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OBJECTIVES: This RCT aimed to compare zirconia and titanium dental implants in the maxillary premolar region. The comparison was based on marginal bone level (MBL) changes, clinical parameters, aesthetic outcomes, and patient related outcome measures (PROMs) 1 year after prosthetic loading. MATERIALS AND METHODS: Fifty patients were randomly assigned to receive either a zirconia (ZrO2, n = 25) implant or a titanium (Ti, n = 25) bone-level implant. Implants were provided with a lithium disilicate crown 3 months after placement. Follow-up was at 1 month and after 1 year. The primary outcome pertained to changes in MBL. Reported secondary outcomes consisted of implant survival, peri-implant tissue health, aesthetics, and PROMs. RESULTS: Mean MBL change after 1 year was 0.01 mm (SD = 0.45; min = 0.72, max = 0.86) for ZrO2 and -0.09 mm (SD = 0.34; min = 0.53, max = -1.06) for Ti (p = .439). Scores for the other clinical outcome parameters and PROMs were generally favorable, with no significant differences. However, significant differences were found for the aesthetic outcomes regarding two criteria: (a) level of facial mucosa (p = .022), in favor of Ti, and (b) root convexity/soft tissue color and texture (p = .005) in favor of ZrO2. CONCLUSION AND CLINICAL IMPLICATIONS: The ZrO2 and Ti implant types used in this study, replacing a single missing maxillary premolar, show a comparable outcome in terms of MBL change after 1 year. Clinical and aesthetic parameters, as well as PROMs, are favorable and similar between both implant types after 1 year of prosthetic loading. These short-term study results suggest that both are suitable for clinical use.

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OBJECTIVE: We compared the effective networks derived from Single Pulse Electrical Stimulation (SPES) in intracranial electrocorticography (ECoG) of awake epilepsy patients and while under general propofol-anesthesia to investigate the effect of propofol on these brain networks. METHODS: We included nine patients who underwent ECoG for epilepsy surgery evaluation. We performed SPES when the patient was awake (SPES-clinical) and repeated this under propofol-anesthesia during the surgery in which the ECoG grids were removed (SPES-propofol). We detected the cortico-cortical evoked potentials (CCEPs) with an automatic detector. We constructed two effective networks derived from SPES-clinical and SPES-propofol. We compared three network measures (indegree, outdegree and betweenness centrality), the N1-peak-latency and amplitude of CCEPs between the two effective networks. RESULTS: Fewer CCEPs were observed during SPES-propofol (median: 6.0, range: 0-29) compared to SPES-clinical (median: 10.0, range: 0-36). We found a significant correlation for the indegree, outdegree and betweenness centrality between SPES-clinical and SPES-propofol (respectively rs = 0.77, rs = 0.70, rs = 0.55, p < 0.001). The median N1-peak-latency increased from 22.0 ms during SPES-clinical to 26.4 ms during SPES-propofol. CONCLUSIONS: Our findings suggest that the number of effective network connections decreases, but network measures are only marginally affected. SIGNIFICANCE: The primary network topology is preserved under propofol.

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Epidermolysis bullosa (EB) is a heritable skin blistering disease caused by variants in genes coding for proteins that secure cell-cell adhesion and attachment of the epidermis to the dermis. Interestingly, several proteins involved in inherited EB are also associated with autoimmune blistering diseases (AIBD). In this study, we present a long-term follow-up of 15 patients suffering from recessive dystrophic or junctional EB. From these patients, 62 sera were analysed for the presence of autoantibodies associated with AIBD. We show that patients suffering from recessive dystrophic EB (RDEB) are more susceptible to developing autoantibodies against skin proteins than patients suffering from junctional EB (70% vs. 20%, respectively). Interestingly, no correlation with age was observed. Most patients showed reactivity to Type XVII collagen/linear IgA bullous dermatosis autoantigen (n = 5; 33%), followed by BP230 (n = 4; 27%), Type VII collagen (n = 4; 27%) and laminin-332 (n = 1; 7%). The pathogenicity of these autoantibodies remains a subject for future experiments.

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The aim of this study was to assess whether immediate bone reconstruction after removal of a fractured dental implant in the posterior mandible provides a sound base for implant replacement, with a favourable treatment outcome and high patient satisfaction. Eight consecutive patients with a fractured implant neck were included. The implant was removed via osteotomy, following which the site was immediately repaired with a mixture of autogenous bone and bone substitute. After a 4-month healing period, sufficient bone and favourable soft tissue conditions were present, allowing implant placement with adequate primary stability. After a further 3 months, the implants were restored with an all-ceramic restoration. Patient satisfaction, the aesthetic outcome, complications, and postoperative morbidity were assessed using standardized clinical and radiographic examinations up to 5 years after crown placement. No implant failures were observed during the follow-up. Plaque accumulation, the presence of calculus, bleeding tendency, and peri-implant inflammation indices were low, indicating healthy peri-implant conditions. The mean marginal bone level change at the 5-year follow-up was - 0.17 ± 0.46 mm. All patients reported a high level of satisfaction (mean overall score 9.3 ± 0.5). In conclusion, immediate reconstruction of the hard tissue after removal of a fractured dental implant is a viable treatment option. This approach facilitates rehabilitation, reduces morbidity, and leads to favourable aesthetic outcomes.

