Implant-supported mandibular overdentures can minimize mandibular bone resorption in edentulous patients: results of a long-term radiologic evaluation

Purpose: It has been suggested that functional loading and light irritative stimuli could lead to changes in bone architecture, shape, and volume, and that by placing implants in the edentulous mandible and subsequently loading them, functional conditions could be created to limit bone resorption or even stimulate bone apposition (the latter was reported only for fixed implant-supported prosthetic reconstructions) in the distal area of the mandibular osseous crest. The aim of this study was to radiographically assess the bone height changes in the posterior area of the mandible after implant placement and loading with an overdenture on two or four implants over a mean follow-up period of 10.5 years. Materials and Methods: Panoramic radiographs were taken of 82 totally edentulous patients before implant placement and at repeated follow-up intervals spread over a mean observation time of 10.5 years. All patients received an implant-supported overdenture as prosthetic treatment. The mandibular bone height in the distal part of the mandible was measured on each of the available radiographs and the initial, intermediate, and final values were compared. Results: A mean mandibular bone height reduction of 0.5 mm was measured. Conclusion: No clinically relevant difference was found between the posterior mandible height before implant placement and at follow-up after functional loading with an implant-supported mandibular overdenture

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology