Cephalometric indicators of the vertical dimension of occlusion

The aim of this investigation was to establish precise indicators of the vertical dimension of occlusion (VDO) which could be used as objective parameters in prosthodontic treatment providing exact control of the reconstructed vertical dimension of occlusion, early detection of errors and correction of the vertical dimension of occlusion during complete denture manufacturing. A total of 60 lateral cephalometric radiographs of subjects with natural dentition and class I skeletal jaw relationship, of Serbian nationality from the region of Vojvodina, were included in the investigation. Thirty subjects were males, and thirty females, their age range was 20 to 29 years. Cephalometric analysis was performed by using "Dr. Ceph" computer software (FYI Technologies, GA, USA). By evaluation of the craniofacial complex in subjects with natural dentition, horizontal dentofacial developmental growth was established in the examined sample and it was based on the relationship between the posterior and anterior total facial height (S-Go:N-Me, female X=68.96%, male X=72.8%) and statistically significant differences were found between the sexes in almost all linear dimensions and in the relation between the posterior and the anterior total facial height. Highly significant differences (p<0.001) between the sexes were found in regard to anterior total facial height (N-Me, male X=120.75 mm, female X=112.72 mm) and the anterior lower facial height (ANS-Me, male X=67.87 mm, female X=61.50 mm) (p<0.05). The proportions of the upper and lower anterior facial heights (N-ANS:ANS-Me, male X=79.36%, female X=80.63%) were within normal values in both sexes. Facial harmony existed both in men and women. Cephalometric study of the subjects with complete natural dentition included in this study provided important and specific parameters for optimal reconstruction of vertical dimension of occlusion in the treatment of edentulous patients.     

Direct restorative treatment of anterior weared teeth after re‐establishment of occlusal vertical dimension: a case report

doi: 10.1111/j.1741‐2358.2012.00630.x Direct restorative treatment of anterior weared teeth after re‐establishment of occlusal vertical dimension: a case report Objective: The loss of posterior teeth resulting in a lack of stability may lead to excessive mandibular load on some points of occlusion of the remaining teeth, causing wear. The rehabilitation of these cases must be carefully planned and the treatment requires a period of adaptation with a new vertical dimension. Background: This case report describes the treatment of a patient with a loss of almost all posterior inferior teeth and a consequential loss of occlusal vertical dimension and accentuated wear of anterior elements. Materials and methods: Provisional removable partial dentures were manufactured and the patient used them for a period of adaptation prior to restoration of the anterior teeth. After the patient’s adaptation with the new occlusal dimension, anterior restorations were made using a mycrohibrid resin composite with different color aspects for an optimal stratification. Results: The restorations achieved an aesthetic configuration with ideal function as the final result and the occlusion showed a satisfactory stability for a provisional removable partial dentures. Conclusion: This article presents an anterior direct rehabilitation approach not only as an alternative option, but also as viable and less expensive treatment option with an optimally aesthetic and functional result.     

Elders with implant overdentures: a 22-year clinical report

doi: 10.1111/j.1741‐2358.2012.00628.x Elders with implant overdentures: a 22‐year clinical report Objective: To report on the long‐term survival and prosthodontic maintenance of two edentulous adults with mandibular overdentures supported by hydroxyapatite (HA)‐coated implants. Background: Mandibular implant overdentures are a successful treatment option with positive impact on the quality of life of elderly edentulous adults. Long‐term survival of the implants requires continued rigorous prosthodontic maintenance. Clinical report: Two elderly edentulous adults with mandibular overdentures supported by 2 HA‐coated implants were presented for prosthodontic rehabilitation after 22 years of placement. The implants were osseo‐integrated and surviving at presentation based on accepted criteria. The mandibular implant overdentures suffered recurrent loss of retention and stability. Prosthodontic treatment involving the replacement of defective attachment systems and construction of new sets of mandibular implant overdentures opposing complete maxillary dentures is presented. Conclusion: The long‐term survival of mandibular 2‐implant overdentures requires continued prosthodontic maintenance. A conservative approach in the rehabilitation of two older edentulous adults with mandibular 2‐implant overdentures was described including proper selection of attachment systems.     

