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PubMed2002

Managing the infected knee: as good as it gets.

The clinical presentation is a useful guide for selecting the treatment of an infected total knee arthroplasty. Prosthesis retention is indicated in patients with infections that occur within 30 days after arthroplasty and in patients with well-functioning prostheses who develop an acute late hematogenous infection. Débridement attempts should be open and not arthroscopic. When prosthesis removal is required, the preferred approach is a delayed reconstructive technique, the 2-staged reimplantation, rather than a direct-exchange procedure. The use of block spacers or mobile articulating devices to deliver high-dose local antibiotics is recommended between implant removal and delayed revision surgery. The use of antibiotic-loaded acrylic cement for cemented prostheses or antibiotic-soaked bone-graft with cementless prostheses is helpful in the overall cure rate of infection.

Anti-Bacterial Agents↗
PubMed1994

Implant prosthodontic procedures for a completely edentulous patient with cleft palate.

Prosthodontic treatment of the edentulous cleft palate patient presents the dentist with numerous challenges for achieving a satisfactory result for the patient. A technique is described for prosthodontic rehabilitation of a completely edentulous cleft palate patient using bone augmentation procedures, root-form dental implants, and a removable maxillofacial prosthesis. Dental implants may improve prosthesis retention, stability, and occlusal function when used in carefully selected cases.

Adult↗
PubMed1988

Prolonged suppression of infection in total hip arthroplasty.

Nineteen periprosthetic infections after total hip arthroplasty were treated with prolonged suppressive antibiotics without removing the components. In 11, antibiotic therapy was monitored with serum bactericidal titers. Eleven had incision and drainage. Indications included patients' refusal of removal or medical contraindications to surgery. Requirements included well-fixed components, highly sensitive organisms, and no systemic sepsis. The follow-up period averaged 4.1 years after treatment. Nine hips showed no deterioration. Seven prostheses failed, five with progressive hip sepsis. Three patients had increasing symptoms without prosthesis removal. Although two-stage reimplantation is preferred, suppressive antibiotics and prosthesis retention can succeed in some patients and may be considered in old, frail patients with an early infection caused by bacteria responsive to oral antibiotic therapy. Suppressive therapy may also be considered for an otherwise compliant patient who refuses removal of an infected prosthesis. The organism must be sensitive to oral antibiotics, and the patient must be tolerant of the antibiotics.

Aged↗
PubMed2003

Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists.

Prosthetic joint infections (PJIs) occur in approximately 1.5%-2.5% of all primary hip or knee arthroplasties. The mortality rate attributed to PJIs may be as high as 2.5%. Substantial morbidity is associated with a loss of mobility, although this is temporary. The costs associated with a single episode of PJI are approximately $50,000 per episode, exclusive of lost wages. Risk factors that increase the occurrence of PJI include revision arthroplasty, time in the operating room, postoperative surgical site infection, and malignancy. Pain is the most consistent symptom. Staphylococcus species are the most common organisms isolated from PJI sites. Two-stage revision is superior to single-stage revision or to debridement with prosthesis retention. Long-term antibiotic suppression and/or arthrodesis are useful for patients too frail to undergo extensive surgery. Using an optimal approach, recurrent infection occurs in <10% of previously infected joints.

Arthroplasty, Replacement, Hip↗
PubMed2006

[Survey of treatment-seeking complete denture wearers concerning tooth loss, retention behavior and treatment expectations].

The aim of the current study was to gather information about time and etiology of tooth loss, and to analyze the reasons for treatment needs with a questionnaire used among edentulous patients. 60 patients (age 44-98 years) who requested dental treatment were included. More than half of the patients were edentulous before the age of 60, in almost all cases the maxilla was affected first. This difference was more pronounced in women, who experienced tooth loss in the maxilla 17 years prior to the mandible. At the time of edentulism women were about ten years younger than men. According to patients'report, periodontal disease was the most common reason for tooth loss. In the mandible, prosthesis retention was influenced by alveolar ridge resorption, while in the maxilla there was no relation between the amount of resorption and perceived retention. This indicates that maxillary prostheses retention is influenced by other factors besides the alveolar ridge morphology. So, permanent intake of drugs potentially causing xerostomia was related to poorer assessment of prostheses retention in the upper jaw. The results of the questionnaire "Patient satisfaction related to prosthetic restoration" before treatment indicated that the general satisfaction with the existing complete denture in the mandible was influenced by functional problems and the impairment of patients'self-confidence (R-squared = 0.754). The main reason for requesting treatment was the poor retention of the lower denture. More than half of the participants stated that they refrained from eating certain foods due to a reduced chewing ability.

Adult↗
PubMed1986

Osseointegration in maxillofacial prosthetics. Part II: Extraoral applications.

The application of osseointegrated fixtures to the cranial skeleton for facial prosthesis retention marks a revolutionary step in the search for the perfect soft tissue replacement. They allow present elastomer technology to be used to its greatest potential by protecting surface coloration, eliminating adhesive-induced base material degeneration, and allowing the long-term retention of fine, but weak peripheral margins. Although not all facial defect patients are candidates for this approach, the concept as applied in our present experience has proved to be a valuable replacement for available adhesive systems.