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A multitude of biomaterials have been used for the production of implants through the years. Titanium or titanium alloy have been regarded as the 'gold standard' for years. However, potential risks and disadvantages regarding biocompatibility and aesthetics have also been reported for the use of titanium in dental implantology. As such, there is need for an alternative material. Zirconia may be regarded as a possible alternative. It is a ceramic with high fracture toughness and other positive qualities, such as beings metal-free, biocompatible, and white, which is aesthetically desirable. Short-term study results of contemporary zirconia implants are promising and comparable to titanium implants. Nevertheless, the material is relatively brittle and susceptible to surface defects. However, no long-term clinical results exists and possible complications are unknown. Long-term clinical research is needed before zirconia implants routine use may be endorsed.

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BACKGROUND: Video consultation (VC) has been scaled up at our academic centre attempting to facilitate and accommodate patient-provider interaction in times of social distancing during the recent and ongoing COVID-19 pandemic. OBJECTIVES: This study evaluates qualitative outcomes with data insights from the electronic health record, to contrast satisfaction outcomes with the actual use of VC. METHODS: Healthcare providers and patients using VC during the COVID-19 pandemic at a large academic centre in the Netherlands were surveyed for user satisfaction and experiences with VC. In addition, quantitative technical assessment was performed using data related to VC from the EHR record. RESULTS: In total, 1,027/4,443 patients and 87/166 healthcare providers completed their online questionnaire. Users rated the use of VC during a pandemic with an average score of 8.3/10 and 7.6/10 respectively. Both groups believed the use of VC was a good solution to continue the provision of healthcare during this pandemic. The use of VC increased from 92 in March 2020 to 837 in April 2020. CONCLUSION: This study strongly signals that VC is an important modality in futureproofing outpatient care during and beyond pandemic times. Further development in end-user technology is needed for EHR integrated VC solutions. Guidelines needs to be developed advising both patients and healthcare providers. Such guidelines should not solely focus on technical implementation and troubleshooting, but must also consider important aspects such as digital health literacy, patient and provider authentication, privacy and ethics.

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The aim of this study was to assess implant retreatment in a group of patients whose maxillary implants were all failing after full arch rehabilitation. Treatment involved implant removal, augmentation, and placement of an overdenture supported by four to six implants. All consecutive patients referred between 2008 and 2018, following multiple late implant failures in the rehabilitated maxilla, were included in the study. Seventy implants in 15 patients were evaluated at 3.3 ± 2.5 years (range 1.1-8.6 years) after loading. Implant survival, complications, clinical parameters, marginal bone loss, and patient-related outcome measures were recorded at the time of evaluation. Overall implant survival was 95.7%. Three implant failures occurred within the first year of function. Marginal bone loss was 0.32 ± 0.46 mm; pocket probing depth was 4.55 ± 1.59 mm. Plaque, calculus, inflammation, and bleeding were hardly seen (median index score 0). Patients scored their satisfaction with their overdentures as high (mean overall score 8.7 ± 1.2, maximum 10). Chewing soft and tough food was scored as 'good' and hard food as 'moderate'. The mean Oral Health Impact Profile score was 29.5 ± 33.3. It can be concluded that the replacement of multiple failing implants in an edentulous maxilla after bone augmentation is a safe and predictable treatment procedure when applied as an implant-supported overdenture.

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The aim of this retrospective study was to assess the clinical and aesthetic outcomes, and patient satisfaction, following dental implant therapy in cleft patients. Implant survival, changes in marginal bone level, pocket probing depths, plaque and bleeding indices, aesthetics, and patient satisfaction were assessed in 17 alveolar cleft patients and 17 matched controls. At follow-up (mean 72.4±46.4 months), one implant had been lost in the cleft group. Mean marginal bone loss at follow-up was -0.4±0.4mm in cleft patients and -0.2±0.4mm in controls. Aesthetics of the peri-implant soft tissues (pink aesthetic score) were less favourable (P=0.025) in cleft patients (5.0±1.9) than in controls (6.5±1.7), while peri-implant parameters were comparable in the two groups. Overall patient satisfaction was 8.6±0.9 in cleft patients and 8.9±1.1 in controls (P=0.331). In cleft patients, no difference in aesthetics was observed between patients who received additional bone augmentation at 3 months prior to implant placement and those who did not (P=0.092). Dental implant therapy in cleft patients is associated with high implant survival, minor marginal bone loss, healthy peri-implant soft tissues, and high patient satisfaction. Only the aesthetics of the soft tissues was worse in cleft patients compared to augmented non-cleft patients.

