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Dental implant
Dental implant | |
Intervention | |
MeSH | D003757 |
A dental implant (also known as an endosteal implant or fixture) is a surgical device used to replace one or more missing teeth by fusing to bone and supporting a crown, bridge of teeth, denture, facial prosthetic or to act as an orthodontic anchor. The term "dental implant" refers to that portion of the structure in the bone. Other functional components may be attached to make the device functional including an abutment, to pass through the gums, an abutment screw to secure the abutment to the implant and prosthetic teeth which attach to the abutment. Collectively, the fixture and components create the dental prosthetic.
The modern dental implant leverages the biologic process of osseointegration where a material (commercially pure titanium, titanium alloy and some ceramics) forms a structural and functional connection between living bone and the surface of a load-bearing artificial implant without causing the body to recognize it as a foreign material. Implantable fixtures to retain teeth are not a new concept. Prior to the discovery of osseointegration, various non-titanium implants were placed in the jawbones (or the periosteum surrounding them) but had high complication rates due to foreign body reactions and amplification of the foreign body response from movement when chewing.
The prerequisites to long term success of dental implants, are healthy bone and gingiva. When a tooth is lost the tissues of the mouth remodel and atrophy preventing the placement of dental implants or lowering long term survival. A group of operations, referred to as pre-prosthetic procedures, have been developed to rebuild the bone height, width, gingiva and connective tissue. In the presence of healthy tissues, a well integrated implant with appropriate biomechanical loads can have long term success rates of 92-96% for the fixture[1] and 10-15 year lifespans for the prosthetic teeth.[2]
Dental implants are used to retain artificial teeth, facial prosthetics or to act as anchor points for orthodontics by making use of osseointegration, the biologic principal where certain metals or ceramics create a connection to living bone to support physical loads, for decades, without failure.
There most basic use in in orthodontics. To move natural teeth through bone, light pressure is applied causing the periodontal ligament to remodel bone, allowing teeth to move in the direction of force. A dental implant, which lacks a periodontal ligament, will not cause bone remodeling under light forces, thereby acting as an orthodontic anchor point to which a spring or wire can be attached to generate the necessary forces.
The principal use of dental implants, however, are to stabilize artificial teeth. When a single tooth is missing, a dental prosthetic (the artificial tooth) can be made using 4 components. The implant fixture, which is placed in bone, a prosthetic abutment which traverses the gingiva and provides a surface for the body to create junctional epithelium, the abutment screw which secures the abutment to the implant fixture and the crown which is cemented to the abutment (diagram). Alternatively, the implant and abutment or the abutment and crown can be one piece.[3]
Dental implants can also be used to retain multiple teeth. Multi-teeth retainers are broadly classified into fixed or removable. Fixed retainers, for small spans are referred to as implant-supported bridges or fixed partial dentures, where teeth attach to "implant abutments" (not to be confused with the "prosthetic abutment", mentioned above) and pontic teeth which span the space of missing teeth fusing to the implant abutments at each end. The entire bridge is one unit with a substructure made of metal or ceramic and a veneer of porcelain overlaid for esthetics. Where an entire arch of teeth is missing, the person is said to be edentulous and a full denture is required.
A fixed full denture can be created in the same manner as a fixed partial denture where a metal or ceramic substructure secures to the implant fixtures and porcelain veneers are added to the substructure for esthetics. Alternatively, a metal substructure can be made with an acrylic prosthetic overlaid, that has an appearance similar to a traditional denture but is fixed to dental implants with abutment screws. In both cases, the prosthetic is said to be fixed because it cannot be removed by the denture wearer.
It is not a requirement that the prosthetic be fixed in place. A removable denture can be created, where implants have a small button, ball, bar or magnetic abutment, that attaches to an analogous female adapters on the underside of the denture. In each solution, the denture can be removed with finger pressure by the denture wearer, and is referred to as an implant supported overdenture.
The same techniques have been used to retain facial prosthetics, like those used to replace facial structures lost due to cancer or battlefield injuries. The implants are placed in the facial bones and custom-made cribs are fabricated to retain the facial prosthetic.
Main articles: Osseointegration and Bridge (dentistry)
- See Prosthetic procedures below for details on the techniques used to attach teeth and implants
Dental implant common uses | ||||||||||||
General considerations
Planning for dental implants focuses on three core areas[4]
- General health condition of the patient
- Local health condition of the mucous membranes and the jaws
- Shape, size, and position of the bones of the jaws, adjacent and opposing teeth
There are few health conditions that absolutely preclude placing implants although there are certain conditions that can increase the risk of failure. Those with poor oral hygiene, heavy smokers and diabetics are all at greater risk for a variant of gum disease that affects implants called peri-implantitis, increasing the chance of long-term failures. Long-term steroid use, osteoporosis and other diseases that affect the bones can increase the risk of early failure of implants.
- see Failure to integrate below for a more detailed discussion about what a failure is and what contributes to it
Bisphosphonate drugs and implants
The use of bone building drugs, like bisphosphonates and anti-RANKL drugs require special consideration with implants, because they've been associated with a disorder called Bisphosphonate-associated osteonecrosis of the jaw (BRONJ). The drugs change bone turnover, which is thought to put people at risk for death of bone when having minor oral surgery. At routine doses (for example, those used to treat routine osteoporosis) the effects of the drugs linger for months or years but the risk appears to be very low. Because of this duality, uncertainty exists in the dental community about how to best manage the risk of BRONJ when placing implants. A 2009 position paper by the American Association of Oral & Maxillofacial Surgeons, discussed that the risk of BRONJ from low dose oral therapy (or slow release injectable) as between 0.01% - 0.06% for any procedure done on the jaws (implant, extraction, etc...). The risk is higher with intravenous therapy, procedures on the lower jaw, people with other medical issues, those on steroids, those on more potent bisphosphonates and people who have taken the drug for more than 3 years. The position paper recommends against placing implants in people who are taking high dose/high frequency intravenous therapy for cancer care. Otherwise, implants can generally be placed.[5]
Biomechanical considerations
The long-term success of implants is determined, in part, by the forces they have to support. As implants have no periodontal ligament, there is no sensation of pressure when biting so the forces created are higher. To offset this, the location of implants must distribute forces evenly across the prosthetics they support.[6] Concentrated forces can result in fracture of the bridgework, implant components, or loss of bone adjacent the implant.[7] The ultimate location of implants is based on both biologic (bone type, vital structures, health) and mechanical factors. Implants placed in thicker, stronger bone like that found in the front part of the bottom jaw have lower failure rates than implants placed in lower dentisity bone, such as the back part of the upper jaw. People who grind their teeth also increase the force on implants and increase the likelihood of early and late failures.[8]
The design of implants, has to account for a lifetime of real-world use in a person's mouth. Regulators and the dental implant industry have created a series of tests to determine the long-term mechanical reliability of implants in a person's mouth by putting the implants in function until the point of failure.[9]
When a more exacting plan is needed beyond clinical judgment, the dentist will make an acrylic guide (called a stent) prior to surgery which guides optimal positioning of the implant. Increasingly, dentists opt to get a CT scan of the jaws and any existing dentures, then plan the surgery on CAD/CAM software. The stent can then be made using stereolithography following computerized planning of a case from the CT scan. The use of CT scanning in complex cases also helps the surgeon identify and avoid vital structures such as the inferior alveolar nerve and the sinus.[10],[11]
Planning with CT scans, stents and models | |||||||||
Core surgical procedures[edit]
Most implant systems have five basic steps for placement of each implant:[12]
1. Soft tissue reflection: An incision is made over the crest of bone, splitting the thicker attached gingiva roughly in half so that the final implant will have a thick band of tissue around it. The edges of tissue, each referred to as a flap are pushed back to expose the bone. Flapless surgery is an alternate technique, where a small punch of tissue (the diameter of the implant) is removed for implant placement rather than raising flaps.[13]
2. Drilling at high speed: After reflecting the soft tissue, and using a surgical guide/stent as necessary, pilot holes are placed with precision drills at highly regulated speed[14] to prevent burning or pressure necrosis of the bone.
3. Drilling at low speed: The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the osteoblast or bone cells by overheating. A cooling saline or water spray keeps the temperature of the bone to below 47 degrees Celsius (approximately 117 degrees Fahrenheit).
4. Placement of the implant: The implant screw is placed and can be self-tapping, otherwise the prepared site is tapped with an implant analog. It is then screwed into place at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone).
5. Tissue adaptation: The gingiva is adapted around the entire implant to provide a thick band of healthy tissue around the healing abutment. In contrast, an implant can be "buried", where the top of the implant is sealed with a cover screw and the tissue is closed to completely over it. A second procedure would then be required to uncover the implant at a later date.
Surgical implant placement | ||||||||||||
Timing of implants after extraction of teeth
There are different approaches to placement dental implants after tooth extraction. The approaches are:
- Immediate post-extraction implant placement.
- Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).
- Late implantation (3 months or more after tooth extraction).
There are also various options for the loading of dental implants, classified into:
- Immediate loading procedure.
- Early loading (1 week to 12 weeks).