Ear, External↗
PubMed2003

Trends in the treatment of orthopaedic prosthetic infections.

The most commonly used therapy for prosthetic joint infection is a two-stage prosthetic exchange separated by 6 weeks of intravenous antibiotic therapy. This often results in long periods of hospitalization, morbidity, severe functional impairment and sometimes increased mortality. Therefore novel and challenging therapeutic approaches have been attempted, particularly in hip prosthetic infection. This includes, whenever possible, according to the type of microorganism, antibacterial susceptibility and clinical presentation (including age and comorbidities): (i) less aggressive surgical techniques (debridement and prosthesis retention, or re-implantation with a single-stage exchange arthroplasty); and (ii) antibiotic combinations active against biofilm-associated bacteria, including rifampicin (particularly with quinolones) with excellent bio-availability which allow prolonged and efficient oral therapy.

Anti-Bacterial Agents↗
PubMed1991

The United States and Swedish experience with osseointegration and facial prostheses.

A survey of experience treating patients with extraoral implants for facial prosthesis retention in 13 United States centers and in Sweden has been completed. Patients who have not received radiation for elimination of malignant disease can be treated with reasonably good expectations for long-term success. Reported success rates indicate that patients who have received radiation should be selected carefully and treated with caution, since overall success rates in this category are disappointingly low.

Eye, Artificial↗
PubMed2006

Management of infections of osteoarticular prosthesis.

Prosthetic joint infections are an uncommon complication of joint replacement surgery, but are associated with significant morbidity and costs when they do occur. Gram-positive cocci, in particular Staphylococcus aureus and Staphylococcus epidermidis, are the most commonly recovered microorganisms (>or=50% of all isolates). About 60% of prosthetic joint infections probably occur by direct contamination during the operative procedure. Certain systemic conditions in the patients, as well as foreign material, have been identified as risk factors for prosthetic joint infection. The clinical diagnosis is only certain when there are sinus tracts that reach the prosthesis or purulent secretion is obtained from joint aspiration or during open surgery. The treatment of an infected joint prosthesis must be individualised, but it generally involves both systemic antibiotics and surgical intervention. Exchange arthroplasty in one or two stages continues to be the standard approach to management. Prosthesis retention, in conjunction with debridement and prolonged (for at least 3 months) oral antibiotic therapy, can be an alternative for early postoperative or late acute haematogenous infections, when the duration of symptoms is less than 1 month, the implant is stable, and the pathogen is relatively avirulent and sensitive to an orally well absorbed antibiotic. Good results have been achieved under these conditions in staphylococcal infections with rifampin associated with quinolones and other antibiotics, e.g., cotrimoxazole, fusidic acid, and linezolid.

Acetamides↗
PubMed1997

Judson C. Hickey Scientific Writing Award Winner. A method of fabrication of a facial prosthesis that improves retention and durability: a clinical report.

This clinical report describes a technique for the fabrication of a facial prosthesis with a visible light-curing resin overlaid with a silicone elastomer. Clinical observations have revealed considerable improvement in the duration of retention of the prosthesis with an adhesive and enhanced longevity of the prosthesis as compared with conventional silicone elastomer facial prostheses retained with the same adhesive.

Acrylic Resins↗
PubMed1978

The atrophic mandible: aspects of technique in lower labial sulcoplasty.

Severe alveolar atrophy is a common sequel to the extraction of teeth from the mandible. This atrophy, coupled with the associated superficiality of adjacent muscle attachments (Fig. 1a) precludes the provision of a stable, retentive prosthesis. This paper discusses some of the operations which have been designed to alleviate this considerable clinical problem and considers three aspects of the sulcoplasty procedure which in the author's opinion are crucial to its success. The paper also introduces the use of lyophilised porcine skin to dress the surface deficit created during surgery, thus obviating the need for skin grafting.

Animals↗
PubMed1981

Tarsal strip procedure for correction of eyelid laxity and canthal malposition in the anophthalmic socket.

Surgically anophthalmic sockets commonly have laxity of the lower eyelid, inferior displacement of the lower eyelid and lateral canthus, shallowing of the inferior fornix, and a deep superior sulcus. These deformities result in difficulty in prosthesis retention, pooling of tears and mucus, epiphora and lower eyelid irritation, and poor cosmesis with an appearance of facial asymmetry. The causes of these problems are numerous, but the main anatomic deformity is a marked laxity and elongation of the lateral canthal tendon. The tarsal strip procedure is ideal for correcting or improving these deformities simultaneously with one simple procedure. We are very pleased with our results in 26 patients with surgically anophthalmic sockets in which this procedure was utilized. We highly recommend the tarsal strip procedure not only to correct these conditions in anophthalmic sockets but in almost any condition where laxity of the eyelids or canthal malposition requires surgical correction.

