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Objectives The aims of this study were (1) to assess the accuracy of estimated fetal weight (EFW) in twins and (2) to assess the accuracy of sonographic examination to predict birth weight discordance (BWD). Methods We retrospectively analyzed collected data on twin pregnancies between 2004 and 2007. All twin pregnancies with at least one ultrasound (US) examination within 15 days of delivery were included in this study. EFW was calculated according to Hadlock1, Hadlock2, Ong, Shepard and Warsof formulas. Mean and SD of the standardized errors and percentage of newborns with birth weight (BW) within 10% of EFW were calculated. Results Two hundred eighty-three twin pregnancies were included. Mean and SD (%) of the standardized errors were 1.54 ± 12.19, 0.19 ± 11.87, 10.93 ± 15.55, − 1.91 ± 14.93 and 5.37 ± 14.91 for Hadlock1, Hadlock2, Shepard, Ong and Warsof formulas, respectively. Hadlock2's formula allowed for the highest proportion of newborns with BW within 10% of EFW and it also performed best to predict discordance of more than 25% as assessed by area under the ROC curve. Conclusions Sonographic prediction of inter-twin BWD within 15 days of delivery seems to be accurate enough for routine clinical use. Performance and predictive values depend on the threshold chosen to define EFW and BW discordance. Copyright © 2010 John Wiley & Sons, Ltd.

Summary The histogenesis of jaw myxoma is still debated. According to some authors it arises from the primitive mesenchymal components of developing teeth. In this study, we have studied the expression of 5-100 protein and vimentin in dental follicle, dental papilla and periodontal ligament cells using monoclonal and polyclonal antibodies. Myxoma of the law expresses vimentin and S-100 protein. On the contrary, as compared to jaw myxoma, the normal developmental structures were immunonegative for S-100 protein but stained for vimentin. These results could indicate a difference in the derivation other than tooth mesenchyma.

Objective To evaluate the impact of a 5-mm error in the measurement of crown–rump length (CRL) in a woman undergoing ultrasound and biochemistry sequential combined screening for Down syndrome. Methods Based on existing risk calculation algorithms, we simulated the case of a 35-year-old-woman undergoing combined screening based on nuchal translucency (NT) measurement and early second-trimester maternal serum markers (human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) expressed as multiples of the median (MoM)). Two measurement errors were considered (+ or − 5 mm), for four different CRLs (50, 60, 70 and 80 mm), with five different NT measurements (1, 1.5, 2, 2.5 and 3 mm) in a patient undergoing biochemistry testing at 14 + 4, 15, 16, 17 or 18 weeks' gestation. Four different values for each maternal serum marker were tested (1, 1.5, 2 and 2.5 MoM for hCG, and 0.5, 0.8, 1 and 1.5 MoM for AFP), leading to a total of 3200 simulations of the impact of measurement error. In all cases the ratio between the risk as assessed with or without the measurement error was calculated (measurement error-related risk ratio (MERR)). Results Over 3200 simulated cases, MERR ranged from 0.53 to 2.14. In 586 simulations (18.3%), it was 1.33. Based on a risk cut-off of 1/300, women would have been misclassified in 112 simulations (3.5%). This would go up to 33 (27.5%) out of the 120 simulations in women with ‘borderline’ risk, with 1.5 MoM for hCG and 0.5 MoM for AFP, and NT measurement of 1 or 2mm. Conclusion Down syndrome screening may be highly sensitive to measurement errors in CRL. Quality control of CRL measurement should be performed together with quality control of NT measurement in order to provide the highest standard of care. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Objective: In a prospective pilot study, short � 10mm ITI-SLA implants were placed in the resorbed posterior maxilla by means of an osteotome sinus floor elevation (OSFE) procedure without grafting material. This paper presents 3-year data assessing bone-level changes around implants. Material and methods: Twenty-five implants were placed in 17 patients to rehabilitate 16 molar and nine premolar sites. The mean residual bone height (RBH) was 5.4 � 2.3mm. A healing period of 3‐4 months was allowed before abutment tightening. Most implants (21/ 25) were 10mm long, and the others were 8 and 6mm long. At the 3-year control, endosinus bone gain, implant length protruding into the sinus and crestal bone loss (CBL) were measured on periapical radiographs. Results: All implants fulfilled the survival criteria. Despite the absence of grafting material, implants were embedded into newly formed bone tissue. All implants gained endo-sinus bone; the mean gained bone was 3.1 � 1.5mm. The residual protrusion length decreased from 4.9 � 2.1 to 1.8 � 2.1mm. CBL was 0.9 � 0.8mm. Conclusions: This study confirms that the OSFE procedure without grafting material is sufficient to create bone beyond the natural limit of the sinus. On the mid-term of 3 years, the technique was found to be predictable in the posterior maxilla when the RBH is limited. Implants gained endo-sinus bone despite the lack of grafting material. Bone gain was still improving over the first-year control. No shrinkage of the augmented area was observed. Poor residual bone height (RBH) in the posterior maxilla beneath the sinus is still ac hallenge for the oral implantologist. To recreate a sufficient volume of bone, var

The purpose of this study was to evaluate the success rate of the SERF EVL evolution implants (Décines, France) through a 5-year longitudinal multicentric study. Patients from 3 clinicians working in 3 different private practices (Grenoble, Nice, and Paris) and familiar with this implant system were included in this study; 413 patients and 1198 implants were followed over 5 years. The implant sites and implant types were recorded at the time of placement. The patients were followed yearly and controlled at the end of the study. The criterion for treatment evaluation or success was a qualitative variable related to 4 possible treatment outcomes: success, failure, ailing, and lost (dropout patients). Different variables (sex, bone quantity and quality at the implant site, location) were submitted to the chi-square test. A survival curve was established over 5 years according to the Kaplan Meyer method. The clinical follow-up was 3.1 +/- 1.2 years (ie, 1 to 6 years). At the end of this follow-up period, 1163 implants were classified as successful, 19 as failures, 12 as ailing, and 4 as lost (dropout). This implant system thus presented an overall success rate of 97.08%, over 5 years, independent of implant location, and for patient indications commonly encountered in private practice.