Morphological integration in the hominin dentition: evolutionary, developmental, and functional factors

As the most common and best preserved remains in the fossil record, teeth are central to our understanding of evolution. However, many evolutionary analyses based on dental traits overlook the constraints that limit dental evolution. These constraints are diverse, ranging from developmental interactions between the individual elements of a homologous series (the whole dentition) to functional constraints related to occlusion. This study evaluates morphological integration in the hominin dentition and its effect on dental evolution in an extensive sample of Plio- and Pleistocene hominin teeth using geometric morphometrics and phylogenetic comparative methods. Results reveal that premolars and molars display significant levels of covariation; that integration is stronger in the mandibular dentition than in the maxillary dentition; and that antagonist teeth, especially first molars, are strongly integrated. Results also show an association of morphological integration and evolution. Stasis is observed in elements with strong functional and/or developmental interactions, namely in first molars. Alternatively, directional evolution (and weaker integration) occurs in the elements with marginal roles in occlusion and mastication, probably in response to other direct or indirect selective pressures. This study points to the need to reevaluate hypotheses about hominin evolution based on dental characters, given the complex scenario in which teeth evolve.     

Differences in Functional Outcomes for Adult Patients with Prosthodontically-Treated and -Untreated Shortened Dental Arches: A Systematic Review

This review examined differences in functional outcomes and patient satisfaction when shortened dental arches are left untreated compared to their restoration to complete arch lengths with different prosthodontic interventions.

Methods

A protocol was developed according to the criteria for a systematic review. All relevant databases were searched to identify appropriate clinical trials regardless of language or publication status. Predetermined eligibility criteria were applied, trial quality assessed and data extracted for each study. Relevant outcomes assessed were: functioning ability, patient satisfaction and harmful effects on oral structures.

Results

Searches yielded 101 articles: 81 from electronic databases and 20 from reference lists of retrieved articles (PEARLing searches). Sixty-nine citations were assessed for eligibility after removing 32 duplicate records. After reading titles and abstracts, a total of 41 records were excluded and the full-texts of the remaining 28 records were read. Only 21 records were included for the SR because 7 records were excluded after reading the full-text reports. These 21 records report the outcomes of four randomized controlled trials (RCTs) and one non-randomized clinical trial (CT) which were pre-specified and used for this review. No on-going studies were found and no eligible studies were excluded for failure to report the reviewer’s pre-specified outcomes. Outcomes were reported in the retrieved 21 articles. A narrative explanation of the pre-specified outcomes is reported for the 3 comparison groups (which were based on the different interventions used for the individual clinical trials). The shortened dental arch as a treatment option is encouraging in terms of functioning, patient satisfaction and cost-effectiveness. By using only high quality studies it was expected that the results would be more reliable when making conclusions and recommendations, but some of the included studies had to be downgraded due to methodological errors.     

A unique form of dental bilophodonty and a functional interpretation of peculiarities in the masticatory system of Arsinoitherium (mammalia,Embrithopoda)

The highly autapomorphic upper molar bilophodonty of the Oligocene mammal, Arsinoitherium (Embrithopoda) is an extreme form of dilambdodonty effected by lingual positioning of normally buccally situated cusps with reduction of lingual cusps. This effectively limits the molar dentition to a single phase shearing occlusal motion. Molar and premolar morphology is very different, premolars exhibiting high longitudinal ectolophs and typical two phase occlusal morphology. A double faceted mandibular condyle and angular discontinuity between lower molar and premolar dentitions is interpreted as a means of separating premolar from molar occlusion. A bifunctional masticatory system is proposed whereby efficient premolar occlusion is achieved only after a repositioning of the temporomandibular joint. Loss of phase II occlusion in the molars is compensated by maintenance of a crushing/grinding mode in the premolars. This coupled with the ability to maintain high occlusal pressures along the length of the mandible explains the unbroken dental arcade. Arsinoitheres therefore possess an extremely specialised masticatory apparatus and are interpreted as highly selective browsing herbivores.     

