Rehabilitation of mandibular resected patients using fixed immediately loaded corticobasal implant -supported prostheses. A case series

INTRODUCTION AND IMPORTANCE

Aliments such as congenital conditions, pathological, and iatrogenic circumstances may result in mandibular defects that can severely disturb the patients' oral health, functions (mastication, speech), aesthetics, and quality of life and present a rehabilitating challenge.

CASE PRESENTATION

we present a multidisciplinary treatment approach for three cases presented with mandibular resection as a consequence of cystic, benign, and malignant tumour eradication that were rehabilitated with immediately loaded fixed corticobasal implant-supported prostheses and a follow-up period of 5,5 and 4 years. The reported cases present with excellent implant survival, along with healthy peri-implant tissues, stable prostheses, enhanced speech, chewing ability, aesthetics, superior patient satisfaction, and improved overall self-esteem.

CLINICAL DISCUSSION

A multidisciplinary oral and maxillofacial team is mandatory for the successful rehabilitation of patients with mandibular resection and to restore soft and hard tissue loss. The reported treatment modality offers the patient immediate fixed implant-supported prostheses omitting the need for a bone grafting procedure, with optimum peri-implant tissue health, excellent biomechanical and prosthetic results, and significant improvement in function and satisfaction.

CONCLUSION

Corticobasal fixed implant-supported prostheses can be a reliable treatment modality for mandibular resection, resulting in notable enhancements in the patients' oral health, appearance, mastication, speech, and self-esteem.

Oral rehabilitation of maxillofacial trauma using fixed corticobasal implant-supported prostheses: A case series

Introduction

Maxillofacial trauma is associated with severe loss of soft and hard tissues that lead to aesthetic and functional disfigurements, adverse psychological impacts on the patient's general and oral health, and decreased quality of life. Therefore, treatment of maxillofacial trauma is challenging.

Presentation of case

We present three patients with maxillofacial trauma owing to road traffic accidents that were rehabilitated by immediate use of loaded fixed corticobasal implant-supported prostheses with follow-up periods of 6, 5, and 7 years. All treated patients had a 100 % implant survival rate, healthy peri-implant tissues, stable prosthesis with significant improvement in mastication and phonation, and high patient satisfaction.

Discussion

Rehabilitation of patients with intensive maxillofacial trauma requires a multidisciplinary approach to ensure the standard of care during treatment. The described treatment eliminates the need for bone grafting, reduces susceptibility to grafting complications, shortens treatment time, and provides the patient with a fixed prosthesis with predictable success, excellent implant survival, healthy peri-implant tissue, improved prosthetic stability, and high satisfaction rates.

Conclusion

Corticobasal implant-supported prostheses are a feasible treatment modality to rehabilitate patients with maxillofacial trauma with high success and survival rates and patient satisfaction.

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Treatment of maxillofacial trauma requires a multidisciplinary approach.

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Hard and soft tissue loss complicates treatment.

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Corticobasal implants do not require bone grafting and reduce treatment time.

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They help achieve satisfactory peri-implant health and patient satisfaction.

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Corticobasal implant-supported prostheses are a feasible treatment modality.

Rehabilitation of Patients with Compromised Ridge Support Using Immediately Loaded Corticobasal Implant-supported Prostheses: A Prospective Observational Study

AIM

The aim of this prospective study is to evaluate the treatment outcomes and patient satisfaction following the use of fixed immediately loaded corticobasal implant-supported prostheses.

MATERIALS AND METHODS

One hundred and seventy-four corticobasal implants (basal cortical screw, BCS implant design) were inserted in 20 consecutive patients with compromised ridge support. Implant survival and success were assessed using the James-Misch implant health quality scale and the Albrektsson criteria for implant success. The peri-implant health was evaluated at 1 week and 3, 6, 9, 12, and 18 months postoperatively. Moreover, the radiographic and prosthetic parameters and patient satisfaction were assessed.