The aim of this study was to compare direct and indirect costs of single-dose methotrexate and laparoscopy in the treatment of unruptured ectopic pregnancy. We conducted a prospective study between 1 January 1995 and 31 May 1997 and recorded costs accrued from outpatient and inpatient treatment with methotrexate (group I) and laparoscopy (group II). We used the French National Social Security nomenclature as reference for the different costs. Indirect costs were estimated from national demographic data. 39 patients were included in group I and 38 in group II. Single-dose methotrexate was the most economic management of unruptured tubal pregnancy ($US1436 per case vs $US3170 per case for laparoscopy) since it reduced the total cost by approximately 50%. This was due to a dramatic reduction in charges related to hospitalisation and the operating room. Indirect costs were also reduced, mainly as a result of a shorter recovery time ($US237 vs $US475). However, there was no further evidence of any cost effectiveness of methotrexate therapy when hospitalisation was required. In conclusion, single-dose methotrexate appeared to be the most economic approach for the treatment of unruptured ectopic pregnancy. Selection of cases is mandatory to guarantee a cost savings for the treatment of unruptured ectopic pregnancy.

OBJECTIVES: Various imaging techniques, including conventional radiography and computed tomography, are proposed to localize the mandibular canal prior to implant surgery. The aim of this study is to determine the incidence of altered mental nerve sensation after implant placement in the posterior segment of the mandible when a panoramic radiograph is the only preoperative imaging technique used. MATERIAL AND METHODS: The study included 1527 partially and totally edentulous patients who had consecutively received 2584 implants in the posterior segment of the mandible. Preoperative bone height was evaluated from the top of the alveolar crest to the superior border of the mandibular canal on a standard panoramic radiograph. A graduated implant scale from the implant manufacturer was used and 2 mm were subtracted as a safety margin to determine the length of the implant to be inserted. RESULTS: No permanent sensory disturbances of the inferior alveolar nerve were observed. There were two cases of postoperative paresthesia, representing 2/2584 (0.08%) of implants inserted in the posterior segment of the mandible or 2/1527 (0.13%) of patients. These sensory disturbances were minor, lasted for 3 and 6 weeks and resolved spontaneously. CONCLUSIONS: Panoramic examination can be considered a safe preoperative evaluation procedure for routine posterior mandibular implant placement. Panoramic radiography is a quick, simple, low-cost and low-dose presurgical diagnostic tool. When a safety margin of at least 2 mm above the mandibular canal is respected, panoramic radiography appears to be sufficient to evaluate available bone height prior to insertion of posterior mandibular implants; cross-sectional imaging techniques may not be necessary.

This study investigates the pre- and posttreatment morphology of the mucosa around immediately loaded implants in the edentulous maxilla.Implants were placed and immediately loaded in edentulous maxillae; pre- and posttreatment impressions were obtained. The resulting casts were digitalized into 3-dimensional images, and the pre- and posttreatment images were superimposed. The width and height of the maxillary alveolar process were measured at central and interproximal implant sites in a vertical section of the superimposed holograms. For statistical analysis, the Delta value (d) was defined as the difference between the pre- and posttreatment images for all measurements.Sixty-seven Straumann implants placed in 9 patients and immediately restored with provisional fixed restorations were analyzed. An increase in width at all measurement sites was observed after treatment. Width increased for both central implant (1.51 +/- 1.16 mm, P.001) and interproximal implant sections (1.02 +/- 1.21 mm, P.001). Mean d for height was found to be decreased at central implant sites (-1.21 +/- 1.67 mm, P = .012) and at interproximal sections (-0.72 +/- 1.68 mm, P = .098).Clinically, it has been observed that the placement of an immediate provisional affects the peri-implant tissue morphology according to its emergence profile. The result after treatment was a wider contour of the peri-implant soft tissue, located in a more apical position than the original mucosal level. The most coronal part of the papilla-like mucosa at interproximal sites would be nearest to the original mucosal level before treatment. The scalloped mucosal configuration obtained was consistent along the rehabilitated arch. Statistically significant dimensional changes of the peri-implant mucosa were observed with an immediate loading approach.

