Long‐term results of osseointegrated implant‐based dental rehabilitation in oncology patients reconstructed with a fibula free flap
Background Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation. Purpose This retrospective study evaluated the long‐term outcomes of patients who underwent...
Gespeichert in:
| Veröffentlicht in: | Clinical implant dentistry and related research 2018-10, Vol.20 (5), p.852-859 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 859 |
|---|---|
| container_issue | 5 |
| container_start_page | 852 |
| container_title | Clinical implant dentistry and related research |
| container_volume | 20 |
| creator | Pellegrino, Gerardo Tarsitano, Achille Ferri, Agnese Corinaldesi, Giuseppe Bianchi, Alberto Marchetti, Claudio |
| description | Background
Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation.
Purpose
This retrospective study evaluated the long‐term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant‐supported prostheses.
Materials and Methods
In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow‐up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow‐up after implant insertion was 90.2 (range, 20‐204) months.
Results
The overall implant survival rate was 97.2% at the 12‐month follow‐up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12‐month follow‐up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy.
Peri‐implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5‐ and 10‐year follow‐up. The risk of developing peri‐implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%).
Conclusions
Long‐term implant‐related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium‐term follow‐up. Moreover, a relevant peri‐implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri‐implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem. |
| doi_str_mv | 10.1111/cid.12658 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2093397181</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2093397181</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3538-92791030087143fb48744dbbc3e598b7777acfa97b742ea105991a8bd941533a3</originalsourceid><addsrcrecordid>eNp1kbFuHCEQhlHkKHacFHmBCMlNXKwNy-4BpXWxY0snpUlqBCx7xmJhDays69K5zTP6STLOOSkiZZqB0ccv5v8R-kDJGYU6t344o-2qF6_QEeVENKIl4gDOfcsaIqQ8RG9LuSOkpXRF36BDRmjXtT0_Qo-bFLdPP35WlyecXVlCLTiNOJXiko_VbbOubsB-moOOFUijC9wHF6sO8OJWGx981dWniH3EKdoU0naHZxgBVICxKZaaF_ss9ODrLdZ49GYJ0LJzeAx6fodejzoU9_6lH6PvV5ff1tfN5uuXm_XFprGsZ6KRLZeUMEIEpx0bTSd41w3GWOZ6KQyH0nbUkhvetU5T0ktJtTCD7GjPmGbH6NNed87pfnGlqskX6wIs59JSVEskY5JTQQE9-Qe9S0uO8DsFPnK-AjtXQJ3uKZvBs-xGNWc_6bxTlKjndBSko36nA-zHF8XFTG74S_6JA4DzPfDgg9v9X0mtbz7vJX8BCPacJQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2117760216</pqid></control><display><type>article</type><title>Long‐term results of osseointegrated implant‐based dental rehabilitation in oncology patients reconstructed with a fibula free flap</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Pellegrino, Gerardo ; Tarsitano, Achille ; Ferri, Agnese ; Corinaldesi, Giuseppe ; Bianchi, Alberto ; Marchetti, Claudio</creator><creatorcontrib>Pellegrino, Gerardo ; Tarsitano, Achille ; Ferri, Agnese ; Corinaldesi, Giuseppe ; Bianchi, Alberto ; Marchetti, Claudio</creatorcontrib><description>Background
Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation.
Purpose
This retrospective study evaluated the long‐term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant‐supported prostheses.
Materials and Methods
In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow‐up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow‐up after implant insertion was 90.2 (range, 20‐204) months.
Results
The overall implant survival rate was 97.2% at the 12‐month follow‐up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12‐month follow‐up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy.
Peri‐implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5‐ and 10‐year follow‐up. The risk of developing peri‐implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%).
