-
relation between males and females
regarding improvement in chewing (R
ϭ 0.996), while the male:female cor-
relation concerning satisfaction from
the new treatment and mucosal health
was much lower (R ϭ 0.528)
Analysis of our results by patient
age showed a better satisfaction from
the new treatment in patients older
than 65 years, while the improvement
of chewing was equal between older
and younger age groups. The analysis
of the results by number of implants
showed a very low correlation be-
tween number of implants and im-
provement of function (R ϭ 0.217).
The main bone loss around im-
plants was approximately 0.5 mm in
the first year, and no correlation was
found between bone loss and glucose
level.
DISCUSSION
Proper selection of patients for
dental implants treatment is one of the
most important factors that can influ-
ence the prognosis and integration of
implants. A primary complication in
the integration of dental implants in-
cludes traumatic surgery, in which the
frictional heat generated during place-
ment of implant causes necrosis to the
surrounding tissues and consequently
lack of healing and integration.3
A sec-
ond complication that interferes with
bone integration is an implant recipi-
ent site of low healing potential. Some
authors10,14–17
claim that various sys-
temic factors such as osteoporosis, di-
abetes, severe alcoholism, renal dis-
ease, and uncontrolled metabolic
disorders increase the rate of implant
failure. However, there is a lack of
data regarding the influence of sys-
temic diseases, especially diabetes
mellitus, on dental implant integration
and long-term success rate in
humans.18,19
Takeshita et al18
studied differ-
ences between diabetic and nondia-
betic rats treated with hydroxyapatite-
coated implants in the tibia. The
diabetes group showed a 30% reduc-
tion in bone contact and 50% reduc-
tion in bone thickness around im-
plants. El-deeb et al20
studied the
response of hydroxyapatite in
diabetes-induced rats. The results of
the histologic analysis revealed that
the reaction of the collagen fibers in
the diabetic group showed a less orga-
Fig. 1. Preoperative and postoperative radiographs of a 65-year-old man before and 6 months
after implantation.
Fig. 2. Twelve months after implantation and restoration.
Fig. 3. Clinical view of the restoration. Note the mucosal health.
118 DENTAL IMPLANTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
4. nized healing response compared with
the nondiabetic group. Nevines et al21
observed the osseointegration of den-
tal implants in diabetic and nondia-
betic animals, histometric results indi-
cated that the quality of bone
formation was similar for diabetic and
control animals; however, less bone–
implant contact was observed among
diabetic animals.
There are limited series and spo-
radic reports on the use of dental
implants in diabetic patients. Some
authors claim that systemic diseases
decrease vascular supply to the im-
plant bed, thus decreasing wound-
healing potential—a possible risk
factor for placement of dental im-
plants. In a retrospective analysis of
104 consecutive patients treated with
313 NobelBiocare implants in a dif-
ferent location in both jaws, Smith et
al14
studied the potential medical risk
associated with dental implant fail-
ure and found no increase in implant
failure in patients with a compro-
mised medical status, including
those with diabetes mellitus.
Shernoff et al19
studied 187 implants
in 89 patients with type 2 diabetes
mellitus and showed a short-term
failure rate of 2.2%; however, the
failure rate rose to 7.3% after 1 year.
This study raised the question of
whether failure is related to diabetes
or improper implant loading. Balshi
et al18
reported a 94.3% survival rate
for implants placed in diabetic pa-
tients. The finding of our study is in
agreement with others, and suggest
that dental implants can be used
safely in diabetic patients if a proper
patient’s selection is done and if di-
abetes is well controlled. The major-
ity of patients in our study reported
satisfaction and improvement with
treatment, though treatment satisfac-
tion was higher in patients older than
65 years. As our results show, mu-
cosal health is the strongest predic-
tive value related to treatment satis-
faction in this patient group. Another
parameter concerning this factor is
that the diabetes did not affect mu-
cosal health. Although it can cause
discomfort and impair wound heal-
ing, diabetes should not alter muco-
sal health if the disease well
controlled.