OBJECTIVES: To compare the clinical outcomes of standard, cylindrical, screw-shaped to novel tapered, transmucosal (Straumann Dental implants immediately placed into extraction sockets. Material and methods: In this randomized-controlled clinical trial, outcomes were evaluated over a 3-year observation period. This report deals with the need for bone augmentation, healing events, implant stability and patient-centred outcomes up to 3 months only. Nine centres contributed a total of 208 immediate implant placements. All surgical and post-surgical procedures and the evaluation parameters were discussed with representatives of all centres during a calibration meeting. Following careful luxation of the designated tooth, allocation of the devices was randomly performed by a central study registrar. The allocated SLA titanium implant was installed at the bottom or in the palatal wall of the extraction socket until primary stability was reached. If the extraction socket was >or=1 mm larger than the implant, guided bone regeneration was performed simultaneously (Bio Oss and BioGide. The flaps were then sutured. During non-submerged transmucosal healing, everything was done to prevent infection. At surgery, the need for augmentation and the degree of wound closure was verified. Implant stability was assessed clinically and by means of resonance frequency analysis (RFA) at surgery and after 3 months. Wound healing was evaluated after 1, 2, 6 and 12 weeks post-operatively. RESULTS: The demographic data did not show any differences between the patients receiving either standard cylindrical or tapered implants. All implants yielded uneventful healing with 15% wound dehiscences after 1 week. After 2 weeks, 93%, after 6 weeks 96%, and after 12 weeks 100% of the flaps were closed. Ninety percent of both implant designs required bone augmentation. Immediately after implantation, RFA values were 55.8 and 56.7 and at 3 months 59.4 and 61.1 for cylindrical and tapered implants, respectively. Patient-centred outcomes did not differ between the two implant designs. However, a clear preference of the surgeon's perception for the appropriateness of the novel-tapered implant was evident. CONCLUSIONS: This RCT has demonstrated that tapered or standard cylindrical implants yielded clinically equivalent short-term outcomes after immediate implant placement into the extraction socket.

Objective This study was undertaken to correlate selectivity of surgery and perinatal outcome in twin-to-twin transfusion syndrome treated by endoscopic laser coagulation, using a quantitative definition of selectivity. Study Design 287 consecutive cases of severe twin-to-twin transfusion syndrome were reviewed. A selectivity index was built as the ratio of selective over nonselective coagulations per procedure. Outcome measures were survival at 28 days and failure of surgery as defined by recurrence of twin-to-twin transfusion syndrome or fetofetal hemorrhage. Results Two populations were identified: a high selectivity group (63.8%) and a low selectivity group (36.2%). Survival of at least one twin and survival of both twins were higher in the high-selectivity group (p = .007 and p = .04 respectively). Failure of surgery rates were similar in both groups. Conclusion A quantitative definition of selectivity appears justified by the large variations found in the practice of a single center and by significant differences in outcome. Survival is significantly improved in highly selective procedures.

Frequently, a fetal genetic abnormality is discovered when the family history leads a fetal medicine specialist to attempt prenatal diagnosis by the identification of particular fetal features or performance of a test requiring an invasive procedure. But the reverse scenario also is possible, in which recognition of disease in the fetus results in the same diagnosis being made in a parent with few or no symptoms, or in relatives who were previously unaware of the problem. An example is the finding of hyperechogenic kidneys in a mid-trimester fetus, which prompts scanning of the parents' kidneys to detect polycystic kidney disease. The authors report 20 such families, seen in the years 1999-2004, in which recognition of a fetal anomaly led to the diagnosis of an asymptomatic parent. In each instance, ultrasound studies demonstrated one or more structural fetal abnormalities. Anomalies found in more than one fetus included cleft lip and palate, cardiac anomalies, nuchal anomalies, micromelia, polydactyly, and bilateral club foot associated with polyhydramnios, akinesia, or camptodactyly. The mean gestational age when the fetal anomaly was diagnosed was 21.2 weeks, and at the time of genetic counseling, 23.4 weeks. Genetic counseling helped to diagnose nine maternal diseases, the commonest being myotonic dystrophy. Eleven paternal diseases were found; the only one diagnosed more than once was osteogenesis imperfecta. In no case did the parents know that they might transmit a genetic disease to their children. None of the couples were consanguineous. In all cases, a family history and clinical examination led to precise diagnosis of the fetal anomaly and disclosed the familial origin of the genetic disease. Twelve individuals had, at the most, minor clinical symptoms. Six had had a defect repaired in infancy and were doing well. Four others had unspecified disease that had not been investigated. Thirteen couples chose to continue the pregnancy; there was one intrauterine fetal death and one preterm birth. The other seven couples wished to terminate the pregnancy because they faced the possibility of the fetus having a more severe form of the disease. Without exception, the diagnosis suspected before birth was confirmed afterward. Prenatal diagnosis of a fetal anomaly may be the first clue that a familial disorder may be present, and can disclose familial disease that has not previously been recognized in one of the parents. Future pregnancies as well as the current gestation should be considered when the parents are counseled and a decision is made regarding whether to continue or end the pregnancy.

Objective The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI-SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material. Material and methods Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4+/-2.3 mm; it was 5.7+/-2.6 mm on the mesial side and 5.1+/-1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3-4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1-year control was calculated. The endo-sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured. Results Abutments were tightened after 3.1+/-0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1-year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo-sinus bone gain; the mean gain was 2.5+/-1.2 mm. The mean CBL was 1.2+/-0.7 mm. Endo-sinus bone gain and RBH showed a strong negative correlation (r=-0.78 on the mesial side and -0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo-sinus bone gain. Conclusion Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1-year control.

The aim of this project was to evaluate the potential of bone formation by the distraction of periosteum. Distraction of calvarial bone in 12 rabbits at 0.25 mm a day caused formation of bone in 3 animals, and distraction at 0.5 mm a day caused formation of bone in 2. A second trial of alveolar distraction in four dogs using a specifically-designed distraction device showed lack of stability of the device.