- Delayed loading (over 3 months)
Healing time
For an implant to become permanently stable, the body must grow bone to the surface of the implant (osseointegration). Based on this biologic process, it was thought that loading an implant during the osseointegration period would result in movement that would prevent osseointegration, and thus increase implant failure rates. As a result, 3–6 months of integrating time (depending on various factors) was allowed before placing the teeth on implants (restoring them).[3]
However, later research suggests that the initial stability of the implant in bone is a more important determinant of success of implant integration, rather than a certain period of healing time. As a result, the time allowed to heal is typically based on the density of bone the implant is placed in and the number of implants splinted together, rather than a uniform amount of time. When implants can withstand high torque (35Ncm) and are splinted to other implants, there are no meaningful differences in long-term implant survival or bone loss between implants loaded immediately, at 3 months, or at 6 months.[15] The corollary is that single implants, even in solid bone, require a period of no-load to minimize the risk of initial failure,[16]
Main article: Osseointegration
One-stage, two-stage surgery
After an implant is placed, the internal components are covered with either a healing abutment, or a cover screw. A healing abutment passes through the mucosa, and the surrounding mucosa is adapted around it. A cover screw is flush with the surface of the dental implant, and is designed to be completely covered by mucosa. After an integration period, a second surgery is required to reflect the mucosa and place a healing abutment.
In the early stages of implant development (1970−1990), implant systems used a two-stage approach, believing that it improved the odds of initial implant survival. Subsequent research proved that no difference in implant survival existed between one-stage and two-stage surgeries, and the choice of whether or not to 'bury' the implant in the first stage of surgery became a concern of soft tissue (gingiva) management[17],.[18]
When tissue is deficient or mutilated by the loss of teeth, implants are placed and allowed to osseointegrate, then the gingiva is surgically moved around the healing abutments. The down-side of a two-stage technique is the need for additional surgery and compromise of circulation to the tissue due to repeated surgeries.[19] The choice of one vs two-stages, now centers around how best to reconstruct the soft tissues around lost teeth.
Immediate placement
An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. One the one hand, it shortens treatment time and can improve esthetics because the soft tissue envelope is preserved. On the other hand, implants may have a slightly higher rate of initial failure. Conclusions on this topic are difficult to draw, however, because few studies have compared immediate vs delayed implants in a scientifically rigorous manner.[20]
Adjunctive surgical procedures (bone grafting and soft tissue surgery)[edit]
In order for an implant to osseointegrate, it needs to be surrounded by a healthy quantity of bone. In order for it to survive long-term, it needs to have a thick healthy soft tissue (gingiva envelope around it. It is common for either the bone or soft tissue to be so deficient that the surgeon needs to reconstruct it either before or during implant placement.
Hard tissue (bone) reconstruction
Bone grafting is necessary when there is a lack of bone. While there are always new implant types and techniques to allow compromise, a general treatment goal is to have a minimum of 10 mm in bone height, and 6 mm in width. Alternatively, bone defects are graded from A to D (A=10+ mm of bone, B=7–9 mm, C=4–6 mm and D=0–3 mm) where an implant's likelihood of osseointegrating is related to the grade of bone.[21]
To achieve an adequate width and height of bone, various bone grafting techniques have been developed. The most frequently used is called guided bone graft augmentation where a defect is filled with either natural (harvested or autograft) bone or allograft (donor bone or synthetic bone substitute), covered with a semi-permeable membrane and allowed to heal. During the healing phase, natural bone replaces the graft forming a new bony base for the implant.
Three common procedures are:[22]
- The sinus lift
- Lateral alveolar augmentation (increase in the width of a site)
- Vertical alveolar augmentation (increase in the height of a site)
Other, more invasive procedures, also exist for larger bone defects including mobilization of the inferior alveolar nerve to allow placement of a fixture, onlay bone grafting using the iliac crest or another large source of bone and microvascular bone graft where the blood supply to the bone is transplanted with the source bone and reconnected to the local blood supply.[23] The final decision about which bone grafting technique is best is based on an assessment of the degree of vertical and horizontal bone loss that exists, each of which is classified into mild (2-3 mm loss), moderate (4-6 mm loss) or severe (greater than 6 mm loss).[24]
Bone grafting types | |||||||||
Soft tissue (gingiva) reconstruction
The gingiva surrounding a tooth has a 2–3 mm band of bright pink, very strong attached mucosa, then a darker, larger area of unattached mucosa that folds into the cheeks. When replacing a tooth with an implant, a band of strong, attached gingiva is needed to keep the implant healthy in the long-term. This is especially important with implants because the blood supply is more precarious in the gingiva surrounding an implant, and is theoretically more susceptible to injury because of a longer attachment to the implant than on a tooth (a longer biologic width).
When an adequate band of attached tissue is absent, it can be recreated with a soft tissue graft. There are various methods to accomplish this by either taking a roll of tissue adjacent an implant (palatal roll), transplanting gingiva from the palate, transplanting the underlying connective tissue from the palate or creating a finger of tissue based on a blood vessel in the palate (vascularized interpositional periosteal-connective tissue (VIP-CT) flap).[25]
Additionally, for an implant to look esthetic, a band of full, plump gingiva is needed to fill in the space on either side of implant.
The most common soft tissue complication is called a black-triangle, where the papilla (the small triangular piece of tissue between two teeth) shrinks back and leaves a triangular void between the implant and the adjacent teeth. Dentists can only expect 2–4 mm of papilla height over the underlying bone. A black triangle can be expected if the distance between where the teeth touch and bone is any greater.[26]
Gingival grafting types | |||||||||
Prosthetic procedures[edit]
The prosthetic phase begins once the implant is well integrated (or has a reasonable assurance that it will integrate) and an abutment is in place to bring it through the mucosa. Even in the event of early loading, most practitioners will place temporary teeth until osseointegration is confirmed. The prosthetic phase of restoring an implant requires an equal amount of technical expertise as the surgical because of the biomechanical considerations, especially when multiple teeth are to be restored. The dentist will work to restore the vertical dimension of occlusion, the esthetics of the smile, and the structural integrity of the teeth to evenly distribute the forces of the implants.[27]
Prosthetic procedures for single teeth, bridges and fixed dentures
An abutment is selected depending on the application. In many single crown and fixed partial denture scenarios (bridgework), custom abutments are used. An impression of the top of the implant is made with the adjacent teeth and gingiva. A dental lab then simultaneously fabricates an abutment and crown. The abutment is seated on the implant, a screw passes through the abutment to secure the it to an internal thread on the implant (lag-screw). There are variations on this, such as when the abutment and implant body are one piece or when a stock (prefabricated) abutment is used. Custom abutments can be made by hand, as a cast metal piece or custom milled from metal or zirconia. Both have similar long-term outcomes.[28]
The platform between the implant and the abutment can be flat (buttress) or conical fit. In conical fit abutments, the collar of the abutment sits inside the implant which allows a stronger junction between implant and abutment and a better seal against bacteria into the implant body. To improve the gingival seal around the abutment collar, a narrowed collar on the abutment is used, referred to as platform switching. The combination of conical fits and platform switching gives marginally better long term periodontal conditions compared to flat-top abutments.[29]
Regardless of the abutment material or technique, an impression of the abutment is then taken and a crown secured to the abutment with dental cement. Another variation on abutment/crown model is when the crown and abutment are one piece and the lag-screw traverses both to secure the one-piece structure to the internal thread on the implant.
Prosthetic procedures for removable dentures
When a removable denture is worn, retainers to hold the denture in place can be either custom made or "off-the-shelf" (stock) abutments. With custom retainers, an impression of the implants is taken and a dental lab creates a custom metal bar with attachments to hold the denture in place. Significant retention can be created with multiple attachments and the use of semi-precision attachments (such as a small diameter pin that pushes through the denture and into the bar) which allows for little or no movement in the denture, but it remains removable. The downside of these types of removable solutions is their bulk and high cost compared to stock abutments. Additionally, a similar number of implants, angled in such a way to distribute occlusal forces can safely hold a fixed denture in place with comparable costs and number of procedures giving the denture wearer a fixed solution.[30],[31]
Alternatively, stock abutments are used to retain dentures using a male-adapter attached to the implant and a female adapter in the denture. Two common types of adapters are the ball-and-socket style retainer and the button-style adapter. These types of stock abutments allow movement of the denture, but enough retention to improve the quality of life for denture wearers at a lower cost than custom solutions.[32] Regardless of the type of adapter, the female potion of the adapter that is housed in the denture will require periodic replacement.
Overdenture options | |||||||||
Maintenance procedures[edit]
After placement, implants need to be cleaned (similar to natural teeth) with a Teflon instrument to remove any plaque. Because of the more precarious blood supply to the gingiva, care should be taken with dental floss. Implants will lose bone at a rate similar to natural teeth in the mouth (e.g. if someone suffers from periodontal disease, an implant can be affected by a similar disorder) but will otherwise last. The porcelain on crowns should be expected to discolour, fracture or require repair approximately every 10 years, although there is significant variation in the service life of dental crowns based on the position in the mouth, the forces being applied from opposing teeth and the restoration material. Where implants are used to retain a complete denture, depending on the type of attachment, connections need to be changed or refreshed every 1–2 years.[33]
Risks and complications[edit]
During surgery[edit]
Placement of dental implants is a surgical procedure and carries the normal risks of surgery including infection, excessive bleeding and necrosis of the flap of tissue around the implant. Because the surgeon is blind to the location of the tip of the drill when it is in the bone, nearby anatomic structures can also be injured such as the inferior alveolar nerve, the maxillary sinus and blood vessels. An inability to place the implant in bone to provide stability of the implant (referred to as primary stability of the implant) increases the risk of failure to osseointegration.[34]
Immediately after surgery and the first 6 months[edit]
Immediate post-operative risks
- Infection (pre-op antibiotics reduce the risk of implant failure by 33% but have no impact on the risk of infection)[35]
- Excessive bleeding[34]
- Flap breakdown (<5%)[34]
Failure to Integrate
An implant is tested between 8 and 24 weeks to determine if it's integrated. There is significant debate as to which factors best determine whether or not an implant has successfully integrated,[36] but common tests are;
- is it clinically stable?
- can it withstand a torque of 35Ncm?
- does it appear confluent with the bone on xray?
