Prosthodontic considerations when using implants for orthodontic anchorage

Between 8 December 1995 and 16 January 1996 seven laboratory confirmed cases of septicaemia owing to infection with Neisseria meningitidis serogroup C strains and one highly probable case of meningococcal septicaemia occurred in three electoral wards in south Rotherham and the Retford area of north Nottinghamshire. All cases occurred among children aged 1-17 years. One patient died. The public health response to this outbreak was the largest community prophylactic antibiotic and immunization programme against meningococcal infection, to date, in the United Kingdom. The target group for each Health Authority was 8900 for Rotherham Health Authorities and 8000 for North Nottinghamshire Health. Local logistical factors led to differences in the implementation of the programme by each Health Authority. At the completion of each programme, 8320 doses of vaccine had been administered (92.5 per cent coverage) during the Rotherham Health Authorities programme and 7660 (95.7 per cent coverage) during the North Nottinghamshire Health programme. The additional financial cost of the exercise amounted to approximately Pounds 125000 for each Health Authority. This paper describes the evolution of the outbreak, the decision-making process resulting in the immunization programme in each Health Authority, the implementation of each programme, problems identified and lessons learned.     

Clinical case report: an improved technique for using dental implants as orthodontic anchorage

The use of endosseous implants as intra-oral anchorage to facilitate orthodontic treatment has been reported in the literature for some years, first in rabbits and dogs, and then in adult human patients. The implants were generally used solely for the purpose of anchorage. This paper reports the successful application of orthodontic forces utilizing dental implants to achieve tooth movement. The implants were subsequently used as fixtures in a pre-determined plan to support a fixed prosthesis. A clinical example demonstrates how implants may serve dual roles, for anchorage and then for fixed prosthetic support. The principles involved in using dental implants as part of a multi-disciplinary approach to dental treatment are illustrated.     

The Orthosystem--a new implant system for orthodontic anchorage in the palate

The present report describes the design and first clinical experiences of a newly developed endosseous orthodontic implant anchor system (Orthosystem, Institut Straumann, Waldenburg, Switzerland) for palatal anchorage. The 1-piece fixture made of titanium consists of a screw-type endosseous implant body (sandblasted, acid-etched, diameter 3.3 mm, lengths: 4 and 6 mm), a cylindrical polished transmucosal neck and an abutment. Clamp-caps provide attachment of square commercially available orthodontic wires (0.032 x 0.032 inch, SS) to the abutment (transpalatal bars). In a pilot study 1 fixture (implant body length: 6 mm) was inserted into the midsagittal anterior palatal region in each of 6 adult patients with Angle class II malocclusion (distocclusion 7 to 8 mm, overjet: approximately 9 mm). The treatment plan included extraction of the first maxillary premolars and retraction of the anterior teeth based on maximum anchorage of the posterior teeth without using compliance-dependent anchorage aids (headgear, class II elastics). Due to the design of the fixture only 1 simple surgical procedure was required for insertion (nonsubmerged method, 1-stage surgery). Accordingly the need for surgical exposure of the abutment for connection and wire insertion was eliminated. Thus, inconvenience to patients was reduced to a minimum. The patients are now at varying active treatment stages. The course of treatment of the most advanced case is described. Evaluation of the clinical and radiological findings after 12 months of treatment (3 months implant healing, 9 months active orthodontic treatment which is equal to the implant loading period) revealed no implant mobility/dislocation, favourable peri-implant soft tissue conditions, no marked mesial movement (approximately 0.5 mm) of the implant/transpalatal bar supported posterior teeth, and 8 mm retraction of the anterior teeth. Retrieval of the fixture and post-operative wound healing were uncomplicated. In the treatment of this case, no compliance-dependent extraoral anchorage was used, and the well aligned mandibular dentition was not bonded provide anchorage support (class II elastics).     

Hydroxyapatite-coated implants: a case for their use

The information on which this article is based comprises a small fraction of the large database compiled from the DICRG study. These results represent the early performance for HA implants (up to 36 months). The study has been ongoing for 6 years, and there are more than 2,000 implants with 4-year data and 1,500 with 5-year data. These data are similar to the 36-month data, and when they are eventually released, they are likely to reinforce the results reported here. Meanwhile, the evidence presented in this article, along with other corroborating studies cited in the introduction, are sufficient grounds to reach the following conclusion: The ideal implant design and material is one that is easy to use, requires average skills, involves minimal bone trauma, presents a biocompatible contact surface, and produces a high rate of survival in most patients. Based on 36-month survival in the DICRG study, HA-coated implants appeared to satisfy these basic requirements better than the other implants used in the study. HA-coated implants were placed in the most challenging bone types and jaw region, in patients with compromised medical histories, by dentists with different training, skills, and experience, under less than ideal clinical conditions, and still showed the highest survival rates of all implants at every point in the treatment up to 36 months.     

