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Biomedical subjects

Alan B Carr

Publications and source records attributed to Alan B Carr.

10 recordsLinked to original sources
PubMed2006

Mayo clinic consensus statement for the use of bisphosphonates in multiple myeloma.

Bisphosphonates are effective in the prevention and treatment of bone disease in multiple myeloma (MM). Osteonecrosis of the jaw is Increasingly recognized as a serious complication of long-term bisphosphonate therapy. Issues such as the choice of bisphosphonate and duration of therapy have become the subject of intense debate given patient safety concerns. We reviewed available data concerning the use of bisphosphonates in MM. Guidelines for the use of bisphosphonates in MM were developed by a multidisciplinary panel consisting of hematologists, dental specialists, and nurses specializing in the treatment of MM. We conclude that intravenous pamidronate and intravenous zoledronic acid are equally effective and superior to placebo in reducing skeletal complications. Pamidronate is favored over zoledronic acid until more data are available on the risk of complications (osteonecrosis of the jaw). We recommend discontinuing bisphosphonates after 2 years of therapy for patients who achieve complete response and/or plateau phase. For patients whose disease is active, who have not achieved a response, or who have threatening bone disease beyond 2 years, therapy can be decreased to every 3 months. These guidelines were developed in the Interest of patient safety and will be reexamined as new data emerge regarding risks and benefits.

Bone Density Conservation Agents↗
PubMed2004

Implant-retained maxillary overdentures.

Overdentures supported by osseointegrated implants overcome many of the complications observed with overdentures supported by natural teeth. Dental implants are free of biologic consequences associated with natural teeth, such as dental caries and periodontal disease. Bone undercuts adjacent to implants do not mimic those found adjacent to natural tooth roots. Implants are used to provide predictable retention, support, and stability for overdenture prostheses. When lip or facial support is required, the overdenture is the treatment of choice. Likewise the overdenture may improve phonetic deficiencies associated with alveolar bone loss.

Dental Implants↗
PubMed2004

Smokeless tobacco: an emerging addiction.

Smokeless tobacco (ST) use is an important health issue in the United States, and chronic use leads to significant morbidity. ST users are exposed to levels of nicotine comparable with smokers and experience symptoms of nicotine withdrawal when attempting to stop. Clinical treatment of ST users requires an understanding of the unique characteristics of ST. This article reviews ST products, epidemiology, pharmacology, health risks, and treatment approaches.

Humans↗
PubMed2004

Nasal stent fabrication involved in nasal reconstruction: Clinical report of two patient treatments.

Total or near-total rhinectomy during tumor ablative surgery creates a large postsurgical defect. Surgical or prosthetic reconstruction may be considered. Surgical reconstruction of such a defect depends on support of the reconstructive tissues to prevent collapse. Without support, the esthetic results and airway patency are compromised. The purpose of this clinical report is to present the use of a nasal stent to support soft and hard tissues for the reconstruction of near-total rhinectomy in 2 patients.

Adult↗
PubMed2003

Quality of dental implants.

BACKGROUND: Clinicians need quality research data to decide which dental implant should be selected for patient treatment. AIM(S)/OBJECTIVE(S): To present the scientific evidence for claims of relationship between characteristics of dental implants and clinical performance. STUDY DESIGN: Systematic search of promotional material and Internet sites to find claims of implant superiority related to specific characteristics of the implant, and of the dental research literature to find scientific support for the claims. MAIN OUTCOME MEASURES: Critical appraisal of the research documentation to establish the scientific external and internal validity as a basis for the likelihood of reported treatment outcomes as a function of implant characteristics. RESULTS: More than 220 implant brands have been identified, produced by about 80 manufacturers. The implants are made from different materials, undergo different surface treatments and come in different shapes, lengths, widths and forms. The dentist can in theory choose among more than 2,000 implants in a given patient treatment situation. Implants made from titanium and titanium alloys appear to perform well clinically in properly surgically prepared bone, regardless of small variations of shapes and forms. Various surface treatments are currently being developed to improve the capacity of a more rapid anchorage of the implant into bone. A substantial number of claims made by different manufacturers on alleged superiority due to design characteristics are not based on sound and long-term clinical scientific research. Implants are, in some parts of the world, manufactured and sold with no demonstration of adherence to any international standards. CONCLUSIONS: The scientific literature does not provide any clear directives to claims of alleged benefits of specific morphological characteristics of dental implants.

Clinical Trials as Topic↗
PubMed2002

Systematic reviews of the literature: the overview and meta-analysis.