Objective. To describe ultrasound characteristics of adnexal malignancies, i.e., borderline ovarian tumors, primary invasive ovarian epithelial cancer stage 1, primary invasive ovarian epithelial cancer stages 2–4, rare types of malignancy, and metastatic tumors. Methods. In a prospective international study involving nine European ultrasound centers, 1066 women with a pelvic mass judged to be of adnexal origin underwent transvaginal gray scale and color Doppler ultrasound examination by a skilled examiner before surgery. A standardized examination technique and predefined definitions of ultrasound characteristics were used. Results. Of 1066 masses, 266 were malignant and are included: 55 ovarian borderline tumors, 144 primary invasive epithelial ovarian cancers (42 stage 1, 102 stages 2–4), 25 rare malignancies, and 42 metastatic tumors. Most (56%) metastatic tumors and most (60%) rare types of tumor were solid and richly vascularized at color Doppler ultrasound examination (on a scale ranging from 1 to 4, color score based on subjective evaluation was 3 or 4 in 88% and 86%, respectively). Borderline ovarian tumors and stage 1 primary invasive ovarian epithelial cancers differed from stages 2–4 primary invasive ovarian epithelial cancers: they were larger (median volume 375 ml and 695 ml vs. 209 ml; P = 0.0213 and 0.0001), a larger proportion contained papillary projections (64% and 67% vs. 41%; P = 0.0072 and 0.0054), they were more often multilocular cysts without solid components (18% and 14% vs. 2%; P < 0.0017 and 0.0204), but they were less often purely solid (5% and 7% vs. 38%; P ≤ 0.0001 and 0.0005). With increasing degree of invasiveness – from borderline epithelial ovarian tumors via stage 1 invasive epithelial ovarian tumors to stages 2–4 invasive epithelial ovarian tumors – ascites became more common (9% vs. 31% vs. 61%; P = 0.0082, Conclusion. Papillary projections are characteristic of borderline tumors and stage 1 primary invasive epithelial ovarian cancer. A small proportion of solid tissue at ultrasound examination makes a malignant mass more likely to be a borderline tumor or a stage 1 epithelial ovarian cancer than an advanced ovarian cancer, a metastasis, or a rare type of tumor.

Traiter une infection bacterienne implique evidemment de pouvoir determiner quels seront les antibiotiques efficaces. C'est le role de l'antibiogramme. Son automatisation permet de simplifier et de normaliser les procedures techniques. Parallelement, la detection des genes impliques dans la resistance renforce l'arsenal de lutte.

Objective Recent studies have reported the efficacy of first-trimester combined screening for Down syndrome based on maternal age, serum markers (human chorionic gonadotropin, pregnancy-associated plasma protein A), and ultrasound measurement of fetal nuchal translucency. However, those do not incorporate the value of the widely accepted routine 20-22 weeks’ anomaly scan. Study design We carried out a multicenter, interventional study in the unselected population of a single health authority in order to assess the performance of first-trimester combined screening, followed by routine second trimester ultrasound examination and/or screening by maternal serum markers (free β-hCG and alpha-fetoprotein measurement or total hCG, alpha-fetoprotein, and unconjugated estriol measurement) when incidentally performed. Detection and screen positive rates were estimated using a correction method for nonverified issues. A cost analysis was also performed. Results During the study period, 14,934 women were included. Fifty-one cases of Down syndrome were observed, giving a prevalence of 3.4 per 1000 pregnancies. Of these, 46 were diagnosed through first (n = 41) or second (n = 5) trimester screening. Among the 5 screen-negative Down syndrome cases, all were diagnosed postnatally after an uneventful pregnancy. Detection and screen positive rates of first-trimester combined screening were 79.6% and 2.7%, respectively. These features reached 89.7%, and 4.2%, respectively, when combined with second-trimester ultrasound screening. The average cost of the full screening procedure was 108 € ($120) per woman and the cost per diagnosed Down syndrome pregnancy was 7,118 € ($7909). Conclusion Our findings suggest that 1 pragmatic interventional 2-step approach using first-trimester combined screening followed by second-trimester detailed ultrasound examination is a suitable and acceptable option for Down syndrome screening in pregnancy.

To determine whether growth velocity parameters derived from routine prenatal ultrasound measurements at first, second and third trimester can identify normal growth at term as well as late-onset growth abnormalities.Longitudinal study of fetal growth in normal singleton pregnancies with three normal ultrasound examinations and delivered at term. Fetuses were classified into 3 groups (10th percentile, 10-90th percentile,90th percentile) based on birth weight. Multiple regression on birth weight classification was used to build up a prediction equation of fetal growth potential (FGP) based on fetal biometry and fetal growth velocity parameters between ultrasound examinations. Best cut-off value for FGP predicting growth restriction and macrosomia were defined.356 pregnancies were included. Fetal biometry growth velocities between examinations were calculated for all measurements. Using best cut-off values, the estimated sensitivity, specificity and odds ratio were: 60% [44;74], 91% [89;92] and 14.55 [6.30;33.98] and 53% [36;69], 89% [88;91] and 10 [4.27;23.49] for the prediction of growth restriction and macrosomia, respectively.Fetal growth potential can be derived and calculated from standard ultrasound measurements. It can improve identification of these fetuses at risk for late-onset growth abnormalities and their related morbidity.

Objective Intrauterine growth restriction in triploidy has been reported as early as in the first trimester. This study was undertaken to evaluate the ability of first-trimester crown rump length (CRL)-based charts to detect triploid fetuses. Material and Methods Analysis of fetal biometry in cases of triploidy diagnosed in the first trimester over the last three years. Biometry for abdominal circumference (AC), head circumference (HC) and biparietal diameter (BPD) was analyzed in relation to both gestational age (GA)-based charts and to CRL-based charts. Results Five cases of fetal triploidy were diagnosed at 11 to 14 weeks. Screening based on nuchal translucency (NT) and maternal age showed a risk > 1/300 in only one of the 5 cases of triploid fetus. In all of these five cases, CRL-based biometry was grossly abnormal, although it was abnormal in only two of these five cases in relation to GA-based charts. Conclusion First-trimester CRL-based biometry charts seem to reflect early asymmetrical growth delay in triploidy more accurately than GA-based charts. CRL-based biometry is likely to improve the early detection of triploid pregnancies without leading to dating error. Copyright © 2005 John Wiley & Sons, Ltd.