Persistent Tn polyagglutination syndrome during febrile neutropenia: a case report and review of the literature

Introduction

Crohn's disease is a chronic inflammatory bowel disease of unknown etiology which may affect any part of the bowel. Fistulas are a common and often serious complication of Crohn's disease. The treatment for fistulizing Crohn's disease can be medical, surgical or a combination of the two. Recently, adalimumab, a fully human anti-tumor necrosis factor monoclonal antibody, has been suggested as a safe and effective treatment for the induction and maintenance of remission in adult patients with moderate to severe Crohn's disease, who are refractory to conventional therapy or intolerant to infliximab. However, large studies focusing on evaluating the efficacy of adalimumab in fistulizing Crohn's disease have not yet been published.

Case presentation

We report the cases of three patients, of European Caucasian ethnicity and Greek nationality, with active luminal and fistulizing Crohn's disease. All of the cases were treated successfully with adalimumab. Patient 1 (a 44-year-old man) and patient 2 (an 18-year-old woman) developed early post-surgical enterocutaneous fistulas, while patient 3 (a 20-year-old woman) had peri-anal fistulizing Crohn's disease. Adalimumab treatment (160 mg subcutaneously at week zero, 80 mg at week two, and 40 mg every other week) was used for three different indications: (1) after the failure of other conservative medical treatments for Crohn's disease (patient 1); (2) as a monotherapy in treating a naive patient (patient 2); (3) after an intolerance to infliximab (patient 3). A remission of the active luminal and fistulizing disease was achieved soon after the initiation of adalimumab and sustained thereafter with maintenance doses. No further surgical intervention was required and no adverse effects were observed in any of the cases.

Conclusions

Fistulizing Crohn's disease remains a challenge in clinical practice. Adalimumab seems to be an effective, well-tolerated and safe treatment option for the induction and maintenance of remission in patients with moderate to severe peri-anal fistulizing Crohn's disease. Furthermore, adalimumab seems to be a promising treatment option for patients with moderate to severe fistulizing Crohn's disease with enterocutaneous fistulas. However, this clinical observation needs to be investigated in further clinical trials.     

Size and morphology of the permanent dentition in prehistoric Ohio Valley Amerindians.

Metric and morphological characterizations of the permanent teeth from a total of 155 prehistoric Amerindians are presented. The individuals represent samples from three Ohio Valley burial complexes (considered together as the Late Diffuse group): Glacial Kame, Adena and Ohio Hopewell. Metric data include common measures of central tendency and dispersion. From these measures estimates and analyses of the magnitude of sexual dimorphism and relative variability are presented as well as analyses of the patterns of these estimates. Forty morphological characters are also tabulated. The results indicate a number of provisional hypotheses: the generally larger tooth size of the Late Archaic Indian Knoll when compared to the Late Diffuse groups is consistent with the hypothesis of mitigated selective pressures in more technologically advanced groups; although tooth size is smaller in the Late Diffuse groups, dental morphology is as complex, or more so when compared to the Indian Knoll group. Since morphology and size do not covary exactly the biocultural forces resulting in smaller tooth size do not seem to act as strongly on dental morphology; odontological differences within the Late Diffuse arise primarily between the Glacial Kame-Adena and the Ohio Hopewell. These differences correspond to major biocultural changes in this area; although provisional hypotheses concerning odontological variability are erected, hypotheses concerning evolutionary trends must await the discovery of evolving lineages within these groups; similarities are noted among all compared groups including the pattern and magnitude of sexual dimorphism and relative variability. These parameters may be similar for all eastern Amerindians during this period; finally, the morphology of the deciduous dentition, which generally predicts that of the permanent teeth, is found to be less complex than the permanent teeth. This may be the result of a selective disadvantage for the individuals in the deciduous dentition sample which is reflected in the dentition.     