- it is free of pain and any signs of inflammation?
Dental implant success is related to operator skill, quality and quantity of the bone available at the site, and the patient's oral hygiene but the most important factor is primary implant stability. While there is significant variation in the rate that implants fail to integrate (due to individual risk factors), the approximate values are 1-6%[34],[15]
Long term based on type of prosthesis[edit]
The long-term complications that result from restoring teeth with implants relate, directly, to the risk factors of the patient and the technology. There are the risks associated with esthetics including a high smile line, poor gingival quality and missing papillae, difficulty in matching the form of natural teeth that may have unequal points of contact or uncommon shapes, bone that is missing, atrophied or otherwise shaped in an unsuitable manner, unrealistic expectations of the patient or poor oral hygiene. The risks can be related to biomechanical factors, where the geometry of the implants does not support the teeth in the same way the natural teeth did such as when there are cantilevered extensions, fewer implants than roots or teeth that are longer than the implants that support them (a poor crown-to-root ratio). Similarly, grinding of the teeth, lack of bone or low diameter implants increase the biomechanical risk. Finally there are technological risks, where the implants themselves can fail due to fracture or a loss of retention to the teeth they're intended to support.[37]
From these theoretical risks, derive the real world complications.
Loss of integration to bone
Long-term failures are due to either loss of bone around the tooth and/or gingiva due to peri-implantitis or a mechanical failure of the implant. Because there is no dental enamel on an implant, it does not fail due to cavities like natural teeth. While large-scale, long-term studies are scarce, one long-term retrospective study found overall, implant failure was 8.16% in the maxilla and 4.93% in the mandible overall.[1] The risk of the prosthetic (the teeth supported by the implants) failing is roughly four-times that of the implant themselves failure.[38] In early implants, all crowns where attached to the teeth with screws, but more recent advancements have allowed placement of crowns on the abutments with dental cement (akin to placing a crown on a tooth). This has created the potential for cement, that escapes from under the crown during cementation to get caught in the gingiva and create a peri-implantitis (see picture below). While the complication can occur, there does not appear to be any additional peri-implantitis in cement-retained crowns compared to screw-retained crowns overall.[39]
Main article: Peri-implantitis
Complications associated with single crown implants (5-year)
- Implant survival: 96.8%[40]
- Crown fracture: a) metal-ceramic: 95.4%, all-ceramic; 95.4% (cumulative rate of ceramic or veneer fracture: 4.5%)[40]
- Peri-implantitis: 9.7%[40]
- Implant fracture: 0.14%[40]
- Screw or abutment loosening: 12.7%[40]
- Abutment screw fracture: 0.35%[40]
Complications associated with fixed complete dentures
- Progressive vertical bone loss but still in function (Peri-implantitis)
- Failure after the first year (5-12 year follow-up for complete denture, lower jaw 7%, upper jaw 16%)[41]
- Incidence of veneer fracture at:
- 10-year incidence of framework fracture: 6% (95% CI 2.6-9.3%)[2]
- 10-year incidence of esthetic deficiency: 6.1% (95% CI 2.4-9.7%)[2]
- 15-year incidence of prosthetic screw loosening: 15% (95% CI 8.2-21.3%)[2]
The most common complication being fracture or wear of the tooth structure, especially beyond 10 years.[2]
Complications associated with removable dentures (overdentures)
- Loosening of removable denture retention: 33%[42]
- Dentures needing to be relined or having a retentive clip fracture: 16-19%[42]
Gallery of complications | ||||||||||||||
Common types of implants[edit]
- root form implants; the most common type of implant indicated for all uses. Within the root form type of implant, there are roughly 18 variants, all made of Titanium but with different shapes and surface textures. There is limited evidence showing that implants with relatively smooth surfaces are less prone to peri-mplantitis than implants with rougher surfaces and no evidence showing that any particular type of dental implant has superior long-term success.[43]
- zygomatic implants; a long implant that can anchor to the cheek bone by passing through the maxillary sinus to retain a complete upper denture when bone is absent. While a novel approach to severe bone loss in the upper jaw, it has not been shown to offer any advantage over bone grafting[44]
- small diameter implants; implants of low diameter with one piece construction (implant and abutment) that are sometimes used for denture retention or orthodontic anchorage.
Common implant types | |||||||||
Composition of implants[edit]
A typical implant consists of a titanium screw (resembling a tooth root) with a roughened or smooth surface. The majority of dental implants are made out of commercially pure titanium, which is available in 4 grades depending upon the amount of carbon, nitrogen, oxygen and iron contained.[45] Cold work hardened CP4 (maximum impurity limits of N .05%, C .10%, H .015%, Fe .50%, O .40%) is the most commonly used titanium for implants. Grade 5 titanium, Titanium 6AL-4V, (signifying the Titanium alloy containing 6% Aluminium and 4% Vanadium alloy) is slightly harder than CP4 and used in the industry mostly for abutment screws and abutments. Most modern dental implants also have a textured surface (through etching, anodic oxidation or various-media blasting) to increase the surface area and osseointegration potential of the implant.
Implant dentistry is the second oldest discipline in dentistry (oral surgery is considered to be the first).[46] Root form implants have been used for thousands of years.[46][47] 4000 years ago, the ancient Chinese used carved bamboo pegs, tapped into the bone, to replace lost teeth.[46][47] 2000 years ago the ancient Egyptians used similarly shaped pegs made of precious metals.[46][47] Some Egyptian mummies were found to have transplanted human teeth, and in other instances, teeth made of ivory.[48][47]
A metal tooth, made of wrought iron, was found in the skull of a man who died around 100 AD, and was buried in a Gallo-Roman graveyard near present-day Essonne, France. It had been pounded into the socket, and subsequent bone formation around the implant suggests that it had integrated into the jaw.[49]
One of the most remarkable finds was by Dr. and Mrs. Wilson Popenoe in 1931, at an archaeological site in Honduras dating back to 600 AD.[46][47][48][50][51] It was the lower mandible of a young Mayan woman, with three missing incisors replaced by pieces of shell, shaped to resemble teeth. Bone growth around two of the implants, and the formation of calculus, indicates that they were functional as well as esthetic. The fragment is currently part of the Osteological Collection of the Peabody Museum of Archaeology and Ethnology at Harvard University.
In the 1950s research was being conducted at Cambridge University in England to study blood flow in vivo. These workers devised a method of constructing a chamber of titanium which was then embedded into the soft tissue of the ears of rabbits. In 1952 the Swedish orthopaedic surgeon, P I Brånemark, was interested in studying bone healing and regeneration, and adopted the Cambridge designed 'rabbit ear chamber' for use in the rabbit femur. Following the study, he attempted to retrieve these expensive chambers from the rabbits and found that he was unable to remove them. Per Brånemark observed that bone had grown into such close proximity with the titanium that it effectively adhered to the metal. Brånemark carried out further studies into this phenomenon, using both animal and human subjects, which all confirmed this unique property of titanium.
Although Brånemark had originally considered that the first work should centre on knee and hip surgery, he finally decided that the mouth was more accessible for continued clinical observations and the high rate of edentulism in the general population offered more subjects for widespread study. He termed the clinically observed adherence of bone with titanium as 'osseointegration'. In 1965 Brånemark, who was by then the Professor of Anatomy at Gothenburg University in Sweden, placed his first titanium dental implant into a human volunteer.
Over the next fourteen years Brånemark published studies on the use of titanium in dental implantology. The hybrid bridge on Brånemark implants was a concept of good clinical results. In 1978 he entered into a commercial partnership with the Swedish defense company, Bofors AB for the development and marketing of his dental implants. With Bofors (later to become Nobel Industries) as the parent company, Nobelpharma AB (later to be renamed Nobel Biocare) was founded in 1981 to focus on dental implantology. Initially, dental implants where intended for those who needed to retain complete dentures, but the technology and markets evolved into the more modern uses in the 1980s. As the technology developed, other companies such as Straumann that where already producing osteosynthesis plates then developed their own technology for dental implants.
- ^ a b Moy, P. K.; Medina, D.; Shetty, V.; Aghaloo, T. L. (2005). "Dental implant failure rates and associated risk factors". The International journal of oral & maxillofacial implants 20 (4): 569–577. PMID 16161741.
- ^ a b c d e f g h Bozini, T.; Petridis, H.; Garefis, K.; Garefis, P. (2011). "A meta-analysis of prosthodontic complication rates of implant-supported fixed dental prostheses in edentulous patients after an observation period of at least 5 years". The International journal of oral & maxillofacial implants 26 (2): 304–318. PMID 21483883.
- ^ a b Branemark, Per-Ingvar; Zarb, Geroge (1989) [1985]. Tissue-integrated prostheses (in English). Berlin, German: Quintessence Books. pp. 211–232. ISBN 0-86715-129-3.
- ^ Branemark, Per-Ingvar; Zarb, Geroge (1989) [1985]. Tissue-integrated prostheses (in English). Berlin, German: Quintessence Books. p. 199. ISBN 0-86715-129-3.
- ^ "American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaw—2009 Update". AAOMS. January 2009. Retrieved 5 November 2013.
- ^ Branemark, Per-Ingvar (1992). Worthington, Philip, ed. Advanced osseointegration surgery: applications in the maxillofacial region (in english). Carol Stream, Illinois: quintessence Books. pp. 15–39. ISBN 0-86715-242-7.
- ^ Pallaci, Patrick (1995). Optimal implant positioning and soft tissue management for the Branemark system (in english). Germany: Quintessence Books. pp. 21–33. ISBN 0867153083.
- ^ Branemark, Per-Ingvar; Zarb, Geroge (1989) [1985]. Tissue-integrated prostheses (in English). Berlin, German: Quintessence Books. pp. 201–208. ISBN 0-86715-129-3.