This article aims to: (1) describe the treatment of three consecutive completely edentulous patients with fixed implant-supported restorations, including simultaneous same-day immediate loading with fixed provisional restorations in both jaws; and (2) illustrate a step-by-step definitive restoration approach. All patients followed the same diagnostic protocol. One surgical intervention was performed for simultaneous implant placement in both maxilla and mandible. Following implant placement, all patients received a simultaneous, same-day, complete-arch, screw-retained provisional restoration in both jaws according to the "pickup" technique. After healing, final impressions were taken, and occlusion recorder devices were prepared on working casts. For the first occlusal record, the "half-provisionals" method was used. Definitive solid abutments were used for both laboratory and clinical procedures. After casting and finishing, the frameworks were tried in, and a new occlusal record was made. The definitive segmented restorations consisted of four fixed partial dentures in the maxilla and three in the mandible and were cemented with provisional cement. All patients received a nightguard. The pickup technique facilitated simultaneous immediate loading in both maxilla and mandible. A complete, fixed, segmented rehabilitation supported by six to eight anteroposterior implants is a reproducible treatment for completely edentulous patients when optimal anatomic conditions are present.

The purpose of the present clinical study was (1) to evaluate the Osstell as a diagnostic tool capable of differentiating between stable and mobile ITI implants, (2) to evaluate a cut-off threshold implant stability quotient (ISQ) value obtained at implant placement (ISQitv) that might be predictive of osseointegration, (3) to compare the predictive ISQitv of immediately loaded (IL) implants and implants loaded after 3 months (DL). Two patient groups were enrolled, 18 patients received 63 IL implants and 18 patients were treated with 43 DL implants. The ISQ was recorded at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. All implants passed the 1-year loading control. Two implants failed, one DL implant with ISQ at placement (ISQi) of 48 and one IL implant with ISQi of 53. The resonance-frequency analysis (RFA) method was not a reliable diagnostic tool to identify mobile implants. However, implant stability could be reliably determined for implants displaying an ISQor =47. After 1 year of loading, all DL implants with an ISQior =49 and all IL implants with an ISQior =54 achieved and maintained osseointegration. By the end of 3 months, implants with ISQi60 had an increase of stability. Implants with ISQi 60-69 had their stability decrease during 8 weeks before returning to their initial values. Implants with ISQ69 had their stability decrease during the first 4 weeks before remaining stable. Although preliminary, these data might orient the practitioner to choose among various loading protocols and to selectively monitor implants during the healing phase.

The purpose of the present study was (1) to measure the primary stability of ITI implants placed in both jaws and determine the factors that affect the implant stability quotient (ISQ) determined by the resonance frequency method and (2) to monitor implant stability during the first 3 months of healing and evaluate any difference between immediately loaded (IL) implants and standard delayed loaded (DL) implants. The IL and DL groups consisted of 18 patients/63 implants and 18 patients/43 implants. IL implants were loaded after 2 days; DL implants were left to heal according to the one-stage procedure. The ISQ was recorded with an Osstell apparatus (Integration Diagnostics AB, Gothenburg, Sweden) at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. Primary stability was affected by the jaw and the bone type. The ISQ was higher in the mandible (59.8+/-6.7) than the maxilla (55.0+/-6.8). The ISQ was significantly higher in type I bone (62.8+/-7.2) than in type III bone (56.0+/-7.8). The implant position, implant length, implant diameter and implant deepening (esthetic plus implants) did not affect primary stability. After 3 months, the gain in stability was higher in the mandible than in the maxilla. The influence of bone type was leveled off and bone quality did not affect implant stability. The resonance-frequency analysis method did not reveal any difference in implant stability between the IL and DL implants over the healing period. Implant stability remained constant or increased slightly during the first 4-6 weeks and then increased more markedly. One DL and IL implant failed; both were 8 mm long placed in type III bone. At the 1-year control, the survival rate of the IL and the DL implants was 98.4% and 97.7%, respectively. This study showed no difference in implant stability between the IL and DL procedures over the first 3 months. IL short-span bridges placed in the posterior region and full arch rehabilitation of the maxilla with ITI sandblasted-and-etched implants were highly predictable.

This article describes (a) an immediate loading technique in the treatment of edentulous arches with screw-retained provisional restorations and (b) the effort to determine whether the described technique is compatible with the predictable achievement of osseointegration.Eight patients with either 1 or 2 edentulous arches were treated. A diagnostic tooth arrangement was carried out for each patient and was then duplicated twice to fabricate a provisional template and a surgical guide. Six to 10 solid-screw ITI implants were placed around the dental arch to reach the first molar regions. On the same day, all patients received splinted metal-free screw-retained provisional restorations according to the pickup technique. The provisional prostheses were retrieved every 2 weeks during the healing phase.Seventy-eight implants were placed in 11 edentulous arches. Two implants were not immediately loaded because of inadequate primary stability. In an 8- to 20-month follow-up period (mean 14 months), two 8-mm implants were lost after 5 weeks of functional loading, resulting in an overall survival rate of 97.4%. All implants were assessed by resonance frequency analysis. After 4 months of functional loading, the mean implant stability quotient was 60+/-4.1 units (range 51 to 72 ISQ units) for maxillary implants and 65+/-6.5 units (range 47 to 74 ISQ units) for mandibular implants.The immediate loading of implants placed in edentulous arches with screw-retained 1-piece (cross-arch) provisional restorations does not appear to jeopardize the achievement of osseointegration. Neither the metal-free design of the provisional prostheses nor the removal of the provisional prostheses during the healing phase adversely affected osseointegration. The pickup technique for immediate provisionalization represents a reproducible treatment option.