CONCLUSION
The clinical outcome of dental im-
plant placement in a selected group of
patients with well-controlled type 2
diabetes mellitus is encouraging. Fur-
ther investigations and clinical trails
over a longer period are needed to
determinate the long-term survival of
implants in diverse groups of patients
with diabetes mellitus.
Disclosure
The authors claim to have no fi-
nancial interest in any company or
product mentioned in this article.
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Reprint requests and correspondence to:
Leon Ardekian, DDS
Department of Oral & Maxillofacial Surgery
Rambam Medical Center
Technion Faculty of Medicine
Haifa, Israel
Phone: 9724–8542345
Fax: 9724–8542557
E-mail: ardikian@netvision.net.il
Dental Implants in Diabetes Type II Patients
Abstract Translations [German, Spanish, Portuguese, Japanese]
AUTOR(EN): Micha Peled D.M.D., M.D.*,
Leon Ardekian D.D.S.**, Nirit Tagger-Green
D.M.D., M.Sc., M.H.A.***, Zvi Gutmacher
D.M.D.****, Eli E. Machtei D.M.D.*****.
*Leiter des Bereiches Gesichts- und Kiefer-
chirurgie, medizinisches Zentrum Rambam,
Technion medizinische Fakultät, Haifa, Israel.
**Leitender Angestellter, Bereich Gesichts-
und Kieferchirurgie, medizinisches Zentrum
Rambam, Technion medizinische Fakultät,
Haifa, Israel. ***Assistenzarzt, Abteilung für
Orthodontie, medizinisches Zentrum Rambam,
Technion medizinische Fakultät, Haifa, Israel.
****Leitender Angestellter, Kiefer- und Ge-
sichtsprothetik, medizinisches Zentrum Ram-
bam, Technion medizinische Fakultät, Haifa,
Israel. *****Abteilungsleiter, Abteilung für
Orthodontie, medizinisches Zentrum Rambam,
Technion medizinische Fakultät, Haifa, Israel.
Schriftvehrker: Leon Ardekian, DDS, Bereich
Kiefer- und Gesichtschirurgie (Dept. Of Oral &
Maxillofacial Surgery), medizinisches Zentrum
Rambam (Rambam Medical Center), Technion
medizinische Fakultät (Technion Faculty of
Medicine), Haifa, Israel. Telefon: 9724 -
8542345, Fax: 9724 - 8542557.eMail:
ardikian@netvision.net.il
Klinische Studie zum Thema: Zahnimplantateinsatz bei Patienten mit Typ II Diabetes
ZUSAMMENFASSUNG: Der Erfolg einer Implantierungsbehandlung kann durch syste-
mische Faktoren, wie zum Beispiel durch das Vorliegen eines Diabetes Mellitus (DM),
gefährdet sein. Schwerpunktmäßig befasst sich die vorliegende Studie daher mit unseren
Erfahrungen bei der Zahnbehandlung von Typ II Diabetes Patienten, bei denen eine
Deckprothese mittels Implantaten durch Verwendung des so genannten MIS-
Implantierungssystems (Medical Implant System (System für medizinische Implantate),
Shlomi, Israel) befestigt wurde. Im Einzelnen soll die Studie Informationen bezüglich der
Zufriedenheit der Patienten mit dem Behandlungsergebnis, der Verbesserung der Funk-
tionalität, des Zustandes der Schleimhäute und des um das Implantat gelegenen Gewebes
und der Knochengewebsdichte im das Implantat umlagernden Knochen liefern. Metho-
den: Zur Untersuchung wurden 41 Patienten mit festgestelltem Typ II Diabetes herang-
ezogen. Insgesamt wurden dieser Patientengruppe 141 Implantate zur Deckprothesenbe-
