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Biomedical subjects

M Handelsman

Publications and source records attributed to M Handelsman.

15 recordsLinked to original sources
PubMed2006

Surgical guidelines for dental implant placement.

The goal of an implant supported reconstruction is to obtain optimal aesthetics and function. In order to achieve this, visualisation of the final restorative reconstruction is necessary prior to beginning treatment. The term 'restorative-driven' treatment planning has been used to identify this process. It requires a team approach of specialists, who can develop a multi-disciplinary treatment plan. It starts with an accurate diagnosis, which will lead to a prognosis of each individual tooth and the overall dentition. This information will help the clinician develop the treatment options suitable for tooth replacement. Only when the goals have been defined can the sequence of therapy be established. Working backwards from the wax-up of the final diagnostic model of the proposed treatment assists not only with the management of the complex case, but will help avoid mishaps. Effective communication between the team and the patient is extremely important. Understanding the patient's expectations is key to a successful outcome. Deciding that these expectations are realistic requires a correct diagnosis and an inter-disciplinary treatment plan that is logical. This approach takes time and requires a comprehensive treatment discussion between the team members, and then a thorough case presentation to the patient. Only then will the patient begin to understand the extent of their problem and the options available to reconstruct their mouth.

Alveolar Ridge Augmentation↗
PubMed2006

[Survey of patient satisfaction at the Yad Sarah Geriatric Dental Clinic].

OBJECTIVES: The purpose of this study is to determine the influence of a supporting professional environment, in a voluntary dental clinic, on the satisfaction among dental patients. METHODS: A sample of 109 patients who received dental care between 3/01-3/02 at the Yad Sarah dental clinic in Jerusalem were asked about : their satisfaction concerning their experience of previous visits, the frequency of their visits, how they heard about the clinic and whether they would return to the clinic in the future. RESULTS: On average, each patient visited the clinic three times. 36.7% of the patients heard about the clinic from friends or family. Most of the patients were highly satisfied (47.2%) or satisfied (36.1%) with the clinic. The two best predictors of patient satisfaction (total 83.2%) were the professionalism of the dentists (41.4%) and the good attitude of the dentists to them. On the other hand, the two best predictors of patient non-satisfaction (14%) were the low professionalism of the dentists (33.3%) and the price of the treatments at the clinic (33.3%). 89% said they would return to the clinic and 93% said they would recommend that other patients use the services of Yad Sarah dental clinic. CONCLUSIONS: Overall, the patients who were treated at the Yad Sarah dental clinic expressed high levels of satisfaction with the care they received. The professionalism and the attitude of the staff were the main contributors to the high level of satisfaction with the Yad Sarah dental clinic.

Aged↗
PubMed2000

A prospective multicenter clinical trial comparing one- and two-stage titanium screw-shaped fixtures with one-stage plasma-sprayed solid-screw fixtures.

