Load factor control for implants in the posterior partially edentulous segment

There are inherent biomechanical differences in the implant treatment of completely edentulous arches and posterior partially edentulous segments. The partial prosthesis does not benefit from cross-arch stabilization and is, therefore, more susceptible to bending loads. Because of the difference in mobility between teeth and implants, implants may carry a major share of load when mixed with teeth in the same quadrant. However, the frequency of implant overload in posterior partial restorations is low, and, with appropriate treatment planning, overload in these situations is almost always preventable. A checklist procedure is proposed to help the clinician enumerate and evaluate deleterious load factors. By screening patients for such factors in advance, the clinician may identify and avoid potential overload situations when conceiving and fabricating implant-supported posterior partial prostheses. A second checklist, for use at follow-up appointments, lists alarm factors that serve as an early warning of overload once the prosthesis is in place.     

Periodontal and restorative considerations of molar uprighting

The sequelae to the loss of a tooth are both numerous and varied. Furthermore, the ramifications of tooth loss increase in severity with time. Consequently, corrective therapeutic measures can become complex both in the diagnosis and treatment of these situations. As the demand for more predictable treatment results grows, the requirements for more efficacious treatment modalities grow as well. Therefore, the need for interdisciplinary treatment within the various areas of dentistry to assist in the complex rehabilitation becomes very important. The purpose of this article is to examine the various benefits of molar uprighting from periodontal, orthodontic, and restorative viewpoints, and to suggest a classification whereby the clinician is directed toward a multidisciplinary treatment approach.     

Titanium screw implants for intermaxillary fixation of partially edentulous jaw

Establishment of the best possible relationship between upper and lower teeth is very important when treating jaw fractures and orthognathic deformities in partially edentulous patients. Many surgeons use arch bars and acrylic splints for intermaxillary fixation (IMF) to obtain the best occlusal relationships after the operation. In patients with sufficient teeth, IMF is not so difficult to realize. However, in partially edentulous patients, the available teeth may not be sufficient to apply arch bars or splints. This paper describes a system for IMF of a partially edentulous jaw. Screws made of medical-grade titanium are implanted into the alveolar ridges where two or more teeth are missing. Arch bars or acrylic splints secured on these implants and available teeth can be used safely for IMF. In vitro axial pull-out tests demonstrated that these implants can withstand the traction forces generated by elastics. Five partially edentulous patients, three with mandibular fractures and two with orthognathic problems, were treated with these implants. All patients healed without any complications and with the best possible occlusal relationships.     

Endodontic considerations in the geriatric patient

Endodontic needs of today's and tomorrow's growing older adult population present increasing challenges for dental care providers. Biologic and anatomic differences in the dental tissues between older and younger patients must be understood and considered in treatment planning and performance for appropriate endodontic procedures. These differences generally do not contraindicate treatment, which, when performed correctly, will be successful in the elderly patient.     

The influence of periodontitis on the subgingival flora around implants in partially edentulous patients

The hypothesis that teeth act as reservoirs of micro-organisms for the colonization of oral implants has recently been stated several times. The present study aimed at examining, in partially edentulous patients with severe periodontitis, whether pockets around teeth and implants harbored a comparable micro-flora. In 6 patients (3 with refractory periodontitis and 3 with advanced chronic adult periodontitis), plaque samples were taken from a deep and shallow pocket around both teeth and implants for differential phase contrast microscopy and DNA probe analysis. The results showed important differences in the sub-gingival flora between the 2 disease groups, as well as between deep and shallow pockets, around both implants and teeth. On the other hand, when pockets around teeth and implants with equal depths were compared a striking similarity was observed in the microbial composition. These observations confirm the hypothesis that pockets around teeth act as a reservoir and highlight the importance of periodontal health when oral implants are planned.     

Clinical and laboratory considerations in the use of a new all-ceramic restorative system

Ceramic systems are continually under development in an effort to refine their clinical application. An all-ceramic full-coverage crown system (Procera, Nobel Biocare, Westmont, IL) that utilizes computer technology and industrial presses to fabricate precise copings has recently been introduced. Using this system, aluminous porcelain is baked over a high-strength, high-purity aluminum oxide coping to fabricate a functional, biocompatible, and aesthetic restoration. This article presents a discussion of the clinical and laboratory considerations that are involved in the utilization of this all-ceramic system.     

Pharmacological considerations for the pediatric patient

The use of pharmacological agents in children warrants special consideration because children have variable pharmacokinetic parameters. Not only are the pharmacokinetic properties of drugs different in children as compared with adults, but these properties can undergo rapid change as children grow and mature. Furthermore, many drugs that would be useful in the pediatric population lack the indication for use in children and, therefore, dosing guidelines are not available. This paper presents an overview of basic pharmacokinetics in children and pediatric dosing guidelines.     

Prosthodontic considerations for the older patient

The elderly have both the greatest level of need for prosthodontic services of any age group, and the greatest degree of complicating dental, medical, and behavioral factors. Issues arise in daily practice of whether or not to replace a missing tooth or teeth for a patient of advanced age and a wide variety of challenges-dental/oral and others-face the dentist who is considering replacing some or all of an older person's teeth. This article focuses on clinical approaches and techniques that have proven particularly important and useful for providing prosthodontic care to the older adult.     

Treatment considerations in the elderly patient with lymphoma

One half of all non-Hodgkin's lymphomas occur in the elderly, a growing segment of the population in North America. Significantly, the incidence of lymphoma in general, and especially in the elderly, is rising rapidly. These trends will combine to double the number of cases of lymphoma in the elderly in the next 2 to 3 decades. Certain lymphomas can be treated as effectively in the elderly as in the young, and others are treatable but with only half the expectation of cure. Further improvements will be made as future clinical investigation focuses on the elderly with lymphoma as a special group.     