RESULTS

The implants showed optimum implant health and a 100% survival rate with none (0%) of the implants failing, mobile, lost, or fractured. Using Wilcoxon signed-rank test, significant decreases in both the modified gingival indexes and the probable pocket depth (PPD) and slight significant increases in the plaque index (PI) at 3, 9, 12, and 18 months and a nonsignificant increase at 6-month follow-up were reported with a range of 0-1. The calculus index (CI) was zero at all follow-up visits. Radiographic evaluations revealed increases in the bone-to-implant contact. Evaluation of the prostheses showed some treatable complications, and all the patients were satisfied.

CONCLUSION

The use of corticobasal implant-supported prosthesis meets the patient's demand for an immediate, fixed treatment modality, with high survival and success rates, optimum peri-implant soft tissue health, and high reported satisfaction.

CLINICAL SIGNIFICANCE

Corticobasal implants can improve the patient's esthetic, phonetic, mastication, and quality of life with the advantage of eliminating the need of bone grafting procedures.

Influence of COVID-19 on lymphocyte and platelet parameters among patients admitted to intensive care unit and emergency

OBJECTIVE

The aim of the study was to detect the effect of COVID-19 on lymphocyte and platelet parameters among Sudanese patients admitted to Intensive Care unit (ICU) and emergency (ER).

PATIENTS AND METHODS

This cross-sectional study was carried out on a total of 787 Sudanese individuals (487 confirmed COVID-19 cases and 300 apparently healthy individuals as controls, in duration between April 2020 to December 2020). Platelets (PLTs) and platelet indices, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT) and platelet larger cell ratio (PLCR) were investigated as part of the complete blood count (CBC) for the case and control group. Also, the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were calculated, and the results were statistically analyzed by SPSS version 21.

RESULTS

The severity of the disease was also affected by the patient's age: 262 COVID-19 cases admitted to ICU were over 50 years old, compared to only four patients in the mild group. Regarding hematological parameters, the absolute lymphocyte count, PLTs, MPV, PDW, and P-LCR were significantly different between cases and control groups (p-values = 0.000, 0.002, 0.000, 0.000, and 0.000, respectively). PLR and NLR levels were found to be significantly higher as disease severity increased; p-values = 0.000 and 0.000, respectively. The study also demonstrated that lymphopenia was associated with severe COVID-19 infection (in 93% of ICU patients, 59.9% of ER, and 9% of the mild group), while thrombocytopenia was detected only among 30.8% of ICU patients.

CONCLUSIONS

Lymphopenia and thrombocytopenia are associated with severe COVID-19 infection. NLR and PLR were markedly increased with COVID-19.

Referral pattern of oral and maxillofacial surgery cases in Sudan: A retrospective age-and sex-specific analysis of 3,478 patients over four years

Oral and maxillofacial surgery (OMFS) is a specialty widening in its scope. An objective analysis of the referral pattern can provide essential information to improve healthcare. This four-year retrospective study was implemented in Khartoum Teaching Dental Hospital. Data (age, sex, diagnosis, and type of treatment) were collected from patient records. Disease frequency, as well as the effect of sex and age, were analyzed for each group. The frequency of treatment types was also assessed. Data were collected from a total of 3,478 patients over the four-year study period. There was a male predominance with the third decade of life being the most common age group. Pathological diseases were the most common (37%) reason for referral, followed by trauma (31%). Temporomandibular joint (TMJ) disorders and dentoalveolar extraction were the least frequently observed. Open reduction and internal fixation (ORIF) was the most commonly performed procedure (28%). These data represent the epidemiology of oral and maxillofacial diseases in Sudan. Given that the third decade of life is the most represented age group, it is beneficial to learn the long-term consequences of these diseases in these young patients and to use modern surgical techniques to improve their lives.

Rehabilitation of an irradiated marginal mandibulectomy patient using immediately loaded basal implant-supported fixed prostheses and hyperbaric oxygen therapy: A 2-year follow-up

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Mandibulectomy after oral cancer resection can cause severe facial disfigurement.