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Implant treatment for two central incisors in the maxillary aesthetic region is complex due to concerns regarding inter-implant hard and soft tissue stability. A treatment protocol was therefore developed and implemented in a 1-year prospective case series study involving 16 patients with two failing or missing central incisors in the maxillary aesthetic region. The protocol consists of five options depending on whether teeth are still present (options 1-3) or not (options 4 and 5) and on the amount of bone available at the start of treatment: (1) extraction followed by immediate implant placement and provisionalization, (2) extraction followed by immediate implant placement and delayed provisionalization, (3) extraction followed by ridge preservation, delayed implant placement and immediate provisionalization, (4) delayed implant placement and guided bone regeneration with delayed provisionalization, (5) guided bone regeneration (extensive bone augmentation of the alveolar ridge), delayed implant placement, and delayed provisionalization. The patients were assessed regarding peri-implant hard and soft tissue parameters, aesthetic index score, and patient satisfaction. All treatment options showed good clinical and radiographic results and high patient satisfaction.

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The fungus Fusarium oxysporum f.sp. cubense (Focub) causes Fusarium wilt of banana. Focub strains are divided into races according to their host specificity, but which virulence factors underlie these interactions is currently unknown. In the F. oxysporum f.sp. lycopersici (Fol)-tomato system, small secreted fungal proteins, called Six proteins, were identified in the xylem sap of infected plants. The Fol Six1 protein contributes to virulence and has an avirulence function by activating the I-3 immune receptor of tomato. The Focub tropical race 4 (TR4) genome harbors three SIX1 homologs: SIX1a, b and c. In this study, the role of Focub-SIX1a in pathogenicity was evaluated since this homolog is present in not only TR4 but also in other races. A deletion mutant of the SIX1a gene from Focub TR4 strain II5 was generated (FocubΔSIX1a) and tested in planta. Mutants were found to be severely compromised in their virulence. Ectopic integration of the Focub-SIX1a gene in the FocubΔSIX1a strain restored virulence to wild type levels. We conclude that Focub-SIX1a is required for full virulence of Focub TR4 towards Cavendish banana.

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Changes in the bone around permucosal endosseous implants can be caused by biomechanical factors. Computer models are used to calculate the location and magnitude of stresses in the bone. The finite element method is used for the construction and calculation of models. The ongoing development of software and hardware 25 years ago made it possible to construct more complex 3-dimensional models. The general aim of the dissertation was to develop a state-of-the-art computer model of an edentulous mandible with dental implants and then to calculate the influence of a number of parameters on the location and magnitude of stresses in the bone. Conspicuous results were that there is hardly any difference between 2 and 4 implants in the interforaminal region and that the length of implants has a negligible effect on the magnitude of stresses. Clinical studies have subsequently demonstrated that these results are in line with reality.

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OBJECTIVE: To assess oral health, health, and quality of life (QoL) of care-dependent community-living older people with and without remaining teeth who recently received formal home care. MATERIALS AND METHODS: For this cross-sectional observational study, community-living older people (≥ 65 years), who recently (< 6 months) received formal home care, were interviewed with validated questionnaires and underwent an oral examination. Oral health, general health, medicines usage, frailty (Groningen Frailty Indicator), cognition (Minimal Mental State Examination), QoL (RAND 36), and oral health-related QoL (Oral Health Impact Profile-14) were assessed. RESULTS: One hundred three out of 275 consecutive eligible older people (median age 79 [IQR (Inter Quartile Range) 72-85 years] participated in the study. Thirty-nine patients had remaining teeth and 64 were edentulous. Compared with edentulous older people, older people with remaining teeth scored significantly better on frailty, QoL, physical functioning, and general health. No significant differences were seen in cognition. Dental and periodontal problems were seen in more than half of the patients with remaining teeth. Two third of the edentulous patients did not visit their dentist regularly or at all. CONCLUSIONS: Care-dependent home-dwelling older people with remaining teeth generally were less frail, scored better on physical functioning and general health and had better QoL than edentulous older people. Dental and periodontal problems were seen in approximately 50% of the elderly. CLINICAL RELEVANCE: Notwithstanding their common dental problems, frailty, health, and QoL are better in home-dwelling older people with remaining teeth. To maintain this status, we advise not only dentists, but also health care workers and governments, to encourage people to maintain good oral health.