BACKGROUND: Brånemark fixtures were originally placed in two stages, whereas titanium plasma-sprayed (TPS) solid-screws are placed in one stage. Long-term survival rates for both types of implants are excellent. Excellent survival rates have also been reported for machined screw-shaped (MS) titanium implants placed in one stage. A small number of studies have compared different implant systems and methods of implant placement. PURPOSE: The purpose of this study is to report clinical outcomes from a prospective longitudinal, multicenter study comparing Brånemark MS fixtures (Nobel Biocare, Yorba Linda, California, USA) placed in either one or two stages with a one-stage TPS system (ITI Straumann, Waldenburg, Switzerland). METHODS: A protocol was designed to compare implant survival rates, changes in crestal bone for titanium MS fixtures placed in one and two stages, and plasma-sprayed solid-screw fixtures placed in one surgical stage. Twenty-nine patients ranging in age from 24 to 82 years received MS fixtures in one stage. The average age for males was 58 years (n = 11), whereas the ages for females (n = 18) ranged from 15 to 84 years (average 58 years). Twenty-nine patients received machined titanium fixtures placed in two stages. There were 20 females ranging in age from 23 to 74 years (average 54 years) and 9 females ranging from 24 to 74 years (average 46 years). Twenty-five patients received TPS fixtures. There were 15 males, ranging in age from 57 to 79 (average 70), and 10 females, ranging in age from 40 to 83 years (average 62 years). Bone quality and quantity were determined from radiographs and during site preparation. Patient age, sex, location of implant placement according to jaw, length of fixtures, and number of lost fixtures were entered onto computer code sheets and continuously entered into a locked computer system. For one- and two-stage MS fixtures, nonstandardized periapical radiographs were taken at abutment connection and follow-up. Solid screws were x-rayed at prostheses connection and follow-up. The average time between implant restoration and radiographic follow-up was 15 months. The x-rays were scanned into a computer, and a program designed to measure radiographs was used to determine changes in crestal bone. Measurements for one- and two-stage MS fixtures were made from the top of the implant shoulder to the first bone to implant contact mesial and distally. Plasma-sprayed screws were measured from the bottom of the implant to the coronal most bone to implant contacts mesial and distally. Mesial-distal radiographic measurements were averaged and changes were compared using the t-test for related samples. RESULTS: This report presents data from the 2- to 3-year follow-up examinations. Twenty-nine patients received 80 one-stage MS fixtures. Between 0 and 1 year, two fixtures were lost, resulting in a 97.5% cumulative survival rate (CSR). The CSR remained unchanged through the 2- to 3-year follow-up. Twenty-eight patients received 78 two-stage MS fixtures. One implant was lost prior to loading and two were lost between 0- and 1-year follow-up, yielding a 96.2% CSR at the end of 1 year. The CSR remained unchanged through the 2- to 3-year follow-up. Twenty-three patients received 78 solid-screw plasma-sprayed screws. One implant was lost prior to loading and one between the 0- to 1-year follow-up, accounting for a 97.4% CSR at the 2- to 3-year follow-up. Changes in bone crest measurements for one-stage titanium threaded fixtures were insignificant (-0.11 mm, p = .08, maxillary; 0.07 mm, p = .42, mandibular). For two-stage MS fixtures, crestal bone loss was insignificant in maxillae (-0.16 mm, p = .92) and significant in mandibles (-0.43 mm, p = .000). There was significant bone loss for TPS implants in maxillae and mandibles (maxillae, 1.31 mm, p = .04; mandibles, 0.98 mm, p = .000). CONCLUSIONS: Cumulative survival rates for MS fixtures placed in one and two stages as well as one-stage TPS screws up to the 2- to 3-year follow-up examination were similar, indicating excellent clinical results. Radiographic measurements for changes in crestal bone loss were clinically insignificant for fixtures placed in one stage. For two-stage fixtures, maxillary changes were insignificant, whereas mandibular bone loss was statistically significant but clinically insignificant. Changes in crestal bone loss for TPS implants were statistically significant.

Adolescent↗
PubMed1999

Crown lengthening surgery: a restorative-driven periodontal procedure.

Improper management of the periodontal tissues during restorative procedures is a common, but often overlooked, cause of failure. When a restoration is placed, the preservation of an intact, healthy periodontium is necessary to maintain the tooth or teeth being restored. Predictable long-term restorative success requires a combination of restorative principles with the correct management of the periodontal tissues.

Crown Lengthening↗
PubMed1998

Treatment planning and surgical considerations for placement of wide-body implants.

Partially edentulous implant treatment has evolved from using a standard diameter fixture for every tooth site to selection of the implant diameter according to the surgical demands, space available, and the dimension of the final prosthetic tooth. The advantages are functional, improved emergence profiles for esthetics, and optimal contours for oral hygiene maintenance. This article reviews presurgical treatment planning for wide-diameter implants.

Bone Density↗
PubMed1993

A comparison of the mental health systems of New York State and Israel.

The article compares characteristics of the residential and non-residential mental health services in Israel and in New York State and considers their influences on extent of service utilization. The data is based on special surveys covering all patients seen in public mental health services in New York State and in Israel during one week in 1986. The results indicate similar overall residential prevalence rates in both systems (1.9 per 1,000 population). Israeli males aged 45-64 show much higher residential prevalence rates than males of this group in NYS. The Israeli non-residential rates are much lower, 3.5 per 1,000 as compared to 5.5 in NYS. These differences are seen in both sexes and across all age groups. Overall diagnostic distributions show a greater percentage of patients with major affective disorder in NYS and a somewhat greater percentage of patients with the diagnosis of schizophrenia in Israel. Three Service Dependency Levels (SDL) are defined and their distribution by loci of care are presented. A greater proportion of patients belong to the highest SDL (1) in Israel as compared to NYS. Both in New York State and in Israel, the development of public mental health services is generally oriented to a preference for the non-residential, community treatment model over the residential, institutional model. However, Israel is less advanced than New York in developing its non-residential psychiatric services, as reflected by the relative low rate of psychiatric referrals to community facilities and clinics. Analysis and explanation of these survey differences are presented.