- ^ "Guidance for Industry and FDA Staff - Class II Special Controls Guidance Document: Root-form Endosseous Dental Implants and Endosseous Dental Abutments". FDA. 2004-05-12. Retrieved 2013-11-11.
- ^ Spector, L. (2008). "Computer-Aided Dental Implant Planning". Dental Clinics of North America 52 (4): 761–775, vi. doi:10.1016/j.cden.2008.05.004. PMID 18805228.
- ^ Viegas, V. N.; Dutra, V.; Pagnoncelli, R. R. M.; De Oliveira, M. L. G. (2010). "Transference of virtual planning and planning over biomedical prototypes for dental implant placement using guided surgery". Clinical Oral Implants Research 21 (3): 290–295. doi:10.1111/j.1600-0501.2009.01833.x. PMID 20074239.
- ^ Branemark, Per-Ingvar; Zarb, Geroge (1989) [1985]. Tissue-integrated prostheses (in English). Berlin, German: Quintessence Books. pp. 214–221. ISBN 0-86715-129-3.
- ^ Becker, W.; Goldstein, M.; Becker, B. E.; Sennerby, L.; Kois, D.; Hujoel, P. (2009). "Minimally Invasive Flapless Implant Placement: Follow-Up Results from a Multicenter Study". Journal of Periodontology 80 (2): 347–352. doi:10.1902/jop.2009.080286. PMID 19186977.
- ^ Brisman, D. L. (1996). "The effect of speed, pressure, and time on bone temperature during the drilling of implant sites". The International journal of oral & maxillofacial implants 11 (1): 35–37. PMID 8820120.
- ^ a b Esposito, M.; Grusovin, M. G.; Maghaireh, H.; Worthington, H. V. (2013). "Interventions for replacing missing teeth: Different times for loading dental implants". In Esposito, Marco. The Cochrane database of systematic reviews 3: CD003878. doi:10.1002/14651858.CD003878.pub5. PMID 23543525.
- ^ Atieh, M. A.; Atieh, A. H.; Payne, A. G.; Duncan, W. J. (2009). "Immediate loading with single implant crowns: A systematic review and meta-analysis". The International journal of prosthodontics 22 (4): 378–387. PMID 19639076.
- ^ Friberg, B.; Jemt, T. (2013). "Rehabilitation of Edentulous Mandibles by Means of Osseointegrated Implants: A 5-Year Follow-Up Study on One or Two-Stage Surgery, Number of Implants, Implant Surfaces, and Age at Surgery". Clinical Implant Dentistry and Related Research: n/a. doi:10.1111/cid.12116. PMID 23879577.
- ^ Byrne, G. (2010). "Outcomes of one-stage versus two-stage implant placement". Journal of the American Dental Association (1939) 141 (10): 1257–1258. PMID 20884929.
- ^ Sclar, Anthony (2003). Soft tissue and esthetic considerations in implant dentistry (in english). Carol Stream, IL: Quintessence Books. pp. 9–12. ISBN 0867153547.
- ^ Esposito, M.; Grusovin, M. G.; Polyzos, I. P.; Felice, P.; Worthington, H. V. (2010). "Timing of implant placement after tooth extraction: Immediate, immediate-delayed or delayed implants? A Cochrane systematic review". European journal of oral implantology 3 (3): 189–205. PMID 20847990.
- ^ Buser, Daniel; Schenk, Robert K (1994). Dahlin, Christer, ed. Guided bone regeneration in implant dentistry (in english). Hong Kong: Quintessence Books. p. 250. ISBN 0867152494.
- ^ Buser, Daniel; Schenk, Robert K (1994). Dahlin, Christer, ed. Guided bone regeneration in implant dentistry (in english). Hong Kong: Quintessence Books. p. 236. ISBN 0867152494.
- ^ Branemark, Per-Ingvar (1992). Worthington, Philip, ed. Advanced osseointegration surgery: applications in the maxillofacial region (in english). Carol Stream, Illinois: quintessence Books. pp. 5–6. ISBN 0-86715-242-7.
- ^ Laskin, Daniel (2007). Decision making in oral and maxillofacial surgery. Chicago: Quintessence Pub. Co. p. 17. ISBN 978-0-86715-463-4.
- ^ Sclar, Anthony (2003). Soft tissue and esthetic considerations in implant dentistry (in english). Carol Stream, IL: Quintessence Books. pp. 113–188. ISBN 0867153547.
- ^ Tarnow, D.; Elian, N.; Fletcher, P.; Froum, S.; Magner, A.; Cho, S. C.; Salama, M.; Salama, H.; Garber, D. A. (2003). "Vertical Distance from the Crest of Bone to the Height of the Interproximal Papilla Between Adjacent Implants". Journal of Periodontology 74 (12): 1785–1788. doi:10.1902/jop.2003.74.12.1785. PMID 14974820.
- ^ Branemark, Per-Ingvar; Zarb, Geroge (1989) [1985]. Tissue-integrated prostheses (in English). Berlin, German: Quintessence Books. pp. 241–251. ISBN 0-86715-129-3.
- ^ Esquivel-Upshaw, J. F.; Clark, A. E.; Shuster, J. J.; Anusavice, K. J. (2013). "Randomized Clinical Trial of Implant-Supported Ceramic-Ceramic and Metal-Ceramic Fixed Dental Prostheses: Preliminary Results". Journal of Prosthodontics: n/a. doi:10.1111/jopr.12066. PMID 23758092.
- ^ Atieh, M. A.; Ibrahim, H. M.; Atieh, A. H. (2010). "Platform Switching for Marginal Bone Preservation Around Dental Implants: A Systematic Review and Meta-Analysis". Journal of Periodontology 81 (10): 1350–1366. doi:10.1902/jop.2010.100232. PMID 20575657.
- ^ Balshi, T. J.; Wolfinger, G. J.; Slauch, R. W.; Balshi, S. F. (2013). "A Retrospective Analysis of 800 Brånemark System Implants Following the All-on-Four™ Protocol". Journal of Prosthodontics: n/a. doi:10.1111/jopr.12089. PMID 23890014.
- ^ Patzelt, S. B. M.; Bahat, O.; Reynolds, M. A.; Strub, J. R. (2013). "The All-on-Four Treatment Concept: A Systematic Review". Clinical Implant Dentistry and Related Research: n/a. doi:10.1111/cid.12068. PMID 23560986.
- ^ Dias, R.; Moghadam, M.; Kuyinu, E.; Jahangiri, L. (2013). "Patient satisfaction survey of mandibular two-implant–retained overdentures in a predoctoral program". The Journal of Prosthetic Dentistry 110 (2): 76–81. doi:10.1016/S0022-3913(13)60343-1. PMID 23929368.
- ^ Branemark, Per-Ingvar (1992). Worthington, Philip, ed. Advanced osseointegration surgery: applications in the maxillofacial region (in english). Carol Stream, Illinois: quintessence Books. p. 76. ISBN 0-86715-242-7.
- ^ a b c d Branemark, Per-Ingvar (1992). Worthington, Philip, ed. Advanced osseointegration surgery: applications in the maxillofacial region (in english). Carol Stream, Illinois: quintessence Books. p. 68. ISBN 0-86715-242-7.
- ^ Esposito, M.; Grusovin, M. G.; Talati, M.; Coulthard, P.; Oliver, R.; Worthington, H. V. (2008). Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. In Esposito, Marco. "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews (3): CD004152. doi:10.1002/14651858.CD004152.pub2. PMID 18646101.
- ^ Albrektsson, T.; Zarb, G. A. (1993). "Current interpretations of the osseointegrated response: Clinical significance". The International journal of prosthodontics 6 (2): 95–105. PMID 8329101.
- ^ Renouard, Frank (1999). Risk Factors in Implant Dentistry: Simplified Clinical Analysis for Predictable Treatment [Facteurs de risqué et traitements implantaires.] (in english). Paris, France: Quintessence International. pp. 27–51. ISBN 0867153555.
- ^ Dhima, M.; Paulusova, V.; Lohse, C.; Salinas, T. J.; Carr, A. B. (2013). "Practice-Based Evidence from 29-Year Outcome Analysis of Management of the Edentulous Jaw Using Osseointegrated Dental Implants". Journal of Prosthodontics: n/a. doi:10.1111/jopr.12084. PMID 23889912.
- ^ De Brandão, M. L.; Vettore, M. V.; Vidigal Júnior, G. M. (2013). "Peri-implant bone loss in cement- and screw-retained prostheses: Systematic review and meta-analysis". Journal of Clinical Periodontology 40 (3): 287–295. doi:10.1111/jcpe.12041. PMID 23297703.
- ^ a b c d e f Jung, R. E.; Pjetursson, B. E.; Glauser, R.; Zembic, A.; Zwahlen, M.; Lang, N. P. (2008). "A systematic review of the 5-year survival and complication rates of implant-supported single crowns". Clinical Oral Implants Research 19 (2): 119–130. doi:10.1111/j.1600-0501.2007.01453.x. PMID 18067597.
- ^ Branemark, Per-Ingvar; Zarb, Geroge (1989) [1985]. Tissue-integrated prostheses (in English). Berlin, German: Quintessence Books. p. 183. ISBN 0-86715-129-3.
- ^ a b Goodacre, C. J.; Bernal, G.; Rungcharassaeng, K.; Kan, J. Y. K. (2003). "Clinical complications with implants and implant prostheses". The Journal of Prosthetic Dentistry 90 (2): 121–132. doi:10.1016/S0022-3913(03)00212-9. PMID 12886205.