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The use of adjunctive radiotherapy may compromise the success rate of reconstructive implant therapy.

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Hyperbaric oxygen therapy (HBO) can repair tissue damage after radiotherapy.

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Basal implants reduces risk of peri-implantitis and osteoradionecrosis.

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This report describes HBO and basal implant treatment for marginal mandibulectomy.

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HBO and basal implants are successful treatment modalities for these patients.

Introduction

The prosthetic rehabilitation of mandibular defects owing to tumor resection is challenging, especially when the patient has undergone subsequent radiotherapy.

Presentation of case

A 46-year old male presented with a marginal mandibular resection. Following surgery, the patient received adjunctive radiation therapy with a total dose of 70 grays. On clinical examination, the patient presented with severely resorbed edentulous jaws, with an anterior marginal mandibular resection and an obliterated vestibular sulcus. The panoramic radiograph showed a hypocellularity of the maxillary and mandibular bones. A multidisciplinary team was formed, and a treatment plan was formulated which involved the construction of a vestibuloplast stent, and the application of 20 hyperbaric oxygen sessions before implant treatment and 10 more sessions after implant insertion. A total of 16 basal cortical screw implants were inserted to support the fixed prostheses, and a vestibuloplasty was performed to improve esthetics. No complications were observed, and at the 2-year follow-up, the patient presented with excellent peri-implant soft tissue health; increased bone-implant contact; and stable, well-functioning prostheses.

Discussion

The construction of a stable, retentive, well-supported removable prosthesis may be complicated in cases of comprehensive mandibular resection. Basal implants can eliminate the need for bone grafting, and reduce the treatment period required for providing a fixed prosthesis.

Conclusion

To our knowledge this is the first evidence reporting the use of fixed basal implant-supported prostheses in irradiated bone, in conjunction with hyperbaric oxygen therapy. A treatment modality that significantly improves the peri-implant tissue health, and ensures an excellent implant-bone contact.

Prosthetic rehabilitation of maxillary and mandibular gunshot defects with fixed basal implant-supported prostheses: A 5-year follow-up case report

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Oral maxillofacial gunshot wounds have serious aesthetic and functional consequences.

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Rehabilitating mandibular gunshot defects is complicated and requires a long time.

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A multispecialty team is necessary to perform challenging rehabilitation procedures.

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Fixed basal implant-supported prosthesis placement does not require bone grafting.

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This procedure produces excellent aesthetic/functional outcomes and implant stability.

Introduction

Gunshot injuries to the oral maxillofacial region have serious aesthetic and functional consequences.

Presentation of case

A 32-year-old male patient presented with a marginal mandibular resection owing to a gunshot wound. A clinical examination revealed destroyed crowns in teeth 12, 11, and 21; extraction in teeth 13, 22, 24, 31, 32-45; a fracture in tooth 38; and severe pain. Further, he had multiple submental scars and a completely obliterated sulcus. Consequently, a multidisciplinary team was formed who devised the following treatment plan: stage 1, root canal treatment for the maxillary anterior teeth, followed by crown construction and transitional mandibular removable partial denture construction, and stage 2, placement of immediately loaded basal implant definitive prostheses supported by 6 corticobasal screw implants. After 5 years of use, the patient presented with excellent peri-implant soft tissue health, prosthesis stability, and great improvements in aesthetics and function. The patient was highly satisfied with the treatment and restoration of his quality of life.

Discussion

Accurate treatment planning is vital for managing complicated cases, including gunshot defect cases, and should involve the selection of the most suitable reconstructive technique with lower susceptible complication rates and high success rates. The described treatment eliminates the need for bone grafting, reduces treatment duration, and involves fixed prosthesis placement.

Conclusion

To our knowledge, this is the first report on basal implant-based full-mouth rehabilitation in a gunshot mandibular defect patient. The fixed hybrid basal implant-supported prosthesis produced highly acceptable aesthetic and phonetic results and greatly improved the patient’s life.

