Inherent challenges of immediate implant placement in the aesthetic zone: a case report

Replacement of missing teeth with implant borne prostheses has become generally become acceptable in the field of dentistry. The traditional “Branemark protocol” has advocated for a period of healing after extraction before placement of implants. This presents an aesthetic challenge and the ensuing bone resorption also complicates the ideal placement of the implant fixture. Immediate placement of the implant presents a solution to these challenges. This case report describes the management of an anterior missing tooth utilising an immediate implant and guided bone regeneration. Soft tissue recession of the adjacent tooth and a reaction to the barrier membrane were encountered. Whereas this technique may be satisfactory for management of tooth loss in the aesthetic zone, clinicians should be aware of the challenges they may encounter and be prepared to manage them

Occurence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in subgingival plaque among patients with periodontal disease at the University of Nairobi Dental Hospital

Objectives: To determine the occurrence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in patients with periodontal disease using polymerase Chain Reaction.Design: A descriptive cross-sectional study.Setting: The University of Nairobi Dental Hospital.Subjects: Patients presenting at the Oral Diagnosis and Periodontology clinics during the period of the study. The patients had periodontal examination done followed by subgingival plaque collection from selected teeth. DNA extraction from the plaque samples was then done followed by PCR based on Taqman probes using commercially available kits.Results: A total of 92 participants were recruited in the study. Aggregatibacter actinomycetemcomitans (A.a) was found in 14 (15.20%) while Porphyromonas gingivalis (P.g) was present in 16 (17.40%) of the study participants. Based on independent sample t-test, statistically significant positive associations were found between detection frequency of Porphyromonas gingivalis and plaque score (t= 2.47, p= 0.015), gingival index (t= 3.24, p= 0.022), but not with clinical attachment loss (t= 1.90, p= 0.061). Chi square test revealed a positive association between detection rate of P.g and periodontal disease severity (X2= 6.34, p= 0.042). Similar association was also found between detection rate of Aggregatibacter actinomycetemcomitans and increasing age (t=2.19, p= 0.031), clinical attachment loss (t= 4.61, p<0.001) and periodontal disease severity (X2=11.23, p= 0.004).Conclusion: The multiplex polymerase chain reaction technique utilised in this study enabled detection of target bacteria in the same reaction mixture as opposed to other periodontal microbiological techniques that require each bacteria to be investigated individually therefore PCR should be considered as an alternative to other methods of periodontal microbiology investigation. The association between periopathogenic microorganisms, A.a and P.g with occurrence and severity of periodontal disease were also confirmed in this study

Towards UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): protocol for an evaluation of the requirements for arthroplasty follow-up, and the production of consensus-based recommendations

Introduction: Hip and knee arthroplasties have revolutionised the management of degenerative joint diseases and, due to an ageing population, are becoming increasingly common. Follow-up of joint prostheses is to identify problems in symptomatic or asymptomatic patients due to infection, osteolysis, bone loss or potential peri-prosthetic fracture, enabling timely intervention to prevent catastrophic failure at a later date. Early revision is usually more straight-forward surgically and less traumatic for the patient. However, routine long-term follow-up is costly and requires considerable clinical time. Therefore, some centres in the UK have curtailed this aspect of primary hip and knee arthroplasty services, doing so without an evidence-base that such disinvestment is clinically- or cost-effective. Methods: Given the timeline from joint replacement to revision, conducting a randomised controlled trial (RCT) to determine potential consequences of disinvestment in hip and knee arthroplasty follow-up is not feasible. Furthermore the low revision rates of modern prostheses, less than 10% at 10 years, would necessitate thousands of patients to adequately power such a study. The huge variation in follow-up practice across the UK also limits the generalisability of an RCT. This study will therefore use a mixed-methods approach to examine the requirements for arthroplasty follow-up and produce evidence- and consensus-based recommendations as to how, when and on whom follow-up should be conducted. Four interconnected work packages will be completed: 1) a systematic literature review; 2a) analysis of routinely-collected NHS data from five national datasets to understand when and which patients present for revision surgery; 2b) prospective data regarding how patients currently present for revision surgery; 3) economic modelling to simulate long-term costs and quality-adjusted life years associated with different follow-up care models; 4) a Delphi-consensus process, involving all stakeholders, to develop a policy document which includes a stratification algorithm to determine appropriate follow-up care for an individual patient