- ^ Esposito, M.; Murray-Curtis, L.; Grusovin, M. G.; Coulthard, P.; Worthington, H. V. (2007). Interventions for replacing missing teeth: different types of dental implants. In Esposito, Marco. "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews (4): CD003815. doi:10.1002/14651858.CD003815.pub3. PMID 17943800.
- ^ Esposito, M.; Worthington, H. V. (2013). Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla. In Esposito, Marco. "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews 9: CD004151. doi:10.1002/14651858.CD004151.pub3. PMID 24009079.
- ^ Arturo N. Natali (ed.) (2003). "Dental Biomechanics". Taylor & Francis, London / New York, 273 pp., ISBN 978-0-415-30666-9, pp. 69-87.
- ^ a b c d e Misch, Carl E. (2007). Contemporary Implant Dentistry. St. Louis, Missouri: Mosby Elsevier. p. 26. ISBN 9780323043731.
- ^ a b c d e Balaji, S. M. (2007). Textbook of Oral and Maxillofacial Surgery. New Delhi: Elsevier India. pp. 301–302. ISBN 978-81-3120-300-2.
- ^ a b Anusavice, Kenneth J. (2003). Phillips' Science of Dental Materials. St. Louis, Missouri: Saunders Elsevier. p. 6. ISBN 978-0-7020-2903-5.
- ^ "Iron False Tooth Discovered from 1,900 Years Ago". The Times. 12 January 1998.
- ^ Ring, Malvin E. (1993). Dentistry: An Illustrated History. New York: Harry N Abrams. ISBN 978-0810981164.
- ^ Wingrove, Susan S. (2013). Peri-Implant Therapy for the Dental Hygienist: Clinical Guide to Maintenance and Disease Complications. Wiley-Blackwell. pp. 1–2. ISBN 978-0-470-96285-5.
- Branemark, Per-Ingvar; Zarb, Geroge (1989) [1985]. Tissue-integrated prostheses (in English). Berlin, German: Quintessence Books. ISBN 0-86715-129-3.
- Branemark, Per-Ingvar (1992). Worthington, Philip, ed. Advanced osseointegration surgery: applications in the maxillofacial region (in english). Carol Stream, Illinois: quintessence Books. ISBN 0-86715-242-7.
- Sato, Haoshi (2000). Periodontal surgery: a clinical atlas. Carol Stream, IL: Quintessence Books. ISBN 0867153776.
- Laskin, Daniel (2007). Decision making in oral and maxillofacial surgery. Chicago: Quintessence Pub. Co. ISBN 978-0-86715-463-4.
- Lee, Jong Suk (2007). Applications of orthodontic mini implants (in english). Hanover Park, IL: Quintessence Books. ISBN 9780867154658.
- Sclar, Anthony (2003). Soft tissue and esthetic considerations in implant dentistry (in english). Carol Stream, IL: Quintessence Books. ISBN 0867153547.
- Buser, Daniel; Schenk, Robert K (1994). Dahlin, Christer, ed. Guided bone regeneration in implant dentistry (in english). Hong Kong: Quintessence Books. ISBN 0867152494.
- Pallaci, Patrick (1995). Optimal implant positioning and soft tissue management for the Branemark system (in english). Germany: Quintessence Books. ISBN 0867153083.
- Renouard, Frank (1999). Risk Factors in Implant Dentistry: Simplified Clinical Analysis for Predictable Treatment [Facteurs de risqué et traitements implantaires.] (in english). Paris, France: Quintessence International. ISBN 0867153555.
- Jensen, Ole T. (1999). The sinus bone graft (in english). Carol Stream, Illinois: Quintessence Books. ISBN 0867153431.


text:
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Item: 149859 Model: 91932ORB
This chandelier has frosted opal glass shade.
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Rising steam and fishing net block 2 (Pattern No. 47C)
Dimensions: 48" x 48"
$3.75 USD for single pattern
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Black Diamond Blue Water CAMP DMM Edelweiss Five Ten Grivel La Sportiva Metolius Omega Pacific PIEPS Petzl Sterling Rope Trango Wild Country
This product qualifies for quantity discount pricing.what's this?
Metolius Monster Webbing slings are custom woven from a technical blend of 36% Dyneema and 64% nylon. This blend yields an incredible strength-to-weight ratio, allowing them to slim down to a narrow 13mm (1/2") width. The Monster Web exhibits excellent mechanical properties including high tensile strength and excellent abrasion resistance. The Dyneema fibers also lower the amount of water absorption, making them ideal for alpine rock, ice and mountaineering applications.
Assorted Colors


text:
Prepared by Vivek Mishra, MD and Myron Kirshenbaum, MD from the Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, IL.
A 32-year-old man presented to the emergency department with complaints of mid-abdominal pain, bloating, decreased appetite, and no bowel movements for 2 days. He had stopped taking his medicine (Pancrease, McNeil Laboratories, Raritan, NJ) 5 months previously. Clinical examination revealed hypoactive bowel sounds and tenderness to deep palpation. Stool was heme-negative. His laboratory work was within normal limits with a normal white blood cell count and normal amylase and lipase.
Meconium ileus equivalent in adults
A radiograph of the abdomen, performed in the emergency department, revealed dilated small bowel loops suggestive of obstruction. A few foci of peritoneal calcification were also seen (Figure 1).
A computed tomography (CT) scan of the abdomen, performed after oral and intravenous contrast administration, revealed dilated small bowel loops with intraluminal bubbly fecal material seen in the distal ileum. Large bowel was unremarkable. The pancreas showed generalized fatty replacement, which is characteristic of cystic fibrosis. Peritoneal calcification was also seen (Figures 2, 3, and 4). A diagnosis of meconium ileus equivalent was made.
The Gastrografin (Bracco Diagnostics, Princeton, NJ) enema done in the radiology department did not show any obstructing lesion, with contrast refluxing into terminal ileum (Figure 5). The patient was given Gastrografin enemas every 4 hours for the first day, and every 12 hours on the second day. Patient was also given Golytely (Braintree Laboratories Inc., Braintree, MA) by mouth on both days. His abdominal pain gradually subsided and the patient had 6 to 7 bowel movements on the third day with relief of his symptoms. He was discharged on a pancreatic enzyme supplement.
Meconium ileus equivalent is a complication that is encountered with increasing frequency due to increased longevity of patients with cystic fibrosis (mucoviscidosis) as a result of improved treatment methods. Clinically it represents partial or complete intestinal obstruction. Some patients may experience acute complete obstruction, but most suffer from chronic partial obstruction, with recurring colicky abdominal pain and distension. The condition occurs only in cystic fibrosis patients who have exocrine pancreatic insufficiency. It has not been seen in other cystic fibrosis patients or other patients with exocrine pancreatic insufficiency. The frequency of these symptoms has been reported to be about 2.4% to 25%. 1 Pathophysiologically, meconium ileus equivalent is caused by a combination of exocrine pancreatic insufficiency, increased transit time, and abnormal intestinal mucus and results from obstruction by putty-like fecal material in the terminal ileum and cecum. 1-3
Microscopically it represents plugging of mucosal crypts with mucoid secretion, distension of goblet cells, and the presence of a thick layer of mucus, admixed with fecal material, adherent to the mucosal surface. 4
Plain films of the abdomen show a small bowel obstruction. A nodular pattern in the small bowel, with the nodules being larger than those seen in quiescent cystic fibrosis, has been reported. 5
On imaging, the CT scan may show features of cystic fibrosis, including fatty replacement of the pancreas, fatty infiltration of the liver, and partial or complete bowel obstruction with presence of bubbly fecal material in the terminal ileum and ascending colon. No other cause for mechanical obstruction may be evident. Other features of meconium ileus, such as peritoneal calcification, may also be seen.
The treatment is primarily nonsurgical. Specific treatment with N-acetyl cysteine, administered orally and/or as an enema, is recommended. Alternative treatment with water-soluble contrast medium, such as Gastrografin, administered orally or as an enema provides an easily available treatment as well as a means to perform a diagnostic study to rule out mechanical obstruction. It has a reported success rate of 81%, with 75% of patients treated as outpatients. 6,7 This was the method employed in our case. It is important that the physician be familiar with the disease entity and available treatment methods. Nonoperative treatment is effective and the morbidity and mortality associated with surgery can be avoided.
Meconium ileus equivalent is an entity that is infrequently encountered, but will be seen more often with the increasing longevity of patients with cystic fibrosis. It is important to be aware of this disease, as nonoperative treatment is effective and the morbidity and mortality of surgery can be avoided.


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It would be impossible for this Hotel to be better situated,as it is right on the main pedestrian precinct of Miskolc.The Hotel has an underground car park just a few yards down the street which is monitored 24/7 by cameras which are viewed from reception. Check-in was effortless and we took the small and amusingly jerky lift up to our... More
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- TripAdvisor is proud to partner with Booking.com, Priceline and HostelBookers so you can book your Hotel Pannonia Miskolc reservations with confidence. We help millions of travellers each month to find the perfect hotel for both holiday and business trips, always with the best discounts and special offers.


