RESUMEN
This article aimed to evaluate whether normal osseointegration occurs in immediate loading following secondary stabilization obtained by means of conical copings and adaptation of patients' old dentures. Two clinical cases of immediate loading of implant-supported prostheses in the edentulous mandible are presented. Prostheses were positioned within 24 hours, with secondary splinting of primary conical copings screwed onto implants. For this purpose, the patients' old removable prostheses were adapted and lined to fit within the secondary acrylic resin copings, which perfectly matched the primary copings screwed onto the implants and milled to 2 degrees.
Asunto(s)
Pilares Dentales , Implantes Dentales , Prótesis Dental de Soporte Implantado , Dentadura Completa Inmediata , Dentadura Completa Inferior , Resinas Acrílicas/química , Anciano de 80 o más Años , Aumento de la Cresta Alveolar/métodos , Implantación Dental Endoósea , Diseño de Prótesis Dental , Diseño de Dentadura , Rebasado de Dentaduras , Femenino , Humanos , Masculino , Mandíbula/cirugía , Oseointegración/fisiología , Propiedades de SuperficieRESUMEN
This report describes the rehabilitation of a patient who was completely edentulous in the mandible with a removable prosthesis supported by implants on four Straumann Wide-Neck implants placed in the positions of the canines and second molars. The Cagliari modified conometry technique was developed to improve and simplify anchorage systems based on conical copings in a removable prosthesis supported by implants. The connection of the removable prosthesis to the implants is obtained by primary conical copings, which are screwed to the implants, coupled to secondary copings equipped with plastic friction devices (Arch-Friction-Soft, Dental Konos). After the secondary copings are positioned on the primary copings, the secondary copings are fixed with acrylic resin to the removable prosthesis in the mouth, with the goal of passive fit. The prosthesis produced with this method is not a classic implant-supported overdenture but is a removable prosthesis completely supported by implants that is shaped like a fixed prosthesis. This type of prosthesis is extremely stable and has modular retention (plastic friction), creating ideal conditions for oral hygiene. The stability of this type of prosthesis results in psychologic comfort and masticatory performance similar to that of a fixed prosthesis but with the hygiene, esthetics, and lower expense of an overdenture.
Asunto(s)
Retención de Prótesis Dentales/instrumentación , Prótesis Dental de Soporte Implantado , Dentadura Completa Inferior , Prótesis de Recubrimiento , Arcada Edéntula/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del PacienteRESUMEN
OBJECTIVE: The use of analgesic drugs in patients admitted to Italian intensive care units (ICUs) was assessed. METHODS: An observational, prospective, cohort study was conducted, involving all adult patients admitted during a 1-month period in 128 Italian general ICUs. The use of analgesic drugs was evaluated for the first 2 postoperative days in surgical patients who stayed in ICU for at least 2 days. RESULTS: We observed 661 postoperative patients who underwent elective (72%) or emergency surgery. Of the patients with an ICU stay of at least 2 days, 49% did not receive any opioids in the first 48 postoperative hours, and more than 35% did not receive any analgesic at all. The most used opioid was fentanyl, followed by morphine and buprenorphine. Among the 336 patients who received at least one opioid, as many as 42% had only a single bolus per day. Pain control was reported as the reason for drug use in 54.5% of opioid administrations, while control of anxiety covered 10.3% of them. The probability of receiving an opioid was lower for patients in coma. CONCLUSION: Management of postoperative pain in Italian ICUs was insufficient, particularly in neurosurgical and comatose patients. A general lack of knowledge about pain and misconceptions about pain drugs may be at the basis of these results.