Comparison of radiological procedures in preoperative assessment of anchorage strength of spinal implants

PURPOSE: To compare three techniques with regards to their ability to estimate pull out strength of spinal fusion hardware. MATERIAL AND METHODS: VDS-screw fixation strength in 50 human cadaveric vertebral bodies was approximated by means of pull out force measurement. Bone quality was assessed by Dual X-ray Absorptiometry (DXA). Quantitative Computed Tomography (QCT) and T2*-relaxation time. For each of these techniques, correlation with axial pull out force strength was investigated. RESULTS: Highest correlation was found for cancellous bone density measured by QCT (r = 0.72; p < 0.001). Immediately followed by DXA (r = 0.70; p < 0.001), which involves all bone components. Inverted T2*-relaxation time (r = 0.55; p < 0.001) and cortical bone density (QCT) correlated just slightly with pull-out force strength. CONCLUSIONS: Absorptiometrical techniques like QCT and DXA are most appropriate to estimate VDS-screw fixation strength preoperatively.     

A review of orthodontic appliance problems in general dental practice

Data from the literature, as well as our previous work, indicate a protective effect of superoxide dismutase (SOD) in topical application against UV-induced cutaneous damage. In the present article we show that pre-treatment of the skin with SOD protects against PUVA-induced inflammatory reactions not only in murine, but also in human skin. Using fluorescently labelled Cu,Zn SOD, epifluorescence microscopy and digital image processing, we demonstrate that the FITC fluorescence localizes in the stratum corneum and upper granulosa, as well as in the epidermal cell layer surrounding the lumina of the hair follicles. These findings were similar for murine and human skin. Since autofluorescence was eliminated by a special filter, it can be ascertained that the fluorescence observed in the tissues was due to FITC-labelled SOD.     

Conceptual research use: Some problems.

Responds to L. Cohen's (see record 1986-04739-001) criticism of the present authors' (see record 1986-04773-001) article on research in the practice of community mental health by identifying problems with the notion of the conceptual use of research. It is suggested that, given that these are actual problems, studies such as that of the present authors are correct in focusing on the instrumental use of research rather than on conceptual research use. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintaining orthodontic success: retention for the adult patient

The paper investigated the chromatographic conditions for TLC analysis of metamphetamine on silica gel and the lipophilic stationary phase RP V 18 in order to qualitatively analyze the drug in urine samples. Attention was also paid to chemical detection. Five detection reagents were tested, out of which Fast Black K salt, yielding orange-red spots with a detection limit of 1 microgram, proved to be the best. In the analysis of metamphetamine in the samples of model urine, the best results were achieved on Kieselgel. Using the developing system ethyl acetate-ethanol-concentrated solution of ammonia (36:2:2), a complete separation of the metamphetamine spot from the spots of ballast from the biological matrix was achieved.     

Making the best use of consultant orthodontic services, Part 2: How to undertake the referral

There is little information on the microbiology of periapical lesions, and no data on the residual microbial flora in the periapex, if any, after apicoectomy procedures. Hence, 64 patients treated by apicoectomy procedures were prospectively studied to assess the bacterial flora in the periapex and to evaluate the residual bacteria in postoperative apicoectomy sites. Of the 64 lesions studied, 14 (22%) were sterile and 50 (78%) yielded bacteria preoperatively. Bacteria could be recovered from 28 (56%) of the latter lesions after apicoectomy and curettage. A total of 105 bacterial strains was isolated from 50 lesions, yielding a range of 1-4 (mean 2.1) species per sample. The isolates comprised 84 (80%) facultative anaerobes and 21 (20%) strict anaerobes. A polymicrobial growth was obtained from 39 lesions whilst 11 lesions yielded pure cultures. On detailed microbiological analyses of 29 lesions, 40% of the isolates were identified as alpha-haemolytic streptococci, half of which were Streptococcus sanguis; anaerobic streptococci were the predominant anaerobes. None of the organisms or group(s) of organisms emerged as recalcitrant colonisers which were difficult to dislodge after surgical debridement. These data indicate that the majority of periapical lesions harbour a variety of flora which cannot be eradicated despite thorough apicoectomy procedures.     

Use of the orbicularis muscle flap for complex lower lid problems: a 6-year analysis

There are several groups of patients seeking lower lid blepharoplasty who present with the potential for unsatisfactory postoperative results, such as those presenting with atonic eyelids, patients with severe blepharochalasis alone or with large fat bags, patients with festoons, those with abnormal anatomy, and patients with deformity due to prior surgery. The orbicularis muscle flap technique provides good results in patients with potentially problematic lower eyelids. Of 600 blepharoplasties, 8.5 percent underwent the orbicularis muscle flap procedure. Follow-up time was 1.3 years, and average patient age was 54 years. Details of this technique are described together with results, including illustrative photographs. Of 51 patients, 49 had excellent or acceptable results and 2 had unacceptable results, 1 of whom required a small correction. This method produces a "minilift" of the lower eyelid and upper cheek skin that cannot be achieved with the standard lower eyelid blepharoplasty as described to date.     