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400 v-8,automatic,factory air,new car trade,numbers matching,rear spoiler,hood scoops, cragars,complete restoration,must see, rust free car!!!!... More
If numbers and investments and paper trails matter to you then this 1971 Pontiac Lemans convertible probably isn't for you. But if you prefer... More
There are MANY reasons to love classic cars. Most people drive them because they look good and sound cool. A lot of folks enjoy... More
1971 Pontiac LeMans Sport convertible - Original V8 engine with automatic trans. Power steering, dual exhaust and true GTO Enduro package. Original window sticker,... More
1971 Pontiac Firebird Tarns Am. Sold new in Atlanta Georgia. A Survivor car with a repaint. Lucerne Blue. Only 1200 Trans Ams were built... More
1971 PONTIAC GRANDVILLE CONVERTIBLE ONE OWNER---ONLY 1800 MADE MATCHING #'S PROTECTO PLATE YEAR: 1971 MAKE: PONTIAC MODEL: GRAND... More
This 1971 Pontiac GTO 455 H.O. 2-door hardtop (Stock # P7017) is available in our Pleasanton, CA showroom and any inquiries may be directed... More
Year: 1971 Make: Pontiac Model: GTO Style: 2 Dr. HT VIN: 242371Z114025 Engine: V8 400 Transmission: 3 speed manual Wheels/Tires: Standard Rear Axle: Standard Interior Color: Black Interior Seating: Bucket seats Interior Material: Vinyl Exterior Color:... More
This 1971 Pontiac Firebird Esprit has a 350c.i. 2BBL (250hp) Pontiac (#s Matching)V8Automatic Turbo 350 (#s Matching) TransmissionGM 10 Bolt Rear w/ Highway Gear... More
PONTIAC: 1971 Ventura 2-door, 350, factory air, runs & drives, first $3,500 gets it. Gary, 501-779-6519, AR.... More
PONTIAC: 1971 GTO Judge convertible, ultra rare, 1 of 17 455 h/o Judge convertibles, tropical lime green, black interior, #s matching 455 h/o, auto,... More


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Cisco Takes Lead In Enterprise SBC Market: Researcher
10:00 AM EST Mon. Oct. 22, 2012Cisco for the first time has overtaken Acme Packet in enterprise session border controller (SBC) market share, according to researcher Infonetics, which also forecast continually strong growth for the segment.
Worldwide revenue for enterprise SBCs hit about $82.5 million in the first half of 2012 and is expected to top $430 million overall by 2016, Infonetics said in a report released Monday.
Acme Packet and Cisco continue to dominate the enterprise SBC spend, but Cisco's substantial presence in IP-PBXes, as well as Acme Packet's recent struggles, have tipped the overall market share in Cisco's favor. Cisco bested Acme Packet with a roughly 26 percent share of enterprise SBC sales in the first half of 2012, Infonetics said, vs. Acme Packet's dominant 34 percent share for the full-year 2011.
[Related: Acme Packet Buys Network Management Specialist IPTEGO]
"Cisco's been able to turn its market-leading position in IP- PBXes, VoIP gateways and data networking equipment into an advantage, upselling its enterprise SBCs to this customer base as they transition to services such as SIP trunking," Diane Myers, Infonetics principal analyst for VoIP, UC and IMS, said in a research note.
Infonetics also noted that systems requiring fewer than 800 sessions are the largest enterprise SBC segment.
The researcher tracks about 15 vendors in the enterprise SBC space, from large networking companies such as Cisco, Avaya and Siemens Enterprise Communications to emerging players such as AudioCodes, Edgewater, Ingate and Sangoma.
SBCs are growing along with the customer embrace of communications protocols such as SIP and the infrastructure they require. Several vendors have marketed SBCs as a prime channel opportunity, including Sonus Networks, which recently expanded into enterprise SBC sales from its previously carrier-focused purview.


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Wall Magazines
Wall Magazines are twelve page A-4 sized photocopied journals conceptualised, editorialised, designed, produced and distributed in the locality by practitioners of all the labs. Wall magazines are put up on walls in public places, and distributed in meeting places like the grocer's or barber's shops in the locality. Discussions at the labs are around which topics to pursue, what tone to adopt - ie, what the vantage point ought to be. Wall magazines are a movement from an experience of being addressed by the world of the adults towards being in a position to gift something to the locality, and evolving a mode of addressing the neighbourhood. The wall magazines brought out from the LNJP, Dakshinpuri and Nangla lab are called, respectively, "Ibarat" (Inscription), "Aamne Saamne" (Face to Face) and "Kuchh Kaho" (Say Something).
Translations of Ibarat 01
Issue dated: November 2001
So here it is, our first presentation to you of one of the ways of seeing our colony. In here are some stories, some poems -- familiar and new. Some photographs that we took. Some pictures we drew.
The first issue of Ibarat: In memory of Ayesha
Translations of Ibarat 02
Issue dated: July 2002
We promised a new Ibarat every month, so here we are again. A little delayed, though, because of several reasons - the realisation of our dream to go to Bombay, school examinations of the Compughar team, relatives' marriages, and power failures from time to time.
We were really happy to read your suggestions, which you wrote on the blank sheets we had placed on the walls alongside the last issue of Ibarat. Suggestions about the need to increase the font size, inclusion of the names of lanes we had missed out, other topics from the basti on which subsequent issues may be based. When we read them we felt you really do consider the Compughar as your own.
The topic for this issue of Ibarat is 'work'. When we all sat down to discuss it, we realised there were many facets to work, and that these are related in myraid ways to every thing. For instance, their relationship with god, with place, with tools, with time, etc. It is about some 'works', this Ibarat.
After we carried bhai Mohataram's interview in the last Ibarat, it became much easier to have conversations [for publishing] with other people. Many people volunteered to tell us things related to them. We hope that, as with the last one, you read this Ibarat with affection.
Our request to you is to not spoil your own toil. What we mean is that you take care of this Ibarat because we try to search the history of our basti (settlement) or that which is related to it and put that in it. If we don't know our basti ourselves, then the government or its workers will not let us get introduced to its life. This is a result of our collective efforts, then why not let this be the ladder to create an identity of the basti.
Don't forget to give us your suggestions. We will return again with another Ibarat. Till then, Khuda Haafiz.
Translations of Ibarat 03
Issue dated: August 2002
"We're back". Remember the "Bombay Trip"? When our team, all packed, was waiting to fulfil its dream of going to Bombay from the basti, there was on the one hand the sadness of leaving behind our parents, and on the other the immense happiness of going to Bombay. Do you know that before we got there, we never thought that Bombay was not a city magical, but another city like Delhi, albeit with its own markings. There, as in Delhi, people breathe, children work to feed themselves, and women can also be seen working. Each person is busy with her/his own work and we would never have got to know this if we hadn't gone to Bombay.
Going there has given us some courage, in a way. Now we feel we are more open to undertaking certain tasks by ourselves, individually. Many of our misconceptions were done away with, like the one about how girls are sold there, or that there is lumpen behaviour on the roads, that we would get 'spoilt' by going there.
The desire to go to a new place, there definitely was. But we never thought it would be realised. Anyhow, how did we find roaming the streets of Bombay, seeing the people there, thinking, reflecting, understanding, talking, visiting different places... so, come with us, we'll take you to Bombay with our writings.


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Civil War Interactive Discussion Board > About this Forum - Start Here > Introductions > Long time viewer, recent member |
Moderated by: javal1 |
Long time viewer, recent member | Rate Topic |
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Posted: Mon May 30th, 2011 12:44 am |
1st Post |
Edmund Ruffin Member
Hello all. Ive been interested in the civil war since I was a boy. Live in Liverpool England. Used to be a re-enactor for many years. One of the first members of the ACWsociety of North west England when it started in 1975(ish?) now called The American Civil war society. Gave it up a number of years ago due to pressure of work, shifts etc. and now age is getting the better ofme, my knees are rickety and not up to it ! Keen wargamer 15mm ACW being one of my main interests usig Johnny Reb and similar rules. Two huge armies based on both sides on the first day of gettysburg. YES you read it right, I do have four divisions of the Army of Northern Virginia and Two Union Corp. At an average of 20 to 25 figures per regiment Ill let you do the maths to work out how many figures I have painted. From that it is a relatively simple equation to work out how head slapping crazy I am !! My other joy is 1/6th scale figure collecting and creation, WWII and ACW, most of the latter I have put together from scratch, with bits and pieces from various kit manufacturers. OnceI figure out how I will post some photos. I have visited quite a number of the civil war battlefields but my passion has always been for gettysburg and have spent days and days wandering the place. Thats enough for now, I'll get to know you all better as time goes on Im sure. Why Edmund Ruffin as my tag? He wasthe man who asserted that he firedthe first shot at Fort Sumter. |
Posted: Mon May 30th, 2011 02:24 am |
2nd Post |
Doc Ce Member
Welcome Edmund Interesting moniker, I'm a descendent of Ruffin. Doc C |
Posted: Mon May 30th, 2011 03:45 am |
3rd Post |
Mark Member
Welcome Edmund! Its exciting to see another Johnny Reb gamer here! You have quite a few more troops than I do. I'm almost done with a division for each side. That's about all my kitchen table can handle at the moment. Again, welcome! V/R Mark |
Posted: Mon May 30th, 2011 04:13 am |
4th Post |
Albert Sailhorst Member
Welcome, Edmund!! I also play Johnny Reb III.....I have 3 Conf. Divisions, 15mm....However, I have 16 figures per Regiment (4 stands with 4 figures per stand), 4 Regiments per Brigade, 4 to 5 brigades per Division. I also have approximately 2 Batterys per brigade, and a Brigade of Cav.....Also have supply wagons, cassions, Divison/Corp?Army command....Me, my wife & son have built houses & buildings, fences & roads for our 9x5 ft. game table.....We wouldn't mind sharing scenarios/ideas!!! I am also a renactor with a Conf. Artillery Unit (Scott's TN Battery....http://www.scottsbattery.org). Nice to meet ya & hope to learn from ya!!! |
Posted: Mon May 30th, 2011 01:38 pm |
5th Post |
Edmund Ruffin Member
Thanks all for the hello Mark wrote: Welcome Edmund! Its exciting to see another Johnny Reb gamer here! You have quite a few more troops than I do. I'm almost done with a division for each side. That's about all my kitchen table can handle at the moment. Again, welcome! I pursuaded the club I attend to do a first day at gettysburg demonstration game at a show some years ago. The table, needless to say, was huge and to best cope with being able to move figures and to include the important areas of the field, was cross shaped with the top "spoke" offset to the left to include oak hill and the gap in the federal line. Four of us provided the figures, myself providing the bulk with Buffords Cavalry, 1st Corp and the two divisions of Hills corp that fought, all the terrain and the "icon" buildings such as the seminary which I scratch built. We used simplfied Johnny Reb II rules (I still prefer them), simplified so that we could better represent incidents and actions in real time. We had a preprepared hourly notice board so that people could see where the battle had reached at any time of day. Needless to say, because we had built in key features of the battle- the gap between the two corp, rubbish moral for 11th Corp etc., despite my best efforts the outcome was markedly similar to the real thing. Since then, because two of the original players no longer game, I have put together all of the units (plus a comparable sized Confederate cavalry unit to Bufords) so that I can put the game on in future without having to rely on anyone else other than to play(if I can find somewhere with big enough tables !). Obviously it also means that I can mix and match for all kind of scenarios and units big and small and with the reb cavalry added, actions at Culpepper and the like are feasible. I've just retired and having inherited a big house intend to have a dedicated wargames room that will be able to handled pretty big games (still not on the size of Gettysburg though!!)....thats once I have done all the other jobs my wife wants doing ! |
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text:
Saint Rufus of Glendalough
Also known as
- Rufin
Additional Information
- Book of Saints, by the Monks of Ramsgate
- Lives of the Saints, by Father Alban Butler
- Our Sunday Visitor's Encyclopedia of Saints
MLA Citation
- "Saint Rufus of Glendalough". Saints.SQPN.com. 22 April 2013. Web. 13 December 2013. <>


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A Career in Academia: Making Successful Applications
Practice No. 666
Last modified: 24/03/2011 09:53:28
Institution: University of Durham
This session focuses on how researchers can effectively market themselves to academic employers via CVs and application forms, through covering letters and at interview. -
Ketso - a hands-on kit for effective group work and engagement
Practice No. 1199
Last modified: 12/11/2010 19:36:05
Institution: University of Manchester
Ketso is an interactive, hands-on toolkit for bringing meetings and workshops to life. It is compact and portable, simple to use and accessible to everyone. Ketso extends people's ability to run effective and enjoyable workshops - virtually anywhere and in any setting. It encourages people to be creative and share in productive dialogue, while also generating real results that can be put into action. Ketso provides a set of tabletop tools that can be used to capture and display people's ideas. It consists of colourful 'branches', 'leaves' and other materials, which can be placed on a felt workspace and easily moved around in response to changing discussion. Ketso is robust and portable, and comes in a handy carrying bag, making it easy to transport to and from events. Ketso provides a series of free resources to help you run effective workshops and engagement processes - such as workshop plans and training videos in planning and running a workshop.
