Disruption of mesectodermal lineages by temporal misexpression of the Drosophila POU-domain transcription factor, drifter

The horizontal and vertical considerations that must be taken into account during the diagnosis and subsequent treatment of the dentally and skeletally compromised patient are discussed. The treatment planning and treatment of a difficult malocclusion that required comprehensive orthodontics with surgical intervention are presented.     

Altered patterns of DNA methylation on chromosomes from leukemia cell lines: identification of 5-methylcytosines by indirect immunodetection

The feasibility of implant treatment in patients after oral ablative tumor surgery has not yet been investigated with consideration of the requisite high periodontal standards. A report on this topic has to deal not only with implant survival but also with implant health, bone response, soft tissue health, failure pattern, time of failure, and ease of restoration. For the assessment of an implant system, an overview must be accomplished that takes into account the different restorations used and their interaction with the implant system that was used. This study presents the Bone-Lock implant system (Howmedica Leibinger GmbH, Freiburg, Germany) in a retrospective investigation after 5 years of follow-up with special emphasis on the prosthetic restorations used following resection of oral malignancies. From early in 1990 through June 1996, we inserted 210 dental endosteal Bone-Lock implants (58 patients) after oral tumor resectioning. Included in the study were 45 patients with 162 implants and prosthetic restorations that had been loaded for 1 year (dentures retained by telescopic or bar-clip or ball attachments, implant-supported prostheses, tooth-to-implant connected bridges). Regular follow-up consisted of evaluation of the Plaque Index (Silness and L?e) and of the Sulcus Bleeding Index (L?e), measurements of pocket probing depth, implant mobility (by means of the Periotest method), bone resorption (according to X-ray findings), and a questionnaire that registered patient satisfaction. The results were evaluated for each restoration and were compared with baseline standards. The overall 5-year survival rate was 83.2%. For implants that had been in place for over 365 days, the survival rate was 93%. The investigation showed that after resection of oral malignancies, patients could be treated with dental implants and superstructures with long-term efficacy similar to that found in healthy subjects considering internationally accepted standards. Implant treatment in tumor patients appeared to offer the most positive periodontic results when use of bar-clip or telescope-retained overdentures was involved. The patient satisfaction level with the described prosthodontic treatment was satisfactory.     

Implants in the partially edentulous patient: restorative considerations

Restorative considerations are critical to the long-term success of fixed implant-supported prostheses, especially in the posterior quadrants of the partially edentulous patient. The parafunctional habit of bruxism must be identified and addressed. The restoration should dictate implant placement. Control of forces directed upon the prosthesis and implants is critical to long-term success. Anatomic limitations to implant placement and surgical procedures to correct these deficiencies must be considered for their impact on the prosthetic restoration. Nonaxial forces or bending moments should be minimized by the use of an adequate number, position and alignment of implants; by control of the occlusion; and by design of the prosthesis. The patient must understand the risks, limitations, costs and time commitments of implant restorations prior to treatment.     

Managing malrelated arches and limited vertical space for implant-supported overdentures: a case report

Advancements in implant therapy have expanded the prosthetic options available to treat edentulous patients. The dental professional must be able to accurately diagnose the status of the intraoral environmental in order to provide the patient with appropriate treatment and a suitable restorative result. Skeletal relationships, arch malalignment, implant angulation, and ridge morphology must be evaluated during initial treatment planning and incorporated into the definitive prosthetic result. This case report demonstrates the application of an implant-supported prosthesis to address the various complications presented in the treatment of edentulous patients.     

Implants and orthodontics

After a detailed historical review of implantology applied to orthodontics, and an analysis of experimental studies on orthodontic implants, the authors assess the interest of implant clinical uses as anchorage for orthodontic movement, prosthetic supports in agenetic cases or retention devices after orthodontic therapy. Different specifications and requirements are also given for a multidisciplinary approach of treatment plants.     