Significant correction of disease after postnatal administration of recombinant ectodysplasin A in canine X-linked ectodermal dysplasia

Patients with defective ectodysplasin A (EDA) are affected by X-linked hypohidrotic ectodermal dysplasia (XLHED), a condition characterized by sparse hair, inability to sweat, decreased lacrimation, frequent pulmonary infections, and missing and malformed teeth. The canine model of XLHED was used to study the developmental impact of EDA on secondary dentition, since dogs have an entirely brachyodont, diphyodont dentition similar to that in humans, as opposed to mice, which have only permanent teeth (monophyodont dentition), some of which are very different (aradicular hypsodont) than brachyodont human teeth. Also, clinical signs in humans and dogs with XLHED are virtually identical, whereas several are missing in the murine equivalent. In our model, the genetically missing EDA was compensated for by postnatal intravenous administration of soluble recombinant EDA. Untreated XLHED dogs have an incomplete set of conically shaped teeth similar to those seen in human patients with XLHED. After treatment with EDA, significant normalization of adult teeth was achieved in four of five XLHED dogs. Moreover, treatment restored normal lacrimation and resistance to eye and airway infections and improved sweating ability. These results not only provide proof of concept for a potential treatment of this orphan disease but also demonstrate an essential role of EDA in the development of secondary dentition.     

Compliance with growth hormone treatment - is it a problem?

Treatments fail for a number of reasons. These include the failure of medicines at a molecular level, failure to achieve the correct diagnosis and therefore use of the correct medication, problems surrounding the doctor-patient relationship, and failure of the service to meet patients' expectations. Compliance is characteristically viewed as the major cause of treatment failures but implicit in the use of the term compliance is the reliance on an imbalance of power where the patient follows what is ordered. Such an approach is likely to lead to failure. A better model is concerned with promoting the full participation of the patient to generate a therapeutic alliance. Despite the need for parental administration and a daily therapeutic regimen there appears to be little evidence to suggest that concordance is a major problem in growth hormone therapy. This is probably because treatment administration relies on the presence of a carer and there are tangible effects. However, concordance is likely to be an issue where there is mismatch between the patient's expectations and those of the doctor. Such a situation may arise when the therapeutic margin is narrow or the therapeutic effect minimal. To resolve this situation, adequate pre-intervention discussion is essential, which should include a clear statement of short- and long-term treatment targets and the likelihood of these being achieved or not. Carefully constructed health care plans are the key and should include educational programmes, home support and regular reinforcement. When concordance problems are suspected, careful consideration needs to be given as to whether the diagnosis is correct, is the treatment really effective and appropriate and does the patient really want the treatment.     

Oral cavity contains distinct niches with dynamic microbial communities

Microbes colonize human oral surfaces within hours after delivery. During postnatal development, physiological changes, such as the eruption of primary teeth and replacement of the primary dentition with permanent dentition, greatly alter the microbial habitats, which, in return, may lead to community composition shifts at different phases in people's lives. By profiling saliva, supragingival and mucosal plaque samples from healthy volunteers at different ages and dentition stages, we observed that the oral cavity is a highly heterogeneous ecological system containing distinct niches with significantly different microbial communities. More importantly, the phylogenetic microbial structure varies with ageing. In addition, only a few taxa were present across the whole populations, indicating a core oral microbiome should be defined based on age and oral niches.     