Conclusions
Long‐term implant‐related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium‐term follow‐up. Moreover, a relevant peri‐implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri‐implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem.</description><identifier>ISSN: 1523-0899</identifier><identifier>EISSN: 1708-8208</identifier><identifier>DOI: 10.1111/cid.12658</identifier><identifier>PMID: 30144257</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Alveolar Bone Loss - etiology ; Bone implants ; Bone resorption ; Connective tissues ; Dental Implantation, Endosseous - methods ; Dental Implants ; Dental materials ; Dental Prosthesis, Implant-Supported - methods ; Dental prosthetics ; dental rehabilitation ; Dental restorative materials ; Dentistry ; Dentition ; Female ; Fibula ; Fibula - transplantation ; fibula free flap ; Flaps ; Free Tissue Flaps - surgery ; functional outcomes ; Grafts ; Humans ; implants ; Jaw ; jaw reconstruction ; Male ; Mandibular Reconstruction - methods ; Microvasculature ; Middle Aged ; Mouth Neoplasms - radiotherapy ; Mouth Neoplasms - rehabilitation ; Mucositis ; Osseointegration ; Patients ; Peri-Implantitis - etiology ; Prostheses ; Prosthetics ; Radiation ; Radiation therapy ; Reconstruction ; Rehabilitation ; Retrospective Studies ; Skin ; Skin grafts ; Success ; Surgical implants ; Survival ; Teeth ; Transplants & implants ; Treatment Outcome</subject><ispartof>Clinical implant dentistry and related research, 2018-10, Vol.20 (5), p.852-859</ispartof><rights>2018 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-92791030087143fb48744dbbc3e598b7777acfa97b742ea105991a8bd941533a3</citedby><cites>FETCH-LOGICAL-c3538-92791030087143fb48744dbbc3e598b7777acfa97b742ea105991a8bd941533a3</cites><orcidid>0000-0002-5815-7591</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcid.12658$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcid.12658$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30144257$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pellegrino, Gerardo</creatorcontrib><creatorcontrib>Tarsitano, Achille</creatorcontrib><creatorcontrib>Ferri, Agnese</creatorcontrib><creatorcontrib>Corinaldesi, Giuseppe</creatorcontrib><creatorcontrib>Bianchi, Alberto</creatorcontrib><creatorcontrib>Marchetti, Claudio</creatorcontrib><title>Long‐term results of osseointegrated implant‐based dental rehabilitation in oncology patients reconstructed with a fibula free flap</title><title>Clinical implant dentistry and related research</title><addtitle>Clin Implant Dent Relat Res</addtitle><description>Background
Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation.
Purpose
This retrospective study evaluated the long‐term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant‐supported prostheses.
Materials and Methods
In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow‐up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow‐up after implant insertion was 90.2 (range, 20‐204) months.
Results
The overall implant survival rate was 97.2% at the 12‐month follow‐up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12‐month follow‐up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy.
Peri‐implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5‐ and 10‐year follow‐up. The risk of developing peri‐implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%).
Conclusions
Long‐term implant‐related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium‐term follow‐up. Moreover, a relevant peri‐implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri‐implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem.</description><subject>Alveolar Bone Loss - etiology</subject><subject>Bone implants</subject><subject>Bone resorption</subject><subject>Connective tissues</subject><subject>Dental Implantation, Endosseous - methods</subject><subject>Dental Implants</subject><subject>Dental materials</subject><subject>Dental Prosthesis, Implant-Supported - methods</subject><subject>Dental prosthetics</subject><subject>dental rehabilitation</subject><subject>Dental restorative materials</subject><subject>Dentistry</subject><subject>Dentition</subject><subject>Female</subject><subject>Fibula</subject><subject>Fibula - transplantation</subject><subject>fibula free flap</subject><subject>Flaps</subject><subject>Free Tissue Flaps - surgery</subject><subject>functional outcomes</subject><subject>Grafts</subject><subject>Humans</subject><subject>implants</subject><subject>Jaw</subject><subject>jaw reconstruction</subject><subject>Male</subject><subject>Mandibular Reconstruction - methods</subject><subject>Microvasculature</subject><subject>Middle Aged</subject><subject>Mouth Neoplasms - radiotherapy</subject><subject>Mouth Neoplasms - rehabilitation</subject><subject>Mucositis</subject><subject>Osseointegration</subject><subject>Patients</subject><subject>Peri-Implantitis - etiology</subject><subject>Prostheses</subject><subject>Prosthetics</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>Reconstruction</subject><subject>Rehabilitation</subject><subject>Retrospective Studies</subject><subject>Skin</subject><subject>Skin grafts</subject><subject>Success</subject><subject>Surgical implants</subject><subject>Survival</subject><subject>Teeth</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><issn>1523-0899</issn><issn>1708-8208</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kbFuHCEQhlHkKHacFHmBCMlNXKwNy-4BpXWxY0snpUlqBCx7xmJhDays69K5zTP6STLOOSkiZZqB0ccv5v8R-kDJGYU6t344o-2qF6_QEeVENKIl4gDOfcsaIqQ8RG9LuSOkpXRF36BDRmjXtT0_Qo-bFLdPP35WlyecXVlCLTiNOJXiko_VbbOubsB-moOOFUijC9wHF6sO8OJWGx981dWniH3EKdoU0naHZxgBVICxKZaaF_ss9ODrLdZ49GYJ0LJzeAx6fodejzoU9_6lH6PvV5ff1tfN5uuXm_XFprGsZ6KRLZeUMEIEpx0bTSd41w3GWOZ6KQyH0nbUkhvetU5T0ktJtTCD7GjPmGbH6NNed87pfnGlqskX6wIs59JSVEskY5JTQQE9-Qe9S0uO8DsFPnK-AjtXQJ3uKZvBs-xGNWc_6bxTlKjndBSko36nA-zHF8XFTG74S_6JA4DzPfDgg9v9X0mtbz7vJX8BCPacJQ</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Pellegrino, Gerardo</creator><creator>Tarsitano, Achille</creator><creator>Ferri, Agnese</creator><creator>Corinaldesi, Giuseppe</creator><creator>Bianchi, Alberto</creator><creator>Marchetti, Claudio</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7QP</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5815-7591</orcidid></search><sort><creationdate>201810</creationdate><title>Long‐term results of osseointegrated implant‐based dental rehabilitation in oncology patients reconstructed with a fibula free flap</title><author>Pellegrino, Gerardo ; Tarsitano, Achille ; Ferri, Agnese ; Corinaldesi, Giuseppe ; Bianchi, Alberto ; Marchetti, Claudio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-92791030087143fb48744dbbc3e598b7777acfa97b742ea105991a8bd941533a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Alveolar Bone Loss - etiology</topic><topic>Bone implants</topic><topic>Bone resorption</topic><topic>Connective tissues</topic><topic>Dental Implantation, Endosseous - methods</topic><topic>Dental Implants</topic><topic>Dental materials</topic><topic>Dental Prosthesis, Implant-Supported - methods</topic><topic>Dental prosthetics</topic><topic>dental rehabilitation</topic><topic>Dental restorative materials</topic><topic>Dentistry</topic><topic>Dentition</topic><topic>Female</topic><topic>Fibula</topic><topic>Fibula - transplantation</topic><topic>fibula free flap</topic><topic>Flaps</topic><topic>Free Tissue Flaps - surgery</topic><topic>functional outcomes</topic><topic>Grafts</topic><topic>Humans</topic><topic>implants</topic><topic>Jaw</topic><topic>jaw reconstruction</topic><topic>Male</topic><topic>Mandibular Reconstruction - methods</topic><topic>Microvasculature</topic><topic>Middle Aged</topic><topic>Mouth Neoplasms - radiotherapy</topic><topic>Mouth Neoplasms - rehabilitation</topic><topic>Mucositis</topic><topic>Osseointegration</topic><topic>Patients</topic><topic>Peri-Implantitis - etiology</topic><topic>Prostheses</topic><topic>Prosthetics</topic><topic>Radiation</topic><topic>Radiation therapy</topic><topic>Reconstruction</topic><topic>Rehabilitation</topic><topic>Retrospective Studies</topic><topic>Skin</topic><topic>Skin grafts</topic><topic>Success</topic><topic>Surgical