festigung eingepflanzt. Ergebnisse: Die bei den Nachuntersuchungen ein Jahr bzw. fünf
Jahre nach erfolgter Implantation ermittelte Erfolgsrate lag bei 97,3% bzw. 94.4%. Nach
Meinung der meisten Patienten erhöhte sich die Funktionalität in Folge der neuartigen
Behandlungsmethode. Enorme Bedeutung wurde dem Zusammenwirken von gesunder
Schleimhaut und Funktionsverbesserung beigemessen. Die Untersuchungsergebnisse las-
sen keinen Rückschluss auf einen Zusammenhang zwischen dem Fehlschlagen einer
Implantationsbehandlung und dem Blutzuckerspiegel zu. Schlussfolgerung: Innerhalb der
von uns zur Implantierungsbehandlung ausgewählten Gruppe von Patienten mit einer
guten Einstellung des Typ II Diabetes zeigten die klinischen Versuchsreihen bei Zahnim-
plantierungsbehandlungen sehr zufrieden stellende Ergebnisse. Sind diese Ergebnisse
auch ermutigend, so bedarf es doch noch weiterführender Forschungsreihen und Unter-
suchungen über einen längeren Zeitraum hinweg, um detaillierte Erkenntnisse über den
langfristigen Behandlungserfolg nach Einsatz von Zahnimplantaten bei verschiedenen
Gruppen von an Typ II Diabetes erkrankten Patienten zu gewinnen.
SCHLÜSSELWÖRTER: Erfolgsrate, Diabetes, Zahnimplantate, Periimplantitis,
Blutzuckerspiegel
Implantes dentales en pacientes con diabetes tipo II; un estudio clínico
120 DENTAL IMPLANTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
6. AUTOR(ES): Micha Peled D.M.D., M.D.*,
Leon Ardekian, D.D.S.**, Nirit Tagger-Green,
D.M.D., M. Sc., M.H.A.***, Zvi Gutmacher
DMD****, Eli E. Machtei D.M.D.*****.
*Jefe del Departamento de Cirugía Oral y
Maxilofacial, Centro Médico Rambam, Fac-
ultad de Medicina de Technion, Haifa, Israel.
**Personal Superior, Departamento de Cir-
ugía Oral y Maxilofacial, Centro Médico
Rambam, Facultad de Medicina de Technion,
Haifa, Israel. ***Residente, Unidad de Peri-
odontología, Centro Médico Rambam, Fac-
ultad de Medicina de Technion, Haifa, Israel.
****Personal Superior, Prostética Maxilofa-
cial, Centro Médico Rambam, Facultad de
Medicina de Technion, Haifa, Israel.
*****Jefe de Unidad, Unidad de Periodon-
tología, Centro Médico Rambam, Facultad de
Medicina de Technion, Haifa, Israel. Corre-
spondencia a: Leon Ardekian, DDS, Dept. of
Oral & Maxillofacial Surgery, Rambam Med-
ical Center, Technion School of Medicine,
Haifa, Israel. Teléfono: 9724-8542345, Fax:
9724-8542557. Correo electrónico:
ardikian@netvision.net.il
ABSTRACTO: PROPÓSITO: Factores sistémicos, tales como la diabetes mellitus (DM)
pueden influenciar el éxito de los implantes dentales. El propósito de este estudio es
describir nuestra experiencia usando el sistema de implante MIS (Medical Implant System
Shlomi, Israel) para la retención de sobredentaduras en pacientes con diabetes tipo II.
Debería proporcionar datos sobre el nivel de satisfacción de los pacientes, la mejora de la
función, salud mucosal y periimplante y el nivel del hueso alrededor de los implantes en
este grupo. MÉTODOS: El grupo de estudio consistió de 41 pacientes con diabetes
mellitus tipo II quienes recibieron 141 implantes para la retención de sobredentaduras.
