Outcomes and influencing factors of dental implants in fibula, iliac crest, and scapula free flaps: a retrospective case-control study

PURPOSE

Reconstruction with vascularized bone grafts after ablative surgery and subsequent dental rehabilitation with implants is often challenging; however, it helps improve the patient's quality of life. This retrospective case-control study aimed to determine the implant survival/success rates in different vascularized bone grafts and potential risk factors.

METHODS

Only patients who received implants in free vascularized bone grafts between 2012 and 2020 were included. The free flap donor sites were the fibula, iliac crest, and scapula. The prosthetic restoration had to be completed, and the observation period had to be over one year after implantation. Implant success was defined according to the Health Scale for Dental Implants criteria.

RESULTS

Sixty-two patients with 227 implants were included. The implant survival rate was 86.3% after an average of 48.7 months. The causes of implant loss were peri-implantitis (n = 24), insufficient osseointegration (n = 1), removal due to tumor recurrence (n = 1), and osteoradionecrosis (n = 5). Of all implants, 52.4% were classified as successful, 19.8% as compromised, and 27.8% as failed. Removal of osteosynthesis material prior to or concurrent with implant placement resulted in significantly better implant success than material not removed (p = 0.035). Localization of the graft in the mandibular region was associated with a significantly better implant survival (p = 0.034) and success (p = 0.002), also a higher Karnofsky Performance Status Scale score with better implant survival (p = 0.014).

CONCLUSION

Implants placed in vascularized grafts showed acceptable survival rates despite the potential risk factors often present in these patient groups. However, peri-implantitis remains a challenge.

The performance of a nitrogen-fixing SBR

A laboratory study has successfully demonstrated that a nitrogen deficient thermomechanical pulping wastewater can be effectively treated in a sequencing batch reactor (SBR) operated under conditions of biological nitrogen fixation (the N-ViroTech process). In comparison to continuous stirred tank reactor activated sludge (CSTR-AS) configurations operated under either nitrogen fixing or nitrogen supplemented conditions, slightly lower removals of dissolved organic material were observed in the SBR. However, this was largely offset by significantly better suspended solids removal in the SBR, which contributes to the overall COD discharge. The settleability and dewaterability of sludge produced by the SBR was significantly better than that obtained from the nitrogen fixing CSTR-AS reactors, and comparable to that of a nitrogen supplemented system. Consistently low total and dissolved nitrogen discharges from the N-ViroTech systems demonstrated the advantage of this system over ones requiring nitrogen supplementation. The feast-famine regime of an SBR-type configuration has significant potential for the application of this technology in the treatment of nitrogen deficient waste streams, particularly those in which conventional single-stage systems may be susceptible to sludge bulking problems.

Characterization of a synthetic peptide impurity by fast-atom bombardment-tandem mass spectrometry and gas chromatography-mass spectrometry

Fast-atom bombardment-tandem mass spectrometry (FAB-MS-MS) was used to characterize the structure of atosiban, a synthetic oxytocin antagonist, and one of its synthesis-related impurities. The nature of the structural modification in the impurity of interest, replacement of the proline residue by 5-aminovaleric acid, was determined directly from its product ion MS-MS spectrum. Confirmation of the identity of the impurity was accomplished with GC-MS.

Characterization of the degradation products of luteinizing hormone releasing hormone

The degradation products of luteinizing hormone releasing hormone [LH/RH; 1; gonadorelin releasing hormone (GnRH); less than Glu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly-NH2] were determined in aqueous solution (pH 6.5) at 25, 37, 50, and 80 degrees C. The predominant route of degradation involved the cleavage of the less than Glu-His and Trp-Ser peptide bonds to give peptides 5-9 and hydrolysis of the terminal Gly-NH2 to the free acid form in peptides 4 and 10. Racemization of the serine and histidine residues to give peptides 2 and 3 was a second route of degradation.

Characterization of the solution degradation products of histrelin, a gonadotropin releasing hormone (LH/RH) agonist

The degradation products of histrelin (1, less than Glu-His-Trp-Ser-Tyr-(D-Nim-bzl-His)-Leu-Arg-Pro-NHEt) were determined in aqueous solution at pH 5.4 and 87 degrees C over an 18-day period (47% degradation). These degradation products (2-5) resulted from the cleavage of less than Glu-His and Trp-Ser peptide bonds, His-Trp diketopiperazine formation, and racemization of serine and histidine residues.

Characterization of the solution degradation products of etintidine, an H2-receptor antagonist

The primary solution degradation products of the antiulcer drug etintidine (1, N"-cyano-N-[2-[[(5-methyl-1H-imidazol-4-yl)methyl]thio]ethyl]- N'-2-propynylguanidine) were determined to be the guanyl urea 2, the guanidine 3, the amine 4a, and the cyanoamine 4b. These products resulted from nitrile hydrolysis and/or intramolecular cyclization of the guanidino and propargyl groups. The amine 4a was found to be a predominant degradation product in aqueous media of pH 4-7 at 70 +/- 0.2 degrees C.

Distinction of alpha- and beta-aspartyl and alpha- and gamma-glutamyl peptides by fast atom bombardment/tandem mass spectrometry

A fast atom bombardment/collisional activation/linked-scan at constant B/E (tandem mass spectrometric) method is described which can distinguish between alpha- and beta-aspartyl and alpha- and gamma-glutamyl underivatized peptides. The method is based upon differences in loss of CO from aspartyl or glutamyl B-fragment ions (IB) in these isomers which are rationalized from the stability of the resultant A-fragment ions (IA). It was observed that the ratio of IB:IA which was used in this determination was dependent upon the collision cell pressure. The higher the collision cell pressure, the larger the difference between the IB:IA ratios for these linkages.

Detection and quantitation of low levels of protected and unprotected (R)-amino acids in the synthesis of thymopentin, an immunoregulatory peptide

Two chiral chromatographic procedures (HPLC and capillary GC) were developed to monitor the extent of epimerization of protected and unprotected amino acids used in a synthesis of thymopentin, an immunoregulatory peptide currently in clinical trials. The capillary GC method allowed the detection of the (R)-enantiomer in the presence of the (S)-enantiomer at levels of greater than or equal to 0.2%, while the HPLC method allowed similar detection at levels of greater than or equal to 0.1%.

Lumi-mestranol and epi-lumi-mestranol

Treatment of lumi-estrone 3-methyl ether (I) with acetylene gave the C-17-epimeric compounds lumi-mestranol (3-methoxy-17 alpha-ethynyl-13 alpha-estra-1,3,5(10)-trien-17 beta-ol, III ) and epi-lumi-mestranol (3-methoxy-17 beta-ethynyl-13 alpha-estra-1,3,5(10)-trien-17 alpha-ol, IV). The structures of the two isomers were assigned on the basis of their molecular rotations and shift-reagent experiments in the NMR. The irradiation of estrone 3-methyl ether (II) to provide compound I was investigated in two solvent systems. Minor products of these reactions were the seco-steroids VII, VIII and X.