implants</topic><topic>Survival</topic><topic>Teeth</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pellegrino, Gerardo</creatorcontrib><creatorcontrib>Tarsitano, Achille</creatorcontrib><creatorcontrib>Ferri, Agnese</creatorcontrib><creatorcontrib>Corinaldesi, Giuseppe</creatorcontrib><creatorcontrib>Bianchi, Alberto</creatorcontrib><creatorcontrib>Marchetti, Claudio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical implant dentistry and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pellegrino, Gerardo</au><au>Tarsitano, Achille</au><au>Ferri, Agnese</au><au>Corinaldesi, Giuseppe</au><au>Bianchi, Alberto</au><au>Marchetti, Claudio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐term results of osseointegrated implant‐based dental rehabilitation in oncology patients reconstructed with a fibula free flap</atitle><jtitle>Clinical implant dentistry and related research</jtitle><addtitle>Clin Implant Dent Relat Res</addtitle><date>2018-10</date><risdate>2018</risdate><volume>20</volume><issue>5</issue><spage>852</spage><epage>859</epage><pages>852-859</pages><issn>1523-0899</issn><eissn>1708-8208</eissn><abstract>Background
Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation.
Purpose
This retrospective study evaluated the long‐term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant‐supported prostheses.
Materials and Methods
In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow‐up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow‐up after implant insertion was 90.2 (range, 20‐204) months.
Results
The overall implant survival rate was 97.2% at the 12‐month follow‐up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12‐month follow‐up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy.
Peri‐implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5‐ and 10‐year follow‐up. The risk of developing peri‐implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%).
Conclusions
Long‐term implant‐related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium‐term follow‐up. Moreover, a relevant peri‐implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri‐implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>30144257</pmid><doi>10.1111/cid.12658</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5815-7591</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1523-0899 |
| ispartof | Clinical implant dentistry and related research, 2018-10, Vol.20 (5), p.852-859 |
| issn | 1523-0899 1708-8208 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2093397181 |
| source | MEDLINE; Access via Wiley Online Library |
| subjects | Alveolar Bone Loss - etiology Bone implants Bone resorption Connective tissues Dental Implantation, Endosseous - methods Dental Implants Dental materials Dental Prosthesis, Implant-Supported - methods Dental prosthetics dental rehabilitation Dental restorative materials Dentistry Dentition Female Fibula Fibula - transplantation fibula free flap Flaps Free Tissue Flaps - surgery functional outcomes Grafts Humans implants Jaw jaw reconstruction Male Mandibular Reconstruction - methods Microvasculature Middle Aged Mouth Neoplasms - radiotherapy Mouth Neoplasms - rehabilitation Mucositis Osseointegration Patients Peri-Implantitis - etiology Prostheses Prosthetics Radiation Radiation therapy Reconstruction Rehabilitation Retrospective Studies Skin Skin grafts Success Surgical implants Survival Teeth Transplants & implants Treatment Outcome |
| title | Long‐term results of osseointegrated implant‐based dental rehabilitation in oncology patients reconstructed with a fibula free flap |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T06%3A16%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Long%E2%80%90term%20results%20of%20osseointegrated%20implant%E2%80%90based%20dental%20rehabilitation%20in%20oncology%20patients%20reconstructed%20with%20a%20fibula%20free%20flap&rft.jtitle=Clinical%20implant%20dentistry%20and%20related%20research&rft.au=Pellegrino,%20Gerardo&rft.date=2018-10&rft.volume=20&rft.issue=5&rft.spage=852&rft.epage=859&rft.pages=852-859&rft.issn=1523-0899&rft.eissn=1708-8208&rft_id=info:doi/10.1111/cid.12658&rft_dat=%3Cproquest_cross%3E2093397181%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2117760216&rft_id=info:pmid/30144257&rfr_iscdi=true |