Oral function in dentate elderly with reduced dentitions

This study covers the characteristics of reduced dentitions in a population of elderly people. The sample consisted of 329 independently living individuals between 55 and 75 years of age. They all had one or more natural teeth and were all interviewed and investigated clinically. The findings showed that 13% of the subjects had a natural dentition with at least the first molars: 4–7 natural occlusal units (defined as ‘pairs of opposing teeth that support the occlusion’) occurred in 37% of the subjects; 1–4 natural occlusal units in 41% and 0 units in 9% (only anterior contacts). A removable partial denture was worn by 39% of the subjects: most of them were acrylic based dentures (61%). The percentages of restored teeth per subject were high. The need for further restorations, however, was low. Periodontal problems were uncommon: 25% of the subjects had one pocket above 5 mm: 8% had severe problems. Poor oral hygiene was present in a quarter of the cases. Most of the subjects (70%) had no pain or noises in the temporomandibular joint. Only 10% of subjects had more than one sign of craniomandibular dysfunction. Most of the subjects (85%) visit their dentist regularly and 65% had their last tooth extraction more then three years ago. A majority mentioned that they have never had problems with their dentition in the past: 50% had had no real toothache for the last five years. However problems with food-packing were often mentioned. It can be concluded that, although the dentitions of the elderly in this population are often reduced, their dentitions are in general in good condition and few give TMJ problems.     

Emergency admissions to a general medical unit: A survey of the accompanying letters,with recommendations

Letters of referral accompanied 166 out of 188 emergency admissions to a general medical unit over a four-month period. Of these, 129 contained useful information concerning past medical history, emergency treatment given, drugs taken, and provisional diagnosis. It is suggested that general practitioners should adopt some format based on essential criteria when writing letters of referral, so that important information is not overlooked.     

Endodontic considerations in the elderly

Tooth retention has increased significantly in older adults, and dentists are now challenged by the need to preserve critical teeth. There will be a need to consider endodontic therapy, and this paper describes how successful endodontics can be provided for elderly patients. Strategic treatment planning is essential, and preservation of key teeth will facilitate satisfactory oral function for elderly patients. These teeth may be important in achieving and maintaining an intact anterior dental arch, for removable partial denture retention or preservation of alveolar bone. In some cases, this can only be achieved if endodontic procedures are undertaken. When infection of a root canal is present, there is no reason why good quality endodontic therapy should not work in a healthy elderly patient. Elimination of infection can be challenging in narrow root canals, and a systematic approach for improving access into and negotiating these canals is outlined.     

Satellite cell activation on fibers: modeling events in vivo--an invited review

Knowledge of the events underlying satellite cell activation and the counterpart maintenance of quiescence is essential for planning therapies that will promote the growth and regeneration of skeletal muscle in healthy, disease and aging. By modeling those events of satellite cell activation in studies of single muscle fibers or muscles in culture, the roles of mechanical stretching and nitric oxide are becoming understood. Recent studies demonstrated that stretch-induced activation is very rapid and exhibits some features of satellite cell heterogeneity. As well, gene expression studies showed that expression of the c-met receptor gene rises rapidly after stretching muscles in culture compared to those without stretch. This change in gene expression during activation, and the maintenance of quiescence in both normal and dystrophic muscles are dependent on NO, as they are blocked by inhibition of nitric oxide synthase (NOS). Mechanical, contractile activity is the defining feature of muscle function. Therefore, ongoing studies of stretch effects in satellite cell activation and quiescence in quiescent fiber and muscle cultures provides appropriate models by which to explore the regulatory steps in muscle in vivo under many conditions related to disease, repair, rehabilitation, growth and the prevention or treatment of atrophy.     

Ecological Restoration of Headwaters in a Rural Landscape (Normandy,France): A Passive Approach Taking Hedge Networks into Account for Riparian Tree Recruitment

The safeguard of riparian ecosystems is a major field of study in the understanding and maintenance of the ecological health of rivers. Vegetation communities found on these ecotones ensure essential functions such as limitation of river bank erosion and protection of rivers from pollutants. The aim of our study is to investigate the potential for natural regeneration of trees on river banks after passive restoration. We have also studied the influence of landscape on recolonization through the analysis of the influence of hedge networks. Our study takes place on headwaters in Normandy (France) on Vallée‐Aux‐Berges, a stream, which has been passively restored for the last 6 years. As passive restoration removes stresses (heavy trampling and grazing) caused by cattle on river banks, we expect it to help the growth of natural plant communities. The condition of this stream—from the start of restoration work to the present—is compared to another one in the same catchment considered to be ecologically healthy. Our results suggest that passive restoration leads to an increase in tree cover on river banks and contributes to the improvement of the banks' physical integrity. Landscape structure seems to be a major factor for this recolonization: the more the stream is surrounded by hedge networks, the more the recolonization by trees on banks is effective. These results indicate that the influence of landscape structure should be considered in future restoration management in similar headwaters.     