The ethical allocation of scarce resources in surgery: implants and cost

This paper is a discussion of the factors involved in instituting a bulk purchasing program for surgical supplies. An improved understanding of the surgical procedure of joint arthroplasty must relate to the variability in surgical methods that achieve patient outcomes. An understanding of the outcomes in relation to the expected duration of the success of an implant and the high costs associated with a revision earlier than expected must be factored into the budget and costs of implants. The ethical implications of choosing one implant over another are considered. A more uniform outcome assessment with respect to surgical activities is needed and potential savings related to other operating-room costs must be examined. Optimizing the implant to patient requirements is the goal within the framework of current fiscal constraints.     

Definitive or exploratory periodontal experimentation: an overview of the literature

Definitive and exploratory randomized controlled trials (RCTs) have different goals as well as different design and analysis characteristics. The goal of definitive studies is to provide unequivocal evidence of a treatment's tangible benefit to the patient; a pre-trial-specified hypothesis is tested by use of a pre-trial-specified method. The goal of exploratory studies is to elucidate biological treatment mechanisms, to identify promising treatments, and to generate hypotheses for definitive studies: multiple hypotheses are evaluated to extract as much information from the data as possible. The purposes of this study were: (1) to survey selected design and analysis characteristics of randomized controlled periodontal trials published between 1988 and 1992 (n = 86), and (2) to classify trials as exploratory or definitive studies. The periodontal RCTs surveyed were typical of exploratory studies whose primary goal was to elucidate biological treatment mechanisms. Trial reports indicated the testing of multiple hypotheses (> or = 6 hypothesis tests in 70 of the 86 trials) on a variety of biological markers (86 out of 86 trials). The sample size (< or = 30 subjects in 67 out of 86 trials), duration (< or = 6 months in 65 out of 86 trials), and design and analysis characteristics (e.g., an absence of masking in 57 out of 86 trials) were also typical of exploratory studies which strive to obtain quick answers (short duration) at a low cost (small sample size; accept bias for increased efficiency and a lower cost). No definitive trials were identified. Promising, biologically active, treatments identified in exploratory trials should be evaluated in definitive studies where the primary goal is the procurement of unequivocal evidence of a treatment's tangible benefit to the patient. The costs and benefits of conducting definitive periodontal RCTs to provide such evidence should be investigated.     

Ischemia detection in women: the diagnostic value of exercise QRS duration changes

The purpose of this review article is to provide the dental practitioner with an understanding of the interrelationship between periodontics and orthodontics in adults. Specific areas reviewed are how periodontal tissue reacts to orthodontic forces, influence of tooth movement on the periodontium, effect of circumferential supracrestal fiberotomy in preventing orthodontic relapse, effect of orthodontic bands on the periodontium, specific microbiology associated with orthodontic bands, mucogingival considerations and time relationship between orthodontic and periodontal therapy. In addition, the relationship between orthodontics and implant restorations (e.g., using dental implants as orthodontic anchorage) will be discussed.     

Lipid peroxidation in patients with ischemic heart disease, hyperlipidemia and/or hypertension while polyunsaturated omega-3 fatty acids of plant and animal origin were in their diet

Missing anterior teeth are being replaced by implant-supported restorations quite frequently in modern dentistry. Providing the patient with a temporary prosthesis prior to or following implant fixture placement must satisfy established esthetic and functional criteria. When orthodontic treatment is included as part of the overall treatment effort, additional considerations include the retention and stabilization of newly established tooth positions. This article describes the fabrication, use and advantages of a provisional anterior prosthesis that replaces missing teeth prior to or following implant placement.     

Interrelations of soft and hard tissues for osseointegrated implants

Success in using osseointegrated dental implants-optimal function, esthetics, and phonetics-requires selection of the treatment modality that is optimal for the patient, protection of tissue blood supply, and adherence to a plan based on a thorough analysis of all deviations from the normal anatomy. The options for correction of hard-tissue deficiencies are mechanical modification of the implants and reconstructive surgery. Mechanical approaches reduce the time needed for reconstruction but direct the occlusal forces in unnatural directions. Surgical reconstruction is preferable. Any bone graft must be precisely fitted to the recipient site to facilitate revascularization. Restoration of hard-tissue dimensions usually requires soft-tissue coverage and augmentation. There are two basic options: (1) flaps with or without inlay or onlay grafts and (2) controlled tissue expansion. An onlay graft can help restore soft-tissue height and width. Inlay grafts have greater vascularity than onlay grafts, and the color matching is better. Controlled tissue expansion creates "like" tissue without a secondary defect, and fewer tissue transfers are needed. However, the technique is difficult, and the patient must make multiple visits to the office. For implant placement to be successful, the patient's expectations must be understood, and the benefit-to-risk ratio should be extremely high.     