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You're watching...
Right-to-work vs. Big Labor
Steven Crowder, Andrew Sullivan battle over Michigan law
Dec 12, 2012
Steven Crowder, Andrew Sullivan
You're watching...
Steven Crowder, Andrew Sullivan battle over Michigan law
Dec 12, 2012
Steven Crowder, Andrew Sullivan
Also in this playlist...
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No not really sort of you'll -- a month.
Right yeah because it's the freedom every moment big shock to all other -- political benefits and yeah.
-- just didn't unions have negotiated I didn't ever really yeah.
And -- yeah.
Yeah yeah and -- -- -- now you want an insight into the ugly and twisted and dark soul of liberalism that as far as taking a look at the events in Michigan over the last 24 hours as everybody knows by now.
The Republican state legislature passed and governor Rick -- signed into law a right to work bill that horror of horrors it -- compulsory union fees.
And workers will no longer be required to pay union fees as a condition of employment as a result.
More jobs are probably gonna come to Michigan as a result this modest very reasonable growth oriented law.
Organized labor has gone insane and now resorted to violence which by the way is perfectly predictable sense.
As a national review puts it is so well organized its -- business model to mechanically.
While identify and use extortion it is in the nature of the -- -- trade to resort to violence when they're frustrated.
Now just the last 24 hours for example Fox News contributor Stephen Crowder was beaten by a mob having been punched repeatedly in the face.
Protesters wielding -- brought down a -- on representatives from the conservative group.
Americans for prosperity -- that's -- -- that was housing women and children and old people and bystanders.
They're also roughed up.
Had a democratic legislature by the name of Douglas Geist he declared on the floor of the Statehouse there will be blood there will be repercussions.
And then Jimmy Hoffa the president of the International Brotherhood of Teamsters.
He said he expects Michigan unions and lawmakers to break out into quote civil war.
Held on -- more on these threats coming up later in the hour.
So what -- -- to make of all this violence all this ugliness now several things point number one what's happening in Lansing is not an isolated event is part of a trend.
We've seen similar acts of violence happen in Madison Wisconsin.
There in response to governor Scott Walker's lawful and correct decision.
Then collective bargaining and state.
And we saw example after example sexual assault rape arson violence.
Even deprecating -- police car's -- in the Occupy Wall Street protests.
How the left is becoming increasingly vicious and violent in how -- conducts itself.
Believing they have a right to physically intimidate and even physically harm their political opponents.
-- this is the kind of stuff you'd expect to see in a banana republics not the United States of America.
How this needs to be condemned in the strongest language possible I'm more importantly the thugs committing these acts of violence they need to be restrained they need to be arrested.
Law and order -- to prevail if it doesn't this violence is gonna spread the -- there will be blood in the streets and at some point.
Some people may in fact die and that's of course we are currently not.
Five point over to the violence that we're seeing is in part a response to desperation by the labor movement they know that the stars are now aligned against them.
They know that their best days are in the past not the future and they know they're losing membership influence and power.
Even in states that are the birthplace of the labor movement.
As their power recedes there anger rises as their anger rises -- lashing out using very dangerous rhetoric and violence to trying get their way.
Now this is not gonna work.
-- point number three the mainstream media is once again showing an un -- double standard.
Tonight we're dedicating an entire segment to this point -- before.
President's ability President Obama who is so quick and eager to preach to Republicans in the country conservatives about the importance of respectful public discourse.
Never ever condemns in powerful terms the violence of the left -- to be sure Obama thankfully doesn't condone violence.
And here in the air he hints through his spokesperson that as a general matter -- doesn't like the violence but the criticisms.
Are as gentle as can be and never specific to groups like the labor movement.
That are committing these acts of violence so.
Why doesn't the president speak out in a forceful candid unvarnished and a direct way.
So we can rein in the excesses of his own allies in other words the people the groups after all.
That he has the most influence on now that's what he should do.
And it's what -- doesn't continue to do wow that's going to be a problem in America.
Joining me now Fox News contributor Stephen Crowder who as you know was at the -- rally yesterday along with the union supporter.
Andy Sullivan he is with blue collar corner dot com gentlemen welcome back to -- Hannity.
Thank you.
-- -- start week with an update yesterday because the -- has been attacking you'll die -- -- -- your injuries or capture.
I Ellison I'm fine I'm still tough enough to take the bad shot -- -- to Latin -- to have a view.
Union -- can throw at me I'm fine thank you for asking.
Okay now secondly we showed a video union guys collapsing that tent they're denying that -- -- not sure.
You would there at a video speed I was there and.
Yeah well there's so much here to think people can try and say I edited video took -- out of context.
Okay what about the hours upon hours of footage from hundreds of different cameras online right now you can Google search it and find more footage than you can watch in a lifetime this occurred over the course of twentieth thirty minutes.
-- with hundreds of people.
Paring down the tent with -- women in marriage yelling -- down one more tank -- tear down one more tank costing them out making death threats at all over the Internet legal and I encourage you to.
All right -- you're saying Steve is asking a simple question.
And you see the reaction this all the punches.
You saw the ten come down old people were there women in -- my question to you you you claim he's inciting the smiles.
Well listen first off that tape was very well edited -- happens who sees some footage.
Where it looked that he actually pushed a guy down to the ground and that was the fellow that was actually striking him.
And that's the way of it to me and if that was the case or what we we just showed I think that they be talking about we're going how does that give -- like almost no you're missing the last segment that I saw in the room and in the -- all -- -- expand -- -- and fact we had try I saw that guys back go down and then he came up wolf is yes there is what does that.
Steve did and didn't attack in the -- with a little -- isn't taking it.
-- are you doing.
The -- -- you don't.
You deserve you -- you want us there you have these are all -- -- union -- swallowed babies are babies flailing before being put to -- They are violent that was not an isolated event look around you -- and that's why the us.
-- he should be so proud taking it you know taking potshots at these people what terrified about losing -- hot -- and livelihood.
Okay that's what you're doing -- -- these people are desperate.
-- are scared.
And people including the leadership.
Are taking advantage of them and using them and believe me I don't I don't advocated by many in this violated -- -- -- push anybody.
I thought I looked at New -- you sent me the raw tape and I looked at a number of times it right I got the unedited -- OK so I look.
Yeah unedited tape -- that.
It with the melee there people every one was grabbing and pulling and trying to keep attempt for being torn down OK that was -- melee now listen if I.
I walked up to someone put my face in their face and say unions -- nanny nanny boo -- that still doesn't merit four shots of the face as far as people being afraid these union thugs being -- you know what they should be afraid.
And they should be afraid because unions threaten their own job security you look at manufacturing job in the United States the single greatest threat to your job security your job being shipped overseas or your company being shut down is a -- or any union that -- this company with costs that they can't -- here.
Hey Stephen you know what I need to be schooled by U.