Systematic reviews in the form of overviews or meta-analyses offer a solution for busy practitioners who have difficulty keeping abreast of current literature. Because systematic reviews can condense numerous studies into reliable and valid summaries of the best available evidence for a specific clinical problem, they offer significant benefit to busy clinicians. This article has summarized the major features and advantages of systematic reviews. It has distinguished those features that attempt to increase the usefulness of reviews by limiting bias, and it provided a summary of important questions clinicians can use to appraise such reviews critically. With this knowledge, clinicians should be able to use the literature more appropriately and in a timely fashion.

Dental Research↗
PubMedDate not supplied

Retrospective cohort study of the clinical performance of 1-stage dental implants.

PURPOSE: To evaluate long-term clinical performance of 1-stage dental implant prostheses at a single clinic, emphasizing clinical and demographic characteristics that affect implant survival. MATERIALS AND METHODS: Dental records of all 308 patients (674 implants) treated with 1-stage implants at Mayo Clinic from October 1993 through May 2000 were reviewed from implant placement to last visit. Exposure and outcome variables affecting performance were collected separately to control bias in the data collection process. Additional confounding factors (age and sex) were adjusted with the stratified Cox proportional hazards model. Implant survival was determined by means of a Kaplan-Meier survival estimate. The log-rank test was used to determine the role of clinical and demographic variables in implant survival. The relative risk associated with the possible effect of clinical and demographic variables on implant survival was estimated with the Cox proportional hazards model. RESULTS: The implant survival rate (n = 654 implants) was 97% (mean +/- SD follow-up, 21.0 +/- 18.8 months; range, 1 to 78 months). Performance bias was limited because nearly all patients were treated by 1 prosthodontist. Two implants failed after loading (6 and 9 months). The incidence of complications was less than 4%. Among the implant failures, use of heterogeneous bone graft was associated with 4.8 times more failures than was use of autogenous bone graft (P = .04). After augmentation, delaying implant placement for 5 to 6 months resulted in 8.6 times more failures than the rate after earlier placement (P < .001). DISCUSSION: Retrospective review of the clinical performance of a 1-stage dental implant system yielded a 97% survival rate, with no failures noted after 13 months. Prosthetic complications were low, especially for fixed implant prostheses. CONCLUSION: Clinical performance of 1-stage dental implant prostheses between 1993 and 2000 demonstrated a high level of predictability.

Adolescent↗
PubMedDate not supplied

Six-month performance of implants with oxidized and machined surfaces restored at 2, 4, and 6 weeks postimplantation in adult beagle dogs.

PURPOSE: The purpose of this study was to compare machined-surface implants (control) and oxidized-surface titanium screw-type implants (test) loaded with fixed partial dentures at 2, 4, and 6 weeks postplacement in terms of implant survival and stability. MATERIALS AND METHODS: The beagle model was chosen for the study. Four mandibular premolars were extracted bilaterally from each dog. After 2 months of healing, 4 implants were placed in each dog. Half of the dogs (n = 6), the test group, received oxidized-surface implants; the other half (n = 6), the control group, received machined-surface implants. In each group, 2 dogs were randomly assigned to a 2-week preloading healing period, 2 to a 4-week period, and 2 to a 6-week period. Three implants were loaded in each dog; 1 was left unloaded as a control. Clinical stability and survival were monitored every 2 weeks for 6 months. RESULTS: Failures were noted only among the implants assigned to the 2- and 4-week groups. Failures accounted for 9.4% (9/96) of the implants--12.5% (6/48) of the control implants and 6.3% (3/48) of the test implants. One hundred percent prosthesis stability was noted for the test-surface implant group. Stability of the test implants was significantly better than stability of the control implants (-2.6 vs -1.7, P < .05). Mean Periotest values at loading were 3.7 for the group loaded at 2 weeks, 1.6 for the group loaded at 4 weeks, and 0.6 for the group loaded at 6 weeks. Fifty percent of the 6-week group, 25% of the 4-week group, and 12.5% of the 2-week group had a Periotest value < 0 at loading. DISCUSSION: The results reveal a qualitative difference in performance between the implant groups. Twice as many failures occurred in the control group, few failures occurred following loading, and no failures occurred after 4 weeks postplacement. The survival curves for both implants were flat after 4 weeks; however, the duration of follow-up may hide effects of time-dependent factors on survival and poses a concern for clinical inference. CONCLUSIONS: Early loading of both implant types was well tolerated, as only 2 failures occurred following loading. A subsequent report will review these outcomes along with histomorphometric data collected at 6 months to better understand the significance of tissue-level implant-surface interaction for survival and stability.

Analysis of Variance↗