RESULTADOS: El éxito fue del 97,3% y 94,4% luego de uno y cinco año posteriores a
la colocación del implante. La mayoría de los pacientes indicaron una mejora en la función
luego del nuevo tratamiento. Se observó una alta correlación entre la salud mucosal y la
mejora de la función. No se encontró correlación entre los implantes fallados y el nivel de
glucosa. CONCLUSIÓN: El resultado clínico de los implantes dentales en un grupo
seleccionado de pacientes con diabetes mellitus II bien controlada es satisfactorio y
positivo. Se necesitan investigaciones adicionales y pruebas clínicas durante un período
largo de tiempo para poder determinar le supervivencia a largo plazo de los implantes en
diversos grupos de pacientes que sufren de diabetes mellitus.
PALABRAS CLAVES: tasa de éxito, diabetes, implantes dentales, perimplantitis, nivel de
glucosa
Implantes odontológicos em pacientes com diabetes do tipo II: estudo clínico
AUTOR(ES): Micha Peled, D.M.D., M.D.*,
Leon Ardekian, D.D.S.**, Nirit Tagger-Green,
D.M.D., M.Sc., M.H.A.***, Zvi Gutmacher,
D.M.D.****, Eli E. Machtei, D.M.D.*****.
*Chefe do Departamento de Cirurgia Oral e
Maxilofacial, Centro Médico Rambam, Facul-
dade de Medicina do Technion, Haifa, Israel.
**Equipe Sênior, Departamento de Cirurgia
Oral e Maxilofacial, Centro Médico Rambam,
Faculdade de Medicina do Technion, Haifa, Is-
rael. ***Residente, Unidade de Periodontologia
Centro Médico Rambam, Faculdade de Medi-
cina do Technion, Haifa, Israel. ****Equipe
Sênior, Protética Maxilofacial, Centro Médico
Rambam, Faculdade de Medicina do Technion,
Haifa, Israe. *****Chefe da Unidade, Unidade
de Periodontologia Centro Médico Rambam,
Faculdade de Medicina do Technion, Haifa, Is-
rael. Correspondências devem ser enviadas a:
Leon Ardekian, DDS, Department of Oral &
Maxillofacia Surgeryl, Rambam Medical Center,
Technion Faculty of Medicine, Haifa, Israel.
Telefone: 9724-8542345, Fax: 9724-8542557.
email: ardikian@netvision.net.il
SINOPSE: Objetivo: fatores sistêmicos, como diabetes mellitus (DM) podem influenciar
o índice de sucesso de implantes odontológicos. Este estudo tem como propósito descrever
nosso experimento ao usarmos o sistema de implante médico (MIS, ou Medical Implant
System, Shlomi, Israel) para a retenção de sobredentaduras em pacientes com diabetes do
tipo II. Os dados provenientes deste estudo devem fornecer informações a respeito do grau
de satisfação dos pacientes, de aprimoramento das funções, da saúde mucosal e periim-
plantária e do nível ósseo em redor dos implantes neste grupo. Metodologia: o grupo de
estudo avaliou 41 pacientes com DM do tipo II, os quais receberam 141 implantes para
retenção de sobredentaduras. Resultados: o índice de sucesso foi 97,3% e 94,4% para,
respectivamente, um e cinco anos seguidos da implantação. A maioria dos pacientes
registrou melhoria de funções consecutivas ao novo tratamento. Observou-se uma alta
correlação entre a saúde das mucosas e o a melhoria das funções. Não registrou-se
correlação entre implantes fracassados e nível de glicose. Conclusão: o resultado clínico
de implantes odontológicos em um seleto grupo de pacientes com diabetes mellitus do tipo
II bem controlada é satisfatório e estimulador.Faz-se necessário um número maior de
investigações e experimentos clínicos ao londo de um maior período de tempo, a fim de
determinar a sobrevivência de implantes a longo prazo em diversos grupos de pacientes
portadores de diabetes mellitus.
PALAVRAS-CHAVES: índice de sucesso, diabetes, implantes odontológicos, periimplan-
tite, nível de glicose
IMPLANT DENTISTRY / VOLUME 12, NUMBER 2 2003 121