A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE)

We established a national audit to assess the thromboprophylaxis rate for venous thromoembolism (VTE) in at risk medical patients in acute hospitals in the Republic of Ireland and to determine whether the use of stickers to alert physicians regarding thromboprophylaxis would double the rate prophylaxis in a follow-up audit. 651 acute medical admission patients in the first audit and 524 in the second re-audit were recruited. The mean age was 66.5 yrs with similar numbers of male and female patients and 265 (22.6%) patients were active smokers. The first and second audits identified 549 (84%) and 487 (93%) of patients at-risk for VTE respectively. Of the at-risk patients, 163 (29.7%) and 132 (27.1%) received LMWH in the first and second audit respectively. Mechanical thromboprophylaxis was instigated in 75 (13.6%) patients in the first and 86 (17.7%) patients in the second audit. The placement of stickers in patient charts didn't produce a significant increase in the number of at risk patients treated in the second audit. There is unacceptably low adherence to the ACCP guidelines in Ireland and more complex intervention than chart reminders are required to improve compliance.

Hyperprolactinaemia: analysis of presentation, diagnosis and treatment in the endocrine service of a general hospital

The charts of 184 patients with clinically significant hyperprolactinaemia who presented to a teaching hospital between 1978-1995 were reviewed, 158 (86%) females and 26 (14%) males. Hyperprolactinaemia was due to a microadenoma or was idiopathic in 36.4%, drug induced in 16%, associated with a macroadenoma in 12%, due to epilepsy in 7%, with other causes each contributing 5% or less. The presenting symptoms were amenorrhoea in 64%, galactorrhoea in 40.5%, infertility in 15%, visual field defect in 9%, with impotence in 30% and, gynaecomastia in 8% of men. One hundred and one patients were treated with bromocriptine (80%), surgery (35.4%) and radiotherapy (10.7%). Twenty-five percent of patients developed side-effects of bromocriptine for which cabergoline, a new long-lasting dopaminergic agonist, was successfully substituted. Presenting features responded to drug treatment in 70-80% of patients.

Palatal ulceration: a complication of regional anesthesia of the oral cavity - a case report

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Enzymic and immunochemical properties of lysozyme. X. Conformation, enzymic activity and immunochemistry of lysozyme reduced at two carboxyl groups

Reduction of lysozyme by diborane, followed by air oxidation of the reduced disulfides and chromatography on CM-cellulose, yielded a homogeneous derivative. In the derivative, the carboxyl groups of aspartic acid 119 and the end-chain leucine residue were reduced to their corresponding alcohols. Correct re-forming of the disulfide bonds was demonstrated by peptide mapping of the tryptic hydrolysates of the derivative and lysozyme without breaking the disulfide bonds, followed by identification of the disulfide-containing peptides. Correct disulfide pairing in the two-disulfide peptide in the tryptic hydrolysate was established from its immunochemical behavior. Preparations of the two-disulfide fragment from lysozyme and derivative had equal inhibitory activities (26 or 32%) of the reaction of lysozyme with two homologous antisera. In ORD measurements, lysozyme and the derivative had equal rotatory powers at neutral pH. However, the bo value for the derivative decreased by about 10%. Below pH 6.4 and above pH 8.0, the derivative was less rotatory than native lysozyme. In CD measurements at neutral pH, the negative ellipticity bands at 220 and 208 nm showed little or no decrease in the derivative relative to the native protein. Although conformational differences between the derivative and its parent protein were almost undetectable by ORD and CD measurements, they were readily detected by chemical monitoring of the conformation. In the derivative, both accessibility to tryptic hydrolysis and reducibility of the disulfide bonds increased markedly. The enzymic activity of the derivative was decreased but retained the same pH optimum. With antisera to lysozyme or antisera to the derivative, lysozyme and its derivative possessed equal antigenic reactivities. The immunochemical findings further confirm the correct refolding of the disulfides. Also, they indicate that aspartic acid 119 and the C-terminal leucine residue are not part of an antigenic reactive region in lysozyme.