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The purpose of the systematic review and meta-analysis was to compare the performance of 3-unit bridges on teeth with 3-unit bridges on implants, evaluating survival of the bridges, survival of the teeth or implants, condition of the hard and soft tissues surrounding the supports, complications and patient-reported outcome measures (PROM) after a mean observation period of at least 1 year. A literature search was conducted using a combination of the search terms: fixed partial denture and fixed dental prostheses (FDPs). An electronic search for data published until January 2017 was undertaken using the MEDLINE, EMBASE and Cochrane Library databases. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational, which evaluated the results of 3-unit FDPs on either 2 implants or 2 abutment teeth. The search identified 1686 unique references. After applying eligibility criteria, 66 articles were included in the analysis. A total of 1973 3-unit FDPs were supported by teeth, and 765 were implant-supported. No significant differences were found either in the survival of the supporting abutments (P = .52; 99% vs 98.7% survival per year) or in the survival of the prostheses (P = .34; 96.4% vs 97.4% survival per year). Both treatments show an almost equally low complication rate, but there is a low level of reporting of hard and soft tissue conditions and PROM. It is concluded that implant-supported 3-unit FDPs seem to be a reliable treatment with survival rates not significantly different from the results of teeth-supported 3-unit FDPs.

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The aim of this study was to assess the 5-year treatment outcome of maxillary implant-retained overdentures opposed by natural antagonistic teeth. Fifty consecutive patients received maxillary overdentures supported by six dental implants. Implants were placed in the anterior region, if enough bone was present (n = 25 patients) Implant were placed in the posterior region if implant placement in the anterior region was not possible (n = 25 patients). Variables assessed included survival of implants, condition of hard and soft peri-implant tissues and patients' satisfaction. The five-year implant survival rate was 97·0% and 99·3%, and mean radiographic bone loss was 0·23 and 0·69 mm in the anterior and posterior group, respectively. Median scores for plaque, calculus, gingiva, bleeding and mean scores for pocket probing depth were low and stayed low. Patients' satisfaction after treatment was high in both groups. Within the limits of this 5-year study, it is concluded that six dental implants (placed in the anterior or posterior region) connected with a bar and opposed to natural antagonistic teeth result in acceptable results for clinical parameters and good outcomes for marginal bone level changes and patient satisfaction.

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OBJECTIVE: In postanoxic coma, EEG patterns indicate the severity of encephalopathy and typically evolve in time. We aim to improve the understanding of pathophysiological mechanisms underlying these EEG abnormalities. METHODS: We used a mean field model comprising excitatory and inhibitory neurons, local synaptic connections, and input from thalamic afferents. Anoxic damage is modeled as aggravated short-term synaptic depression, with gradual recovery over many hours. Additionally, excitatory neurotransmission is potentiated, scaling with the severity of anoxic encephalopathy. Simulations were compared with continuous EEG recordings of 155 comatose patients after cardiac arrest. RESULTS: The simulations agree well with six common categories of EEG rhythms in postanoxic encephalopathy, including typical transitions in time. Plausible results were only obtained if excitatory synapses were more severely affected by short-term synaptic depression than inhibitory synapses. CONCLUSIONS: In postanoxic encephalopathy, the evolution of EEG patterns presumably results from gradual improvement of complete synaptic failure, where excitatory synapses are more severely affected than inhibitory synapses. The range of EEG patterns depends on the excitation-inhibition imbalance, probably resulting from long-term potentiation of excitatory neurotransmission. SIGNIFICANCE: Our study is the first to relate microscopic synaptic dynamics in anoxic brain injury to both typical EEG observations and their evolution in time.

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To conduct a systematic review on the clinical outcome of single implant-supported two-unit cantilever FDP's and to conduct a 5-year prospective comparative pilot study of patients with a missing central and lateral upper incisor treated with either a single implant-supported two-unit cantilever FDP or two implants with solitary implant crowns in the aesthetic zone. Medline, Embase and the Cochrane Central Register of Controlled Trials were searched (last search 1 August 2016) for eligible studies. In the comparative pilot study, an implant-cantilever group of five patients with a single implant-supported two-unit cantilever FDP (NobelReplace Groovy Regular Platform) was compared with an implant-implant group of five patients with two adjacent single implant-supported crowns (NobelReplace Groovy Regular Platform) in the aesthetic zone. Implant survival, marginal bone level (MBL) changes, pocket probing depth, papilla index and patient satisfaction were assessed during a 5-year follow-up period. Five of 276 articles were considered eligible for data extraction. Implant survival ranged from 96·6% to 100%. Marginal bone level changes were higher in the anterior region than in the posterior region. Technical complications occurred more often in the posterior than anterior region. In the 5-year comparative pilot study, no clinically significant differences in hard and soft peri-implant tissue levels occurred between both groups. Single implant-supported two-unit cantilever FDP's can be a viable alternative to the placement of two adjacent single implant crowns in the aesthetic zone. Due to technical complications, placement of two-unit cantilever crowns in the posterior region can be considered unwise.

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