Adolescent↗
PubMed1991

Guided tissue regeneration for implants placed into extraction sockets: a study in dogs.

Twelve 10 mm implants were placed into immediate extraction sockets in dogs. Six implants were isolated with PTFE membranes and 6 sites served as controls. Standardized clinical measurements were taken at test and control sites. At 18 weeks the dogs were anesthetized and flaps were laid for the purpose of obtaining clinical measurements. The average gain of bone around augmented implants was 2.6 mm, while control sites had an average bone gain of 1.0 mm. Ridge width adjacent to augmented sites increased by 1.2 mm and control sites had an increased width of 0.6 mm. Histologic evaluation of test and control specimens showed greater bone formation around augmented implants. Implants augmented with PTFE membranes had clinically significant amounts of bone regeneration when compared with controls.

Alveolar Process↗
PubMedDate not supplied

Use of wide implants and double implants in the posterior jaw: a clinical report.

As experience with osseointegrated implants has grown, greater use has been made of placement in the posterior jaw. To reduce the risk of implant failure and increase the ability of posterior implants to tolerate the occlusal forces, it is beneficial to create a wider base either by using wider (eg, 5-mm) implants or by placing two or even three standard implants at one site. In the present series, unpaired 5-mm Nobelpharma implants were placed in 38 sites in the mandible and 21 sites in the maxilla. All implants were uncovered and restored with ceramometal crowns, with follow-up ranging from 3 to 26 months (mean 16 months) postloading. Two implants in one patient failed and were replaced successfully at 14 months. At 20 sites, pairs of 5-mm implants were placed and restored, and with a loading period of 3 to 26 months (mean 14 months), all of these implants were successful. At 34 sites, a 5-mm implant was paired with a 3.75-mm or 4-mm implant. With a loading period of 3 to 24 months (mean 13 months), one implant 5 mm wide and 8 mm long failed and was replaced successfully at 13 months, and an implant 4 mm wide and 10 mm long failed and was not replaced. The failure rate for this group of implants therefore was 3%. Double 3.75-mm or 4-mm implants were placed at 149 sites in the mandible and 13 sites in the maxilla. All of these double-root implants were uncovered and restored with ceramomental crowns. With follow-up ranging from 4 to 78 months (means 37 months) postloading, there were five implant failures in four patients, for a failure rate of 1.2%. The failure rate for all 5-mm implants was 2.3%, and that for all double implants was 1.6%. The use of either 5-mm or double implants necessitates changes in surgical technique, and both are highly dependent for their success on proper surgical execution.

Bite Force↗
PubMedDate not supplied

One-step surgical placement of Brånemark implants: a prospective multicenter clinical study.

This prospective longitudinal multicenter study evaluated the clinical outcomes after placement and restoration of one-step Brånemark implants into the maxillae and mandibles of completely and partially edentulous patients. Six surgical treatment centers participated in this study, in which 135 implants were placed into 63 adult patients. All implants were stable after placement. The majority of implants were placed into type B bone with minimal jaw resorption and type 2 bone quality. After implant placement, standard transmucosal healing abutments were firmly placed. The average amount of time between implant placement and prosthetic abutment connection was 170 days in the maxillae and 147 days in the mandibles. To evaluate crestal bone changes caused by implant placement, a periodontal probe was used to measure midbuccally from the top of the implant cylinder to the alveolar crest; in 29 patients, 54 midbuccal bone crest sites were remeasured following prosthetic abutment connection. Crestal bone changes in mandibles and maxillae were statistically and clinically insignificant. Six implants were lost prior to loading and one implant has not been restored. No implants or restorations were lost after loading. At 1 year, the implant success rate was 95.6%. Mesiodistal radiographic measurements from 34 patients were averaged, and changes from prosthetic abutment connection to, on average, 12 months follow-up were compared. The radiographs, which were digitalized, measured from the bottom of the implant cylinder to the most coronal bone in contact with implant thread. For mandibular implants, the mean radiographic bone level at prosthetic abutment connection was 1.07 mm; after loading, it was 1.35 mm. For maxillary implants, the mean radiographic bone height at prosthetic abutment connection was 1.16 mm; after loading, it was 1.36 mm. These changes were not statistically significant. The 1-year outcomes from this patient series indicate that one-step Brånemark implants provide excellent clinical results when placed in patients with good bone quality and quantity.

Adult↗