Synthesis of a biologically active fluorescent derivative of GM1, a main Ginseng saponin metabolite formed by intestinal bacteria

PURPOSE: Prosthodontic components for implant treatment have been developed with minimal reported scientific investigation. This paper aims to highlight a number of problems caused by this approach to the development and marketing of prosthodontic components and to suggest solutions. CONCLUSION: Prosthodontic components must be developed with a scientific approach that involves both laboratory and clinical testing so as to optimize treatment outcomes in the future.     

Restriction as a method for reducing bias in the estimation of direct effects

The direct effect of a treatment on some outcome is that part of the treatment's effect not referred through a specified covariate intermediate on the pathway between treatment and outcome. Such direct effects are often of primary interest in a data analysis. Unfortunately, standard methods of analysis (for example, stratification or modelling) do not, in general, produce consistent estimates of direct effects whether or not the covariate is 'controlled'. Robins and co-authors have proposed two methods for estimation of direct effects applicable when reliable information is available on the covariate. We propose a third approach for reducing bias: data restriction. By restricting the analysis to strata of the data in which the effect of treatment on the covariate is small, we can (under certain assumptions) reduce bias in estimating treatment's direct effect. We discuss these points with reference to difference and ratio measures of treatment effect. The approach will sometimes be applicable even with an unmeasured or poorly measured covariate. We illustrate these points with data from an observational study of the effect of hormone replacement therapy on breast cancer.     

Nonsurgical treatment of the patient with vertical discrepancy

Conventional orthodontic treatment of the patient who has excessive anterior facial height is difficult. Many times, the patient is presented only a surgical-orthodontic option. However, some "orthodontics only" options are available. These options can generally give the patient acceptable facial balance and a good functional occlusion. The two keys are differential diagnosis and a carefully monitored force system. Conventional treatment of two patients with high angle facial dimension will illustrate these concepts.     

The role of the restorative dentist in the diagnosis and maintenance phases of implant therapy--Part III: The restoration and maintenance of oral health prior to the provision of the implant prosthesis

Establishing and maintaining the patient's oral health prior to provision of the definitive implant restoration is the responsibility of the restorative dentist and is an important aspect of comprehensive treatment. The additional time and expense required to provide oral hygiene and conventional dental treatment needs to be acknowledged by the implant team and the patient. An anticipated three to five treatment hours are often required to provide maintenance and hygiene care, with additional time needed to provide individualized conventional dental treatment to each patient. The provision of implant therapy is a rewarding experience when all aspects of treatment are properly planned and competently performed. The general practitioner is the logical resource to provide much of the necessary treatment that is directly and indirectly related to the provision of implant restorative dentistry.     

Clinical disorders of magnesium metabolism

Dental care of the aging patient presents a number of problems not encountered in younger patients. Most of these problems result from tissue changes that occur during aging. Dental implants and implant-retained and/or implant-supported prostheses are viable treatment options for older patients. The majority of elderly patients in their younger retirement years are relatively healthy and not limited in activity. The clinician must be aware of the physical, metabolic, and endocrine changes associated with aging and how these changes may affect implant treatment. The elderly deserve the best care the dental profession can offer.     