Surgery-specific considerations in the cardiac patient undergoing noncardiac surgery

Myocardial infarction after noncardiac surgery in patients with coronary artery disease results from the interplay of patient-specific, anesthetic-specific, and surgery-specific factors. Surgery-specific factors include the stress response to injury, both neurohormonal and hemostatic alterations, and clinically-significant operative parameters such as urgency, duration, blood loss, body core temperature, fluid shifts, and location of surgery. The impact of these factors bears out during the entire perioperative period and influences preoperative risk assessment, cardiac evaluation and intervention, intraoperative strategy, and postoperative management. Overall, the morbidity and mortality of surgery is minimal even in high-risk patients, and the contribution of surgery-specific factors to operative risk is subtle compared with that of patient specific-factors such as severity of coronary disease and other comorbid conditions. Nonetheless, the optimal surgical management of patients with coronary disease requires the collaborative effort of the anesthesiologist, cardiologist, and surgeon.     

Anesthetic considerations for the pediatric plastic surgical patient

An understanding of the anesthesiologist's concerns during pediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Prior to surgery, the child's history is obtained and physical examination is performed. The condition of the airway is the primary concern. Preoperative medication is usually given by oral routes to avoid injections. Induction intubation, maintenance, and emergence are discussed. Specific postanesthesia care is described. Special precautions are given for children having surgical repair of craniofacial anomalies. Cleft lip and palate and mandibular advancement are described.     

The therapist as patient: Special problems and considerations.

Argues that despite the awareness among mental health professionals of the need for the care of fellow practitioners, with emphasis on professional burnout and occupational counseling, the difficulties encountered by therapists in the treatment of their colleagues have been noticeably neglected. Based on experience treating colleagues, interventions and insights designed to avoid pitfalls while facilitating treatment are offered. It is suggested that the choice of a therapist should permit the patient a reasonable degree of social life-space anonymity, a sense of compatible treatment values and philosophy, and knowledge of and respect for the therapist's professional expertise. Factors that motivate a therapist to seek personal therapy are often more complex in reality than for the general patient population. Therapists who become patients have apprehensions that feelings emerging in their own psychotherapy will erode the carefully honed sense of self-as-healer/patients-as-wounded paradigm. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Audit of casual patient attendance at a restorative dentistry clinic

The aim of this prospective study was to audit casual attendance at the Conservation clinic of the School of Clinical Dentistry, Belfast. Details of 500 consecutive casual patient attendances were collected over a four month period. There were 253 male and 247 female patients with a mean age of 43.4 years. Fifty-eight percent of patients lived within five miles of the clinic with 16% travelling more than 15 miles. Sixty-five per cent of patients were self-referred, 27% were referred from within the School and 3% were referred from their General Dental Practitioner. Pulpal or endodontic problems were diagnosed in 42% of cases, 25% presented with loss of a crown or bridge and 14% complained of a pain-free loss of the filling. Half the patients were given a further appointment to attend the Conservation clinic while only 33% were directed to the General Dental Services for further care. It was concluded that the majority of casual attendees to the Conservation clinic were local residents who referred themselves for treatment. A minority of patients were currently under treatment at the School of Clinical Dentistry but over 65% remained their immediate responsibility. Recommendations for improvements in the current service were also made.     

Forum: trauma and infection: considerations for patient and health care professional

Trauma and infection are leading causes of morbidity, mortality and health care expenditures despite remarkable advances in treatment over the past two decades. Numerous research studies report that in those trauma patients who survive the initial injury, infections account for over one-third of the deaths. While the immediate resuscitation of trauma patients is based on the principles of management for restoring airway, breathing, and circulation, long-term survival requires prevention of infection. Additionally, infection of the health care professional has long been known as a possible complication of caring for acutely ill and injured patients. This article reviews the risk of infection, the pathogenesis of infection, prevention, antimicrobial therapy and infection control for health care professionals.     

Management of the intraaortic balloon pump patient. Pharmacologic considerations

This article reviews the common pharmacologic agents used in conjunction with the IABP for treatment of LV failure. The complex interaction between the IABP and pharmacologic agents must be carefully monitored to optimize outcome in this critically ill patient group. It is important that ICU nurses be aware of the treatment goals and their rationale, as well as monitored parameters which detect, trend and predict the direction of hemodynamic change. By using these early indicators of hemodynamics, early information can be given to the physician and intervention can be implemented on a timely basis. Early and appropriate intervention can improve outcome in many patients and may ultimately reduce costs.     

Ectodermal dysplasia in adulthood: the restorative difficulties and management

Ectodermal dysplasia can result in a number of oral problems. As the condition is usually diagnosed in childhood, multidisciplinary specialist dental care at an early age may minimize the long-term dental complications. This article describes the restorative management of an adult patient suffering from ectodermal dysplasia for whom such support was not available, resulting in the provision of complex and highly invasive restorative treatment in adult life to provide a functional and aesthetically acceptable dentition. The various treatment options that were considered are discussed together with the details of the treatment provided.     

Special considerations for the clinical microbiology laboratory in the diagnosis of infections in the cancer patient

The clinical microbiology laboratory faces enormous challenges in diagnosing infections that cause morbidity and mortality in cancer patients. Such laboratories face several issues that surpass those faced by laboratories that perform more routine work. Issues such as sources of clinical specimens, need for correlation and interaction between laboratory and clinical services, blood cultures, susceptibility testing, and the role of new molecular diagnostic techniques are considered in this article.