Determinanten der präimplantologischen Augmentation : eine Untersuchung zur Feststellung klinischer Behandlungsroutinen

Die vorliegende Studie untersucht, welche präimplantologischen Techniken zur Vorbereitung des atrophierten schmalen Kieferkamms auf eine adäquate Implantation von Chirurgen favorisiert werden. Darüber hinaus sollte der Einfluss des unterschiedlichen Ausbildungsweges bei Mund-, Kiefer- und Gesichtschirurgen und Oralchirurgen sowie bestimmter Prädiktoren auf die Therapieentscheidung eruiert werden. Mit Hilfe eines Befragungsbogens, der an 250 Mund-, Kiefer- und Gesichtschirurgen und Oralchirurgen gesendet wurde, sollte diesen Fragen nachgegangen werden. Die Rücklaufquote betrug 46,8%. Therapie der Wahl bei der Behandlung des zahnlosen Unterkiefers ist Resektion und der Einsatz von Knochenersatzmaterial. Bei der Schaltlücke steht eher die Rekonstruktion des Kieferkamms im Vordergrund. Mund-, Kiefer- und Gesichtschirurgen wenden bei identischen klinischen Ausgangsbedingungen häufiger invasivere Methoden an als Oralchirurgen. Patientenbezogene Merkmale wie Tabakkonsum, notwendige Endokarditisprophylaxe und Bisphosphonate haben Einfluss auf die Therapieentscheidung.Determinants of pre-implant augmentation – an investigation of clinical treatment rou-tines The objective of this study was to examine which pre-implant procedures are preferred by surgeons when preparing narrow atrophic alveolar ridges for adequate implantation. In addi-tion, influences of the different training pathways for maxillofacial surgeons (MFS) and oral surgeons (OS) as well as certain predictors on therapy decisions were determined. These is-sues were examined with the help of a three-part questionnaire. The first part contained doc-tor- and practice-related characteristics. The second part detailed clinical routines for pre-implant treatment of narrow parts of alveolar ridges. The third part consisted of clinical case vignettes. A total of 250 maxillofacial and oral surgeons received the questionnaire; 117 (46.8 %) com-pleted and returned it. There were no significant differences between the two groups in professional experience and postgraduate training. More than half the surgeons inserted between 100 and 500 implants per year, about one third (29.1 %) between 500 and 1000 implants, and only 6.4 % more than 1000 implants. A further outcome was that maxillofacial surgeons placed significantly more implants than oral surgeons. In the second part of the questionnaire, the study participants were asked about treatment op-tions for edentulous mandibles and single tooth gaps. Treatment options included bone split-ting, bone block grafting, augmentation with bone substitutes and/or particulate autogenous bone, distraction, mesh and resection. For edentulous mandibles, the surgeons preferred bone substitutes, followed by resection. For single tooth gaps, they also preferred bone substitutes, but followed by bone block grafting. Resection was rejected by almost all participants. Bone block grafting was significantly more often associated with maxillofacial surgeons, and bone substitute with oral surgeons. In general, maxillofacial surgeons preferred more invasive pre-implant treatment methods in cases with the same initial diagnoses, as compared to oral surgeons. In the third part of the questionnaire, the surgeons received four vignettes with real patient cases, two with edentulous mandibles, and two with single tooth gaps. The case vignettes con-tained anamneses, clinical findings and x-rays (orthopantomograms and cone beam computed tomography (CBCT) sections). The augmentation techniques specified were bone splitting, bone block grafting, augmentation with bone substitutes, resection or “no therapy”. Each vignette had two variable descriptors. In the edentulous mandible cases, the descriptors were the patient's age and smoking behavior, potential fear of the treatment and any existing radiation therapy. Resection was by far preferred to all other forms of therapy, regardless of the four determi-nants. In the case of older patients, the surgeons tended to refrain from complex and invasive interventions. Smoking as a risk factor generally led to rejection of interventions. Fear of in-terventions had no significant influence on therapy decisions; radiation