This paper reports on a 7-year life table analysis on ITI titanium plasma-sprayed (TPS) and sandblasted and etched (SLA) implants placed in a private practice and loaded for at least 1 year. In 236 patients, 528 (264 TPS and 264 SLA) implants were placed, 351 (66.5%) implants rehabilitated the posterior region and 71.1% implants wereor =11 mm. In the posterior mandible and maxilla, the mean implant length was 9.90 and 9.74 mm respectively. Implant length was determined through standard radiographs only. Increase of the number of implants or reduction of the width or length of the rehabilitations was no specifically sought for the shorter implants. One hundred and twenty-two SLA implants were loaded within 63 days. All early loaded SLA implants resisted the applied 35 N cm without rotation or pain. Three implants failed, one early and two late failures, all were SLA implants placed in the mandible. Shorter implants did not fail more than longer ones. The cumulative success rate was 99.40%. The predictable use of short implants supporting single crowns and small fixed partial dentures of 2-4 units supported by two to three implants permitted (1) restricting the need for sophisticated and expensive presurgical procedures aimed to determine precisely the available bone height by computerized radiographic methods, (2) the placement of prosthetically driven restoration instead os surgically driven ones, (3) reducing the indications span for complex invasive procedures like sinus lift and bon grafting procedures, (4) facilitating the surgery, without attempting to place the longest implant and (5) avoiding the occurrence of sensation disturbance. The safe use of short implants in a private practice should make implant therapy simpler and accessible to a higher number of patients and practitioners.

This study evaluated the dimensions and characteristics of the cementoenamel junction (CEJ) of maxillary anterior teeth; the natural CEJ was compared to current implant design and used for design optimization. Standardized digital images of 137 extracted human teeth (45 central incisors, 46 lateral incisors, and 46 canines) were used to measure cervical dimensions, CEJ curvature, and distance from zenith of CEJ to interdental contact on proximal views. The x- and y-coordinates of the CEJ contour were digitized before mathematic processing to allow the representation of a single average curve for buccal, palatal, mesial, and distal surfaces for each tooth type. These measurements were combined to existing data related to dentogingival and "implantomucosal" junction to extrapolate specific biologic landmarks around teeth and implants. Mean cervical dimensions, distance from zenith of CEJ to interdental contact, and CEJ curvature were compared. Cervical dimensions significantly differed, with a more symmetric cervical cross-section for central incisors, slightly more rectangular shape for lateral incisors, and distinctly rectangular shape for canines. CEJ curvature was statistically different between all tooth groups (centralslateralscanines); within groups, curvature value was always superior at the mesial aspect compared to distally (3.46 mm vs 3.13 mm for centrals, 2.97 mm vs 2.38 mm for laterals, and 2.55 mm vs 1.60 mm for canines). Tooth-implant biologic width discrepancies ranged from 4.10 to 5.96 mm and were different between all groups of teeth (centralslateralscanines); within groups, the discrepancy was always superior at the mesial aspect compared to distally. Current implant design featuring a flat, rotation-symmetric shoulder should be reconsidered in view of natural CEJ contour to improve biologic considerations and related esthetics.

The SLA (sandblasted with large grit and acid etched) surface is a textured surface that has been documented to lead to a rapid and strong implant fixation. The purpose of the present study was to determine the contribution of sandblasting in addition to etching to implant anchorage. It was also aimed to determine if the pits carved during etching alone have a bone-interlocking capacity that leads to microanchorage between the implant and bone. SLA implants and machined-and-acid-etched (MA) implants were placed in the maxilla of Land Race pigs. After 10 weeks of healing, they were reverse torqued. The reverse torque of the SLA and MA implants was 157.29 ± 38.04 N cm and 105.33 ± 25.12 N cm, respectively. Sandblasting increased bone anchorage by 49.3%; the difference was statistically significant (p = .028). Bone was found attached to both surfaces; bone ingrowth was found in the pits of both surfaces. It is suggested that the two surfaces are able to generate bone interlocking and mechanical coupling at the interface. When finite-element modeling is performed with these surfaces, it is suggested that the bound mode be used instead of the slip mode. © 2003 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 68B: 149–159, 2004

The anchorage of machined Brånemark and ITI TPS-coated implants of various lengths was investigated in an animal model. Brånemark fixtures 7 and 10 mm long and ITI implants 6 and 10 mm long were inserted in the mandible of dogs and were reverse-torqued after 3 months of healing. The failing mode was different for the two implant systems. For the ITI implants, loosening coincided with the peak reverse-torque values. For the Brånemark fixtures, two reverse-torque values were identified and recorded, a 'start to rotate' and a peak value. The 'start to rotate' values for the 7 and 10 mm Brånemark fixtures were 36.67 and 38.57 Ncm, respectively, the peak values were 61.88 and 69.13 Ncm. The increase in implant length from 7 to 10 mm did not significantly improve the anchorage. The mean reverse-torque values for the 6- and 10-mm ITI implants were 104.66 and 192.25 Ncm, respectively; the difference was statistically significant. The mean removal torque of the 6-mm ITI implant was higher than the 7- and 10-mm Brånemark implants. It is suggested that the distinct anchorage magnitude and the distinct loosening patterns registered for both implant systems might be related to the various surface states. The latter might account for the different failure tendencies mentioned in the literature for short Brånemark and ITI implants.

Several bioabsorbable collagen membranes are either currently available or under investigation for use in guided tissue regeneration (GTR) procedures. The aim of this 12-month reentry study was to evaluate a diphenylphosphorylazide (DPPA)-cross-linked bovine type I collagen membrane in the healing of mandibular Class II furcation defects. The DPPA technique prevents the inclusion of foreign cytotoxic cross-linking substances in the reticulated molecules, thus providing a more biocompatible product.Forty non-smoking periodontally compromised adult subjects volunteered for this study, and one defect was randomly selected in each patient. At baseline, plaque index (PI), gingival index (GI), probing depth (PD), gingival margin location (GML), clinical attachment level (CAL), and width of the attached gingiva (AG) were measured. Intrasurgical hard tissue measurements consisted of the vertical open probing attachment level (V-OPAL) and horizontal open probing attachment level (H-OPAL), as well as furcation entrance width (FW) and height (FH) and subclassification of defects according to vertical bone loss. All soft tissue measurements were repeated 12 months after membrane placement using conservative flap reentry surgeries; hard tissue parameters were also assessed at this time.DPPA-cross-linked collagen membranes demonstrated good handling characteristics, and no postoperative adverse tissue reactions or clinically detectable localized allergic responses were observed. GI and PI remained low during the entire study period. When the one year reentry values were compared to the baseline measurements, a significant reduction in PD (1.9 +/- 1.4), FW (2.1 +/- 1.7), FH (2.9 +/- 1.6), and gain in CAL (1.7 +/- 1.5), V-OPAL (2.1 +/- 1.9), and H-OPAL (4.7 +/- 1.4) were observed (Por = 0.05). However, there were no significant differences in GML or AG. Hard tissue improvements resulted in the complete closure of 30% (12) of the defects, and transformation of 67.5% (27) of the defects to Class I, while one defect remained a Class II (2.5%).Based on this 12-month clinical reentry study, a DPPA-cross-linked collagen membrane could be beneficial in GTR treatment of Class II mandibular furcation involvements, both in terms of soft and hard tissue improvements.

The aim of the present study was to evaluate longitudinally the stability of a cohort of esthetic implants that had been in function for at least 1 year prior to the baseline examination.Sixty-one maxillary anterior ITI implants in 45 systemically healthy patients, supporting single crown restorations, were randomly selected and examined. Clinical, microbiologic, and biochemical parameters were recorded at baseline and again after 3 years. Clinical examination included Plaque Index, Gingival Index, bleeding on probing, probing pocket depth (PPD), distance between implant shoulder and mucosal margin (DIM), and mobility. Dark-field microscopy and immunofluorescence were used to evaluate the bacteria morphotypes and the presence of 5 specific pathogenic bacteria, respectively. Peri-implant crevicular fluid (PICF) was collected at the mesial and distal sites of each implant, and total amounts of 3 biochemical markers were assessed: alkaline phosphatase was measured by using p-nitrophenyl-phosphate as substrate, elastase activity was measured by the use of a low-molecular-weight fluorogenic substrate, and the inhibitor alpha2-macroglobulin (alpha2M) was measured by enzyme-linked immunosorbent assay.The only statistically significant differences between baseline and follow-up examination concerned PPD and DIM measurements, which increased slightly. The remainder of the clinical measurements and almost all of the microbiologic and biochemical parameters did not change significantly. Furthermore, no associations were observed between the above results and the number of years that implants had been in function.Based on an observation period of 4 to 9 years (mean 6.8 years at the time of the follow-up examination), it can be concluded that in patients with appropriate oral hygiene, the intracrevicular position of the restoration margin does not appear to adversely affect peri-implant health and stability.

Diagnosis of abnormalities of the posterior fossa, such as Dandy-Walker malformation, can be assessed during the first trimester of pregnancy by ultrasonography. We report on 5 cases of posterior fossa abnormalities, 4 Dandy-Walker malformations and 1 Dandy-Walker variant, diagnosed during the first trimester of pregnancy by ultrasound examination. All cases were confirmed later during the pregnancy by further ultrasound examinations or by postmortem examination when parents elected for termination of pregnancy. Two of our Dandy-Walker malformation cases were siblings from consanguineous parents and had a Meckel syndrome variant associated with the posterior fossa malformation, multicystic kidneys and hepatic fibrosis. We believe first trimester diagnosis of Dandy-Walker complex is possible, but needs to be confirmed later during the pregnancy and should prompt a detailed survey for other abnormalities.

The titanium surface obtained by sandblasting and etching (SLA) is an easily alterable surface that smears and loose its typical texture. In addition, the etching process modifies the surface composition of commercially pure titanium; the latter contains titanium and an added 20-40% of titanium hydride. Therefore, the influence of a heavy surface alteration and the influence of the composition at the SLA surface, i.e. with and without titanium hydride, were investigated in vivo. Three implant groups were inserted in the mandible of Land Race pigs and left to heal during 10 weeks in a submerged way: (1). a standard SLA control group (SLAstd) with the SLA surface containing titanium hydride; (2). a test group with the SLA surface heavily altered at the thread level (SLAalt); (3). a test group with an SLA surface devoid of titanium hydride (SLAT). Sample size was n = 8. Histomorphometry analysis did not show a statistically significant difference between the control group (SLAstd: 82.12 + 6.1%), the altered surface test group (SLAalt: 86.25 + 7.4%) and the SLA without titanium hydride test group (SLAT: 75.12 + 7.6%). The data suggest that alteration of the SLA surface, if it occurs, should not be detrimental to bone response. The soft and easy smearable SLA surface might even be an advantage when surface maintenance is required. Surface composition did not play a significant role in the bone response to the SLA surface and it can therefore be concluded that the osteophilic properties of the SLA surface are due to its surface topography and not to its specific surface composition.