Okay I've been in this business -- are no -- one as well first off let me explain something about unions.
Okay including the studio I'm sitting in right now I built.
Okay my friend and everything from a financial setup up -- Yankee -- gradually has been built by union labor.
So stop demonizing them they're not the ones that Jordan -- and their -- and demonized OK the people or closing this labor.
Dispute is the leadership and of course at -- about the end of it it's a good -- again.
Well I'd let let me go to Elizabeth -- -- -- again but let me go to specific issue because you're one of the few union people actually.
Criticizes leadership and -- when I agree with you but here's the question.
They are forcing you can't work at a company in less you you join the union.
That you don't want to join paid delusional wanna pay.
And they take the leadership takes money and -- the political parties -- wanna donate to.
What's wrong with the right to work why would you be against freedom of choice I think that's a little too extreme the right to work as far as as far as altering.
-- you know what I would be -- I think the way the unions are set up right now.
Is is almost like a dictatorship it's a single party rule.
And I think right now the GOP is missing out on a golden opportunity I wish somebody from the Republican Party.
Would reach out to unions and have a competing.
Up party to two advocating representation I mean just think about -- you -- why do you union guys I've heard take on leadership.
It was what they do to rank and file money what they do with rank and file money is.
I -- -- -- -- -- -- OK -- and unions have become parasites in this country who keep their host a lot to look at GM they look for new -- the taxpayer right now on Michigan.
These parasites are looking for new host and that's forcing Michigan citizens who do not want them there to be thrust into unions that they don't want to join.
Stop blaming the from the rank and file union member did not the ones that are close in this that they the leadership summit because they are did a taxi.
After Stephen had his hands on his back and the guy got up not knowing how to hit and -- we -- -- and children it's not me.
Hundreds of people who were in a tent come on man let's be honest I know -- flame -- is a cancer patients everywhere.
-- more dramatic that's great -- -- -- -- thank you both for being with us.
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By Steve DeVane Staff writer
CARTHAGE - Moore County commissioners elected a new chairman and welcomed a new member Monday.
Nick Picerno was elected chairman by a unanimous vote. Outgoing Chairman Larry Caddell first nominated Commissioner Jimmy Melton, but Melton asked that his name be removed because of heavy business commitments in the upcoming year.
Melton then nominated Picerno. Melton nominated Craig Kennedy for vice chairman. He also was elected unanimously.
Picerno, who was re-elected to the board last month and is beginning his second term, took the oath of office just after the meeting started. This his third time serving as chairman.
Commissioner Randy Saunders also took the oath of office. He was elected in November to replace Tim Lea, who did not seek re-election.
Picerno thanked Caddell for his leadership in the past year.
"He did a fantastic job," Picerno said.
After electing officers, commissioners recessed for a 45-minute reception.
Later, commissioners met in closed session for 22 minutes. Picerno said commissioners discussed potential candidates to serve as interim county manager.
James Westbrook Jr. started work as interim county manager Nov. 26, but died the next day in a car accident on Niagara-Carthage Road. Former County Manager Cary McSwain retired Nov. 30.
Picerno said the candidates will be contacted in the next few days to determine their interest in the position. Commissioners probably will have a special meeting to name an interim manager.
Picerno asked people attending the meeting Monday to stand in a moment of silence honoring Westbrook. Randy Thorton, pastor of Grace Church in Southern Pines, prayed for Westbrook's family during an invocation at the beginning of the meeting.
In other action, commissioners voted unanimously to give contractor D.H. Griffin until March 23 to replace the roof on the new public safety center. The roof was not properly installed, said Rich Smith, who is overseeing the project for the county.
The replacement will not cost the county anything, Smith said. The building is otherwise complete, but installation of computer equipment is expected to take about 90 days, he said.
In a separate meeting Monday, the Moore County school board elected Ed Dennison as its chairman. Enola Lineberger was elected vice chairwoman.
Newly elected school board member Ben Cameron and three school board members - Kathy C. Farren, Laura K. Lang and Bruce Cunningham Jr. - and who were re-elected took the oath of office. Cameron defeated incumbent Dr. Lorna C. Clack in November's general election.
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text:
Hail to the King, baby!
I don't know why people keep asking me about published pocketbook with my strips about Arthas, but I promised I'd check how much would it cost to do a small amount printing.
I checked the prices and it was too high (as expected) %)
Anyway I decided my Arthy (printed or not) deserved a cute cover, so I made some doodles.
FYI, big horny sh%t on the back is Anub'Arak %)))


text:
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Packaged in a thick, clear glass with an apothecary profile, this bold + unique jar will add fragrance and fun to every space.
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Burn Time:60 hours
Dimensions:3.5 x 3.95
Weight:265 grams/9.3 oz


text:
Topic Review (Newest First) |
selzer |
I generally use STAY. In obedience work, sometimes you get that very obedient dog who doesn't want to come because you said STAY. So we use some subtle double-commands. When we say STAY, we then cross our arms across our chest and walk away, every single time. This means DON'T MOVE, I AM COMING BACK. If we are going to call the dog, we use the term WAIT, and walk away with our arms down at our sides, this gets the dog ready to be called. We want the dog to come front, but we can't use "COME FRONT" so I just use the word FRONT. This means come to me and sit in front of me. Where COME just means come to me. The FRONT releases the dog from the WAIT command, which was only holding him by a thread anyway. |
mightyschwartz |
With Lola, we were doing "Stay", but after watching various videos, we picked up on a point from solidk9training.com that a "stay" should be implied for any and all commands given. That just made sense to us... It was slow going at first because she wouldn't want to be still since she was just a puppy and from a working line that seemingly needs to be "broken" in terms of her ridiculously strong-willed nature. However, she is now at the point where I can toss food/treats on the floor or throw a toy and she won't move until I tell her to. We do it for getting water and food/sit/down. We've also conditioned her to sit when walking through doors, up and down stairs and stopping when walking on the leash... consistency has been the key with her. Now she will approach a door or the stairs and instinctively sit and look at us for permission to cross the invisible wall in her way(as Maik said above). Another thing I've noticed is that she has started lying down when a car passes because when she was initially lunging at cars due to prey instinct or for whatever reason, I started having her lie down when I saw one coming from off in the distance to keep her calm. Now I'm trying to get her to keep walking when one is just passing by. Walks when everyone is leaving/entering the neighborhood in the morning/night are interesting. |
Maik | Interesting discussion.....I will add one more wrinkle. I never use either wait or stay because I believe they are unnecessary and redundant. When I tell them to sit, or lie down, they are not to move unless I give them another command. For example, at any door, they are to sit, until I release them to pass through it. I can not think of many examples of where I would want them to "stay" without sitting. |
LeoRose | I use "wait" to mean "hang on a minute, until I release you", usually for eating and doors. I use "stay" to mean "don't move from either this spot or position until I tell you otherwise". |
Gretchen | I keep it simple and just use stay. |
llombardo | Stay is used for longer time frames. Wait is more for a brief time. |
warpwr |
We think stay means don't move until released. So if you tell the dog stay and then go grocery shopping, that dog should still be in the stay position when you return (that of course would be incredible). Wait is more like a sit here until I'm out the door and gone, then do whatever you want. By the way, I don't ever personally use the stay command because if I tell Molly to sit or down for example, she can't move until released. So down (or sit) coupled with stay is redundant. |
VTGirlT |
Wow i feel bad for my dog, she really could use more consistency. I will have to think about what i want and can expect from her and go from there. Thanks for the reply Cassidy's mom, I like the concept of your wait especially on walks. because usually instead i will ask her to come if she is getting to far. Which is good, but perhaps i could say hold up or something. |
Cassidy's Mom |
You can use whatever command you want to mean whatever you like, as long as you're consistent in your criteria for that particular command, so train the way it makes sense to you. For me, stay implies that the dog remain in a particular place in a particular position: sit/stay, down/stay, stand/stay, regardless of whether I return to the dog or release the dog to come to me. I use wait in more of a "do not cross this invisible line" way. If I have my dog wait at the door while I walk out to get the mail or the newspaper, I don't care if they actually stay right there. They can turn away from the door and walk further into the house if they want, they just can't cross the threshold. I use wait as I set down their food bowls before releasing them to eat, (although this is actually a default behavior now, I don't actually have to tell them to do it anymore), before letting them jump into the car or out of the car, or going in or out of the house. I also use wait when the dogs are ahead of us at the park and I want them to stop moving until we catch up, and then I'll release them to continue walking. |
VTGirlT | Actually this is what "kikopup" does with her dogs. Which i thought was a good idea. But she has the habit of sitting and than laying down after, i think its because she finds it to be more relaxing? especially if she is tired? And so i let it slide.. Yeah, bad idea on my part.. So now she still does that, and i tell her to sit again and usually she will, and then after that she will 2-3 times try to down again. Than she will stick with the sit position. So this is all my fault for not showing her what i really wanted right from the beginning so i really have to back track. Because having them stay in the position you asked for would be ideal in any situation. |
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Buffalo Sabres forward Patrick Kaleta has been suspended five games for boarding New York Rangers centre Brad Richards on Sunday night. Kaleta is considered a repeat offender under the terms of the Collective Bargaining Agreement. He will lose more than $72,000 in salary, and begin serving the suspension Tuesday, when Buffalo plays at Carolina. The Rangers got a scare 3:28 into the third when Richards was shoved from behind into the half boards by Kaleta. Kaleta, who has already been suspended twice in his NHL career, was assessed a five-minute major for checking from behind and was given a game misconduct.
Sabres' Kaleta suspended five games for boarding
Published On: Mar 04 2013 06:37:46 PM EST
Updated On: Mar 04 2013 06:37:46 PM EST
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