therapy only influ-enced bone splits. In the single tooth gap cases, the descriptors were the patient's age and any endocarditis prophylaxis, the patient’s attitude towards the treatment and any bisphosphonate therapy. Here, the patient's age and fear seemed to have no influence on the therapy decisions made by oral surgeons, and only a marginal influence on the decisions made by maxillofacial surgeons. The surgeons were critical of any endocarditis prophylaxis or bisphosphonate therapy.Die vorliegende Studie sollte untersuchen, welche präimplantologischen Techniken zur Vor-bereitung des atrophierten schmalen Kieferkamms auf eine adäquate Implantation von Chi-rurgen favorisiert werden. Darüber hinaus sollte der Einfluss des unterschiedlichen Ausbil-dungsweges bei Mund-, Kiefer- und Gesichtschirurgen (MKG-Chirurgen) und Oralchirurgen sowie bestimmter Prädiktoren auf die Therapieentscheidung eruiert werden. Mit Hilfe eines Befragungsbogens, der aus drei Teilen bestand, sollte diesen Fragen nachgegangen werden. Der erste Teil beinhaltete die arzt- und praxisbezogenen Charakteristika. Der zweite Teil gab die klinischen Routinen bei der präimplantologischen Behandlung schmaler Kieferkamman-teile wieder. Der dritte Teil bestand aus klinischen Fallvignetten. 250 MKG- und Oralchirurgen erhielten den Befragungsbogen, davon kamen 117 (46,8%) beantwortet zurück. Hinsichtlich der Berufserfahrung sowie postgraduierter Fortbildungen gab es keine signifikan-ten Unterschiede zwischen den beiden Gruppen. Mehr als die Hälfte der Chirurgen inserierten jährlich zwischen 100 und 500 Implantaten, etwa ein Drittel (29,1%) zwischen 500 und 1000 Implantaten und nur 6,4% mehr als 1000 Implantate. MKG-Chirurgen setzten signifikant mehr Implantate als Oralchirurgen. Im zweiten Teil des Fragebogens wurden die Studienteilnehmer nach Behandlungsoptionen für den zahnlosen Unterkiefer und für die Schaltlücke befragt. Zu den Behandlungsoptionen gehörten Bone Split, Knochenblock, Augmentation mit Knochenersatzmaterial und/oder par-tikuliertem Knochen, Distraktion, Mesh und Resektion. Für den zahnlosen Unterkiefer wurde von den Chirurgen Knochenersatzmaterial bevorzugt, gefolgt von Resektion. Auch für die Schaltlücke präferierten die Studienteilnehmer am häu-figsten Knochenersatzmaterial, hier allerdings gefolgt von Knochenblock. Resektion wurde von so gut wie allen Teilnehmern abgelehnt. Statistisch signifikant war Knochenblock häufi-ger mit MKG-Chirurgen und Knochenersatzmaterial mit Oralchirurgen assoziiert. Im Allgemeinen bevorzugten MKG-Chirurgen bei derselben initialen Diagnostik invasivere präimplantologische Behandlungsmethoden im Vergleich zu Oralchirurgen. Im dritten Teil des Fragebogens erhielten die Chirurgen vier Vignetten mit realen Patienten-fällen, zwei mit zahnlosem Unterkiefer, zwei mit Schaltlücke. Die Fallvignetten enthielten Anamnese, klinische Befunde und Röntgenbilder (Orthopantomogramm und Ausschnitte von Zusammenfassung 2 digitalen Volumentomographien). Vorgegebene Augmentationstechniken waren Bone Split, Knochenblock, Augmentation mit Knochenersatzmaterial, Resektion oder „keine Therapie“. Jede dieser Vignette hatte jeweils zwei variable Deskriptoren. Bei den Fallvignetten mit dem zahnlosen Unterkiefer waren die Deskriptoren das Patientenalter und das Rauchverhalten so-wie eine mögliche Angst des Patienten der Behandlung gegenüber und eine bestehende Strah-lentherapie. Die Resektion wurde mit großem Abstand vor allen anderen Therapieformen präferiert, unab-hängig von den vier Determinanten. Bei höherem Patientenalter nahmen Chirurgen eher Ab-stand von komplexen und invasiven Eingriffen. Rauchen als Risikofaktor führte generell eher zu einer Eingriffsablehnung. Die Eingriffsangst hatte keinen signifikanten Einfluss auf die Therapieentscheidung, eine Radiatiotherapie lediglich auf einen Bone Split. Bei der Schaltlücke waren die Deskriptoren das Patientenalter und eine mögliche Endokardi-tisprophylaxe sowie die Eingriffseinstellung und mögliche Bisphosphonat-Therapie. Patien-tenalter wie Patientenangst schienen bei der Schaltlücke keinen Einfluss auf die Therapieent-scheidung der Oralchirurgen zu haben und bei MKG-Chirurgen nur gering. Einer möglichen Endokarditisprophylaxe sowie Bisphosphonat-Therapie standen die Chirurgen kritisch gegenüber