The use of grommets for flexible hinge toe implants. A case report

The postmortem examination of bilateral first metatarsophalangeal flexible hinge toe implants in a 66-year-old woman with rheumatoid arthritis is reported. The prosthesis had been inserted with grommets in 1 joint and without grommets in the other 2.5 years before her death. The implants were removed, and the bone/implant interfaces were examined microscopically by hematoxylin eosin stains and an electron probe microanalyzer. Surfaces of the implants were examined by scanning electron microscopy. Silicone particles within the fibrous tissue at the bone/implant interface, and a tear and significant scuffing of the implant surface, were detected in the joint without grommets. Such changes were not detected in the joint with grommets. These findings suggest that grommets may improve implant durability and preventing silicone synovitis.     

Cochlear implants in children: an analysis of use over a three-year period

OBJECTIVE: This study aimed to determine whether children continue to wear their cochlear implant systems 1 and 3 years after implantation. STUDY DESIGN: The design was a prospective study based on the analysis of forced-choice questionnaires on implant use completed independently by parents and teachers. SETTING: The study was performed at a dedicated pediatric cochlear implant program in a tertiary referral center in the United Kingdom. PATIENTS: All 85 consecutively implanted children who had reached the 1-year interval after implantation and 37 children who had reached the 3-year assessment interval after implantation participated. The patients represented all socioeconomic status groups, the entire range of educational settings, and often lived at a considerable distance from the implant center. MAIN OUTCOME MEASURES: Parents and local teachers were asked to describe implant use in the following categories: 1) all of the time; 2) most of the time; 3) some of the time; and 4) none of the time. RESULTS: One year after implantation, parents and teachers, respectively, rated 79 (93%) and 82 (96%) children as full-time users (category 1). Parents rated six children (7%) as users most of the time (category 2), and teachers rated three children (4%) as users most of the time. No child was rated as an occasional or nonuser (category 3 or 4). At 3 years after implantation, 33 (89%) and 34 (95%) children were rated as full-time users (category 1) by parents and teachers, respectively. Parents judged four children (11%) and teachers rated two children (5%) to be users most of the time (category 2). Again, no child was rated in category 3 or 4 as an occasional or nonuser. CONCLUSIONS: The majority of implanted children use their implant systems all of the time over a 3-year period after implantation when selected appropriately and given appropriate follow-up.     

The use of high-density polyethylene implants in facial deformities

OBJECTIVE: To determine the usefulness of porous high-density polyethylene implants (Medpor) in a variety of facial skeletal deformities and subcutaneous defects, excluding those associated with acute maxillofacial trauma. DESIGN: Case series. SETTING: Academic tertiary care referral center in Baltimore, Md. PATIENTS: Thirty-four patients (age range, 20-74 years) with facial deformities requiring skeletal defect reconstruction or augmentation (38 cases), treated between January 1, 1992, and January 1, 1997. Follow-up ranged from 6 months to 40 months. MAIN OUTCOME MEASURES: Age, type and origin of the deformity treated, type of treatment, and complications. RESULTS: Types of deformities and defects treated include 7 patients with orbital defects (secondary traumatic or oncologic deformities), 8 with temporal fossa defects, 8 with frontocranial defects, 4 with maxillary or malar defects, 7 with calvarial bone graft donor site defects, 2 with microtia, and 2 with chin deficiency. Forty implants were placed. Complications included implant exposure in 4 patients and inappropriate augmentation in 1 patient (chin implantation). CONCLUSIONS: High-density polyethylene implants offer an excellent alternative to autogenous and other alloplastic materials in reconstruction of many facial defects and deformities. Advantages include its versatility and relatively ideal pore size that allows for excellent soft tissue ingrowth and coverage. Disadvantages include its rigid nature and difficulty in contouring to the surface of complex skeletal structures.     

Managing suicidal emergencies: Recommendations for the practitioner.

All practicing psychologists with an active caseload occasionally encounter a patient or client whom they consider to be a suicidal emergency. Few psychologists, however, have had education or training focused on managing such cases. The current article conceptualizes what a "behavioral emergency" is, gives recommendations for containing the emergency client's emotional turmoil, and sets forth an evidence-based approach, using diagnosis-specific risk factors, for improving the clinician's ability to estimate suicide risk. Recommendations are also given for appropriate responses to the patient or client on the basis of the level of estimated risk. Having such an algorithm or plan for dealing with the suicidal client is essential to good practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The needs of women with substance use problems: an expanded vision for treatment

Although the number of females served in United States treatment programs for substance use has increased over the last decade, women continue to be underrepresented. This suggests that the prevalent treatment models, which tend to be male-oriented, may not provide appropriate strategies to meet women's needs. Substance use problems in women appear to be multideterminded phenomena in which genetics, familial history, psychosocial issues, and other environmental factors play contributing roles. Working from a relational theoretical model of female psychosocial development, a continuum of expanded services addressing the entire context of women's lives is discussed.