Adolescent↗
PubMed1997

A long-term study of transverse stability of maxillary teeth in patients with unilateral complete cleft lip and palate.

The aim of this study was to investigate the long term post-treatment transverse stability of the maxillary dental arch in subjects with unilateral complete cleft lip and palate (UCLP) treated by the Harvold/Bøhn method of orthodontic expansion and prosthodontic retention. The treatment of 22 consecutive patients, primarily operated on during the period 1957-60, was completed at a mean age of 18.1 years by the provision of a fixed partial retention prosthesis across the cleft using the cleft side central incisor and canine only as abutment teeth. The cleft side lateral incisor was missing in each case. Dental casts were made at the time of abutment preparation and at six subsequent times with the final observation 13.5 years after treatment completion. Measurements of any shift in the transverse position of cleft side and non-cleft side canines, premolars and first molars were made on standardized photographs of the casts. A constructed anteroposterior palatal line served as 'midline' reference. A mean reduction of width at the final observation, as recorded from the palatal surface to the reference line, was for the cleft side canine: -0.4 mm, the premolar immediately distal to the prosthesis and the first molar: both -1.2 mm. The corresponding mean width reductions on the noncleft side were: canine -0.9 mm, premolar -1.2 mm, first molar -1.6 mm. The rate of movement towards the midline decreased linearly with In(time) for all variables (P < 0.02) but for the cleft side canine.

Adolescent↗
PubMed2003

Reconstruction of anterior teeth using an aesthetic post-and-core and all-ceramic material.

Ceramic post-and-core systems offer biocompatibility, aesthetics, reinforcement of the remnant root, and prosthesis retention. Aesthetic posts-and-cores contribute to the optical properties of the overlying restorations when metal-free crowns are used. This article illustrates the use of these materials to provide strength and aesthetics during the restoration of endodontically treated teeth. The case presentation detailed herein demonstrates the rehabilitation of anterior dentition following substantial structural loss and exhibits the biomechanical treatment of these structures using contemporary restorative materials.

Adult↗
PubMedDate not supplied

An in vitro evaluation of ZiReal abutments with hexagonal connection: in original state and following abutment preparation.

PURPOSE: Laboratory processing of implant-supported prostheses may alter the surface of the abutment in contact with the implant head, with potential repercussions for the interface fit. The purpose of this study was to assess changes at the implant interface of high-strength zirconia ceramic esthetic abutments with a hexagonal connection (ZiReal; 3i/Iimplant Innovations, Palm Beach Gardens, FL) following abutment preparation for single-tooth restorations. MATERIALS AND METHODS: The depth (d) and width (w) of the titanium hexagonal portion of the abutment, the apical diameter of the abutment (D), and the rotational freedom (R) of the abutment were assessed for 20 ZiReal abutments prior to preparation (time 0) and following abutment preparation (time 1) to detect any eventual change of fit of the abutment on the top of the implant hexagon. RESULTS: No significant differences relative to any study parameter (d, w, D, and R) were observed between time 0 and time 1 (P = .9542). DISCUSSION AND CONCLUSIONS: The hexagonal misfit of the titanium machined ZiReal abutment on the implant hexagon may be implicated in screw joint loosening. The results of this report suggest that if all laboratory steps are carefully observed, changes at the implant/ZiReal abutment do not occur. The maintenance of the original features of the ZiReal abutment may reduce the risk of screw loosening.

Ceramics↗
PubMed1983

Upper eyelid retraction in long-standing anophthalmic sockets.

Marked retraction of the upper eyelid is a rare but distressing complication of the anophthalmic socket. It usually occurs in long-term prosthesis wearers who have undergone enucleation in childhood or 20 to 30 years previously. Contributing factors include a large prosthesis, infrequent removal of the prosthesis, and lid closure difficulties. Clinically, the upper eyelid may be severely retracted, producing a wide-eyed stare as well as problems with comfort and prosthesis retention. The upper fornix may be foreshortened or of adequate depth but misdirected posteriorly. The postulated mechanism of anophthalmic upper eyelid retraction is a contraction of the levator muscle because of its role as an antagonist to the underutilized orbicularis muscle. Barring excessive atrophy of the lid layers, the eyelid can be brought forward out of the orbit to an acceptable position with surgical correction. Transcutaneous levator recession with interposition of eyebank sclera is the procedure used by the author.

Adult↗
PubMedDate not supplied

Multidisciplinary treatment for an implant retained auricular prosthesis rehabilitation.

Retention of a facial prosthesis is the most important factor in creating a useful prosthesis for the patient. This paper presents a detailed case study of an auricular defect that was rehabilitated using two types of prosthetic retention: adhesive and osseointegration. We present the patient selection criteria, the surgical considerations prior to implant placement, retention component selection, prosthetic fabrication techniques and patient management after prosthetic delivery. The osseointegrated prosthesis made a large improvement in the patient's quality of life.

Acrylic Resins↗