Decision-Making in Implantology—A Cross-Sectional Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible

This cross-sectional study aimed to investigate the influence of possible factors in the patient history on decision making in the therapy for a severely atrophied edentulous mandible. A vignette-based survey among 250 maxillofacial and oral surgeons was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery, and radiotherapy in the head and neck area (the implant region is not in the direct radiation area). To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material, and bone resection. There also was the option of rejecting any therapy. The response rate was 47%. Patient age, radiotherapy, and fear of surgery did not influence the approval of a therapy. Smoking was associated with a significantly lower endorsement of a treatment. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. In summary, it can be said that, of the four determinants, only smoking influenced treatment refusal. Bone resection is the preferred therapy independent of all determinants

How do specialist surgeons treat the atrophic tooth gap? A vignette-based study among maxillofacial and oral surgeons

Background There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. Results A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion “Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy

Serum Irisin Levels in Patients with Acute Atrial Fibrillation

Objective: The purpose of this research was to investigate whether changes in serum irisin levels can represent a marker of altered energy requirements in patients with acute atrial fibrillation (AF) undergoing cardioversion (CV). Methods: The research was planned as a randomized, prospective case-control study. Patients presenting to the emergency medicine and cardiology departments of a university hospital due to acute AF were included in the study. Irisin levels were measured from serum specimens collected 24 and 72 hours (h) following restoration of sinus rhythm with CV in patients in AF rhythm. The values obtained were then compared using statistical analysis. Results: Thirty-one patients undergoing CV due to acute AF were enrolled. Mean irisin levels were studied from serum specimens collected 24 and 72 h following restoration of sinus rhythm with CV, and were then compared. No statistically significant difference was determined at comparison of patients’ basal to 24 h, basal to 72 h, and 24 to 72 h mean irisin values (p0.734, p0.958, and p0.643, respectively). Negative correlation was determined between basal serum irisin levels and LDL (r= -0.519, p= 0.002), but no significant correlation was observed with epicardial adipose tissue (EAT) thickness. Conclusion: We determined no change in serum irisin levels studied 24 h and 72 h following return of normal sinus rhythm after CV from basal serum irisin levels in patients with acute AF. No correlation also was determined between serum irisin levels and EAT thickness

Successful resuscitation of prolonged cardiac arrest occurring in association with ‘skunk’ and toluene toxicity

We report a case of prolonged and successful resuscitation following cardiotoxicity-related arrest occurring after inhaling toluene and Skunk, which is an increasingly popular synthetic cannabinoid (SC). Following presentation to the emergency department because of lethargy, nausea and chest pain, a 28-year-old male user of Skunk and toluene suffered from cardiac arrest due to ventricular fibrillation (VF). Cardiogenic shock, severe metabolic acidosis and regular wide QRS tachycardia were observed in the patient, and he developed VF every 5–10 minutes over the course of 10 hours. The patient responded to prolonged resuscitation and was discharged on 8th day of his admission in a healthy condition. This case report is the first report that cardiac arrest occurring as a result of Skunk and toluene inhalation, which was resolved without sequelae after prolonged resuscitation

Terpenoid and Fatty Acid Profiling along with Anti-Tyrosinase and Anti-Urease Potentials of Scorzonera pygmaea Sibth. & Sm. an Endemic Plant of Turkey

Petroleum ether (PE), chloroform (CH), ethyl acetate (EA) and butanol (BU) fractions were obtained from ethanol extracts of the roots (SPR) and the above ground (SPH) parts of S. pygmaea. PE fractions were evaluated by GC/MS for profiling the terpenoids and the fatty acids of the plant. 29 compounds in total including saturated (major palmitic acid), unsaturated (major linoleic acid) fatty acids and triterpenes were tentatively determined. Short-term extraction methods might be preferred to avoid esterification of fatty acids. Phytochemical profiles of SPR-PE and SPH-PE were found to be similar to each other and to other few Scorzonera species reported previously. These results will contribute to the chemotaxonomic studies about the genus which is considered taxonomically complex genus. Activity studies were carried out using kojic acid (87.10 % inhibition) standard for tyrosinase and thiourea (95.83 % inhibition) standard for urease. SPR-CH was determined as the most potent fraction with 55.94 % and 55.10 % inhibition of tyrosinase and urease, respectively at the same concentration of the standards (200 microgram/mL). These moderate results might be considered encouraging for more detailed studies to determine the active compounds and to evaluate the plant's potential in pharmaceutical, food and cosmetic industries in terms of tyrosinase and urease inhibition

Innovative Crisis Management in Construction: Approaches and the Process

World Conference on Technology, Innovation and Entrepreneurship -- MAY 28-30, 2015 -- Istanbul, TURKEYWOS: 000380509900280Crisis management is a process that includes catching and evaluating crisis signals and needs to take and implement necessary precautions in order to overcome a crisis with a minimal damage. Detecting the early warning signals of a crisis contributes firms to hinder the occurrence of the crisis and to survive without huge financial losses. Other factors that contribute construction firms to survive with zero defect can be listed as follows: (i) catching indirect signals before a crisis, (ii) developing proactive methods to defend themselves against the crisis by means of these signals, (iii) taking the crisis under control, (iv) taking required measures after the crisis for the recovery of the firm, and lastly (v) recording the lessons learned from the crisis. Construction firms that can successfully manage a crisis can quit it with a minimum loss and can expand their market shares after the crisis. In other words, firms that can escape from a crisis with zero or minimum damage may strategically have competitive advantages over existing rivals. Considering all these issues, this study describes the concept of crisis management in terms of the construction industry and introduces related objectives and characteristics. In addition, both innovative crisis management approaches and the corresponding process were discussed in detail from the perspective of construction companies. In fact, this is a virgin area in the construction management literature and thus can contribute to the creative and innovative management of companies under potential crises in micro and macro levels. Consequently, this study attempts to reveal how construction firms can manage crises better and turn to their former positions in the short term through innovation-based means. (C) 2015 The Authors. Published by Elsevier Ltd