To assess the feasibility, tolerance and diagnostic accuracy of endometrial biopsy (EB) during sonohysterography (SH) compared to EB after hysteroscopy (HSC) in endometrial disorders.105 consecutive patients with irregular uterine bleeding were included prospectively in the calendar year 2001. SH and flexible HSC were performed in an office setting, subsequently and in a random order, by two different practitioners blind to the former experiment. SH-EB was performed using a 3.1-mm ultrasound-guided Bernard catheter in the uterine cavity still partly distended and with a gentle 20-ml syringe vacuum aspiration. The biopsy was directed on focal lesions or else randomly when no targets had previously been found. A Cornier Pipelle was used to perform EB after HSC. We investigated all patients by biopsy, independent of the endometrial thickness. HSC-EB was the gold standard.For both methods, cervical catheterism was impossible in 20 patients, 75 of them successfully underwent both exams. Duration and tolerance were similar. SH was effective in the distinction between normal and pathologic cavities, as well as in the diagnosis of polyps. Endometrium appeared significantly thinner with HSC (1.8 mm) when compared to SH (2.9 mm, p0.05). Histological endometrial assessment failed in 30 cases of SH-EB and in 22 cases in HSC-EB (NS). There was a poor correlation of the histological results of both techniques. Hyperplasia has never been diagnosed by SH-EB, whereas 3 EB issued from HSC-EB brought up this diagnosis.SH-EB with our technique did not improve the diagnostic potential of SH and severe diagnosis was missed. Histological assessment should fail less when we exclude endometrial atrophy. The diameter of the catheter and the aspiration technique must be revised and the learning curve must be considered. Our technique cannot replace EB by HSC.

The aim of this investigation was to determine the presence of selected enzymes and enzyme inhibitors in crevicular fluid collected from implants with and without clinical, radiographic and microbiological signs of periimplantitis. Eleven implants with symptoms of periimplantitis in eight patients (four men and four women) were compared to eleven implants in seven subjects (one man and six women) without periimplantitis. Periimplant crevicular fluid (PICF) was collected at the mesial and distal sites of each implant. Alkaline phosphatase activity (ALP) was measured by using p-nitrophenyl-phosphate as substrate, elastase activity (EA) by the use of a low molecular weight fluorogenic substrate, and the inhibitor alpha2-macroglobulin (alpha2M) by ELISA. ALP, EA and alpha2M were detected in the majority of samples in both groups. In comparison to the clinically healthy implants, total amounts of each of these substances were significantly higher in PICF collected around implants with periimplantitis. The mean total amounts of EA, alpha2M and ALP in the healthy group were: EA: 1.8 ng, alpha2M: 3.1 ng, ALP: 24.1 U, and in the periimplantitis group EA: 23.1 ng, alpha2M: 25.2 ng and ALP: 142.3 U. In addition, all three mediators were correlated with the clinical parameters. The results confirm the similarity of the inflammatory response of tissues surrounding implants and natural teeth, and suggest that ALP and EA could be promising markers of bone loss around dental implants.

Summary: ITI® dental implants are available with two bone-anchoring surfaces, a titanium plasma-sprayed (TPS) surface, and a recently introduced sandblasted and acid-etched (SLA) surface. Cell culture and animal tests demonstrate that the SLA surface stimulates bone cell differentiation and protein production, has large amounts of bone-to-implant contact, and results in large removal torque values in functional testing of the bone contact. As a result of these studies, a prospective human clinical trial was initiated to determine whether the 4.1 mm diameter SLA ITI® solid screw implants could be predictably and safely restored as early as six weeks after implant placement surgery. The protocol restricted the use of the reduced healing time to a) healthy patients with sufficient bone volume to surround the implant, and b) those patients who had good bone quality (classes I-III) at the implant recipient site. Patients with poorer bone quality (class IV) did not have restorations until 12 weeks after implant placement. The clinical trial is an ongoing multicenter trial, with six centers in four countries, and with follow-up over five years. The primary outcome variable was abutment placement with a 35 Ncm force, with no countertorque and no pain or rotation of the implant. A secondary outcome was implant success, as defined by no mobility, no persistent pain or infection, and no peri-implant radiolucency. To date, 110 patients with 326 implants have completed the one-year post-loading recall visit, while 47 patients with 138 implants have completed the two-year recall. Three implants were lost prior to abutment connection. Prosthetic restoration was commenced after shortened healing times on 307 implants. The success rate for these implants, as judged by abutment placement, was 99.3% (with an average healing time of 49 days). Life table analyses demonstrated an implant success rate of 99.1%, both for 329 implants at one year and for 138 implants at two years. In the 24-month period after restoration, no implant losses were reported for the 138 implants. These results demonstrate that, under defined conditions, solid screw ITI® implants with an SLA endosseous surface can be restored after approximately six weeks of healing with a high predictability of success, defined by abutment placement at 35 Ncm without countertorque, and with subsequent implant success rates of greater than 99% two years after restoration.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 4 - p. 381-382