Clinical studies on duct occlusion with prolamine

To prevent recurrence the pancreatic duct occlusion firstly was employed in the treatment of chronic pancreatitis. In combination with a Whipple's procedure a duct occlusion of the situ remaining pancreatic tail was performed in 141 cases since 1978. In the late follow-up only one patient developed a recurrent pancreatitis. In patients with pre-operatively normal glucose tolerance no post-operative diabetes was induced by this method. On the basis of these findings ductal occlusion also was carried out in a case of simultaneous pancreas-kidney-transplantation. Whereas the kidney did not function satisfactorily, the grafted pancreas with obstructed duct showed good endocrine function for over 9 weeks. The patient, who previously required injections of 60 IU insulin daily, needed no insulin during this period. The serum insulin level in several determinations was markedly above that of healthy normal people (65,3 microU/ml). Because of an infection which was uncontrollable under immunosuppression, the pancreas had to be removed again.     

Peptidomimetics and the template approach to nucleation of beta-sheets and alpha-helices in peptides.

Introducing structural constraints into engineered analogs of natural proteins is important for defining essential characteristics, such as specificity or stability, of the protein. This may be achieved by the use of peptidomimetics--elements which mimic the structure of natural peptide components, or conformational templates which induce specific structure formation in contiguous peptide sequence.     

Restoration of fertility after treatment for cancer

The late effects of chemotherapy and radiation treatment on fertility are an important issue for long-term survivors of cancer who may not have started or completed a family at the time of diagnosis. Attempts at protecting reproductive function using hormonal manipulation have proved largely unsuccessful and other strategies have to be considered. For men, semen cryopreservation allows subsequent artificial insemination of a female partner or ivf but cryopreserved semen is a finite resource, does not allow natural conception and is not an option for prepubertal boys. In an effort to overcome this, research is in progress to investigate whether testicular cells harvested and cryopreserved before the start of chemotherapy can be reintroduced to the testis after treatment and resume normal spermatogenesis. This has been achieved in a mouse model and the results of experimental protocols in men are awaited with interest. For women, harvested mature oocytes are only poorly tolerant of the freezing process although immediate in vitro fertilization and cryopreservation of embryos can be successful. An experimental technique of great interest is the harvesting and cryopreservation of ovarian cortex before the start of sterilizing treatment. In ewes, the reimplantation of autologous ovarian cortical tissue into surgically castrated animals has resulted in resumption of oestrus, conceptions after normal matings and the birth of live offspring. Recently, ovarian function has been re-established using a similar technique in a patient following treatment for Hodgkin's lymphoma, but so far pregnancy has not been reported.     

The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis

We conducted a comprehensive meta-analysis of 12 studies to examine whether maxillary protraction face mask associated with rapid maxillary expansion (FM/RME) could be an effective treatment for Class III malocclusion and to evaluate the effect of timing on treatment response. Patients with a maxillary deficiency who were treated with FM with or without RME were compared with those who had an untreated Class III malocclusion. In both treatment groups, forward displacement of the maxilla and skeletal changes were found to be statistically significant. In addition, posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the control group. However, no significant differences were observed between the early treatment groups and late treatment groups. The results indicated that both FM/RME and FM therapy produced favorable skeletal changes for correcting anterior crossbite, and the curative time was not affected by the presence of deciduous teeth, early mixed dentition or late mixed dentition in the patient.