Significant reduction in circuit pressure with modified plasma separation chamber for a heparin removal device

OBJECTIVE: This study aimed to determine the maximum dose of radiation the CLARION 1.2 cochlear implant can withstand safely. INTRODUCTION: Cochlear implants restore functional hearing to patients with sensorineural deafness. Because some patients may need radiation therapy, it is important to investigate the influence of ionizing radiation on cochlear implant function. METHODS: This study tested the function of four CLARION 1.2 implants (Advanced Bionics, Sylmar, CA, U.S.A.) after varying radiation treatments with gamma rays. The first implant received a cumulative dosage of 69 Gy over nine treatments (single doses between 0.1-30 Gy). The second was irradiated with a total of 90 Gy, receiving three treatments of 30 Gy each. The third and fourth received doses more typical of patient therapy (i.e., 2 Gy) approximately 30 times, for a cumulative dosage of approximately 60 Gy. Implant function was tested after every treatment; the CLARION implant incorporates a back-telemetry system, allowing impedance and current output testing. RESULTS: Despite the type of treatment, the results were quite consistent: difficulties in function occurred when the cumulative dosage inside the implant was approximately 60 Gy. The first implant recovered completely and the second recovered partially. DISCUSSION: The CLARION 1.2 cochlear implant seems to safely withstand approximately 60 Gy of radiation before experiencing functional difficulties. In a clinical situation, the implant would not likely be in the target volume irradiated, and thus the patient's therapeutic cumulative dosage might be higher.     

Long-term efficacy of total SILASTIC implants: a subjective analysis

A retrospective analysis of the long-term efficacy of total SILASTIC implant arthroplasty performed before 1986 is presented. A total of 50 patients responded to subjective questionnaires regarding pain, function, complications, and overall patient satisfaction. The average age of the patients at the time of surgery was 55.1 years with an average follow-up of 13.4 years (range 10.7 to 16.9 years). Ninety-seven percent of patients reported relief from pain, and the overall success rating was 90.7%. Results were calculated based on a modification of the American Orthopaedic Foot and Ankle Society clinical rating system; the mean rating was 87.3. Attention must be directed at realigning the joint via appropriate osteotomies and soft tissue balancing procedures for increased success. Although radiographic deterioration of the implant was demonstrated in all implants, this deterioration did not correlate with patient satisfaction and should not be the sole criterion for implant removal. We conclude that total implant arthroplasty is a proven procedure for long-term relief of pain in selected patients with degenerative joint disease of the first metatarsophalangeal joint.     

Treatment of accidental extravasation of antitumor agents with dimethylsulfoxide and alpha-tocopherol

INTRODUCTION: The aim of this study was to test topical applications of dimethylsulfoxide and alpha-tocopherol for the prevention of ulcerations after antimitotic extravasation. METHODS: An open prospective study was conducted in 10 patients in 4 different chemotherapy wards who had experienced infusion accidents leading to phlebitis (4 cases) or cellulitis (8 cases) including 2 at implant sites. Topical application of the dimethylsulfoxide alpha-tocopherol combination was initiated within the first hours and continued for 3 to 15 days. One patient was given dimethylsulfoxide alone. RESULTS: Necrosis was never observed. The implant sites were preserved and remained functional. CONCLUSION: The absence of secondary ulcerations and the preservation of the implant sites are clear advantages of this topical combination which should be used as first line treatment. Favorable results have been reported in the literature while other techniques used depend on the antimitotic agent and give variable results.     

Use of provisional restorations to enhance soft-tissue contours for implant restorations

The objective of restoring missing teeth with implant-supported restorations should not merely be achieving osseointegration with an implant and a biomechanically sound restoration. The objective must be the esthetic and functional restoration of the missing teeth. To achieve this, proper treatment planning is critical. Precise implant placement and delicate soft-tissue manipulation during surgery will allow the restorative dentist to enhance the peri-implant soft-tissue contours with the use of provisional restorations. Empirically, it seems that the earlier the provisional restoration is delivered in the treatment process the more ideal the esthetics. Several methods of using provisional restorations to enhance soft-tissue contours are presented. The concept of immediately delivering provisional restorations on placement of an implant is discussed.     

Reality and danger in psychoanalytic treatment

In recent papers there has been considerable interest in the disclosure of the analyst's erotic countertransference. In our view this discussion touches a more fundamental issue: must something "real" take place between analyst and patient in order for real change to occur? And if what takes place is "real," will it not be dangerous and potentially destructive? Tracing the history of psychoanalytic understandings of what is "real" in the patient's life and what is "real" in the transference, we explore these questions in a clinical vignette and discuss the implications of this issue for our understanding of the process of psychoanalytic treatment.