Analytic Morphomics in Myositis-Related Interstitial Lung Disease.

PURPOSE: Interstitial lung disease (ILD) is the most common non-musculoskeletal manifestation of idiopathic inflammatory myopathies (IIM). Identification of body composition change may enable early intervention to improve prognosis. We investigated muscle quantity and quality derived from cross-sectional imaging in IIM, and its relationship to ILD severity. METHODS: A retrospective cohort study assessing IIM of ILD patients (n = 31) was conducted. Two datasets separated in time were collected, containing demographics, biochemical data, pulmonary function testing and thoracic CT data. Morphomic analysis of muscle quantity (cross-sectional area) and quality (density in Hounsfield Units) on thoracic CT were analysed utilising a web-based tool allowing segmentation of muscle and fat. Bilateral erector spinae and pectoralis muscle (ESM&PM) were measured at defined vertebral levels. RESULTS: FVC and DLCO decreased but within acceptable limits of treatment response (FVC: 83.7-78.7%, p < 0.05, DLCO 63.4-60.6%, p < 0.05). The cross-sectional area of the PM and ESM increased (PM: 39.8 to 40.7 cm2, p = 0.491; ESM: 35.2 to 39.5 cm2, p = 0.098). Density significantly fell for both the PM and ESM (PM: 35.3-31 HU, p < 0.05; ESM: 38-33.7, p < 0.05). Subcutaneous fat area increased from 103.9 to 136.1 cm2 (p < 0.05), while the visceral fat area increased but not reaching statistical significance. The change in PM density between time points demonstrated an inverse correlation with DLCO (p < 0.05, R = - 0.49). CONCLUSION: Patients with IIM ILD demonstrated significant body composition changes on CT imaging unlikely to be detected by traditional measurement tools. An increase in muscle area with an inverse decrease in density suggests poor muscle quality.

Paediatric deep brain stimulation: ethical considerations in malignant Tourette syndrome.

Gilles de la Tourette syndrome (TS) is a childhood neuropsychiatric disorder characterised by the presence of motor and vocal tics. Patients with malignant TS experience severe disease sequelae; risking morbidity and mortality due to tics, self-harm, psychiatric comorbidities and suicide. By definition, those cases termed 'malignant' are refractory to all conventional psychiatric and pharmacological regimens. In these instances, deep brain stimulation (DBS) may be efficacious. Current 2015 guidelines recommend a 6-month period absent of suicidal ideation before DBS is offered to patients with TS. We therefore wondered whether it may be ethically justifiable to offer DBS to a minor with malignant TS. We begin with a discussion of non-maleficence and beneficence. New evidence suggests that suicide risk in young patients with TS has been underestimated. In turn, DBS may represent an invaluable opportunity for children with malignant TS to secure future safety, independence and fulfilment. Postponing treatment is associated with additional risks. Ultimately, we assert this unique risk-benefit calculus justifies offering DBS to paediatric patients with malignant TS. A multidisciplinary team of clinicians must determine whether DBS is in the best interest of their individual patients. We conclude with a suggestion for future TS-DBS guidelines regarding suicidal ideation. The importance of informed consent and assent is underscored.

Long-term follow-up of implant treatment for oligodontia in an actively growing individual: a clinical report.

An 11-year-old patient with a history of oligodontia and hypohidrotic ectodermal dysplasia had implants placed in the anterior and posterior mandible as part of his prosthetic rehabilitation. The maxilla was restored by using traditional prosthodontic methods. The long-term follow-up of the treatment is presented, and the clinical implications of placing implants in an actively growing child are discussed.

A treatment planning classification for oligodontia.

PURPOSE: The aim of this research was to provide a classification for patients with oligodontia that could act as an aid in treatment planning. MATERIALS AND METHODS: Panoramic radiograph records of 70 patients with oligodontia were used to categorize the extent of the disability and treatment modality. Patients were classified into types 1 through 3 depending on the number of missing primary and permanent teeth, as well as in relation to their prosthodontic requirements. The radiographs were then assessed independently on two separate occasions by three experienced clinicians to validate the classification. RESULTS: There was a high level of intrarater consistency in allocating patients into the three different types with a Kappa (k) score of 0.77 for clinician 1, 0.87 for clinician 2, and 0.94 for clinician 3. There was also a strong interrater agreement (overall k score: 0.88). A k score greater then 0.6 is regarded as being good and greater than 0.8 as being very good. CONCLUSIONS: Oligodontia is a heterogeneous condition. Patients with oligodontia can be classified as having three different types according to the extent of their disability and the complexity of their prosthodontic requirements. This classification is a reliable diagnostic tool based on the positive outcome of the inter- and intrarater consistency.

The interdisciplinary management of a Class II division 1 malocclusion with an associated mandibular defect following surgical excision of fibromatosis: a clinical report.

Surgical excision of malignant or nonmalignant tumors of the maxillofacial region can result in significant anatomical loss/compromise. Correction of the residual defect can be complicated by the presence of an underlying malocclusion and can be a significant clinical challenge if large numbers of teeth have been lost in surgery. This clinical report discusses the interdisciplinary treatment to rehabilitate a patient with a history of surgical removal of fibromatosis. Treatment involved the use of osseointegrated implants to facilitate orthodontic correction of an underlying malocclusion. The implants were subsequently used in the prosthodontic rehabilitation of the residual surgical defect.

Inflammation associated with implants with different surface types.

OBJECTIVES: The aim of this study was to determine the nature of the inflammatory infiltrate associated with different transmucosal implant surfaces in dogs. METHODS: Three experimental and one control single-stage implants were randomly placed on each side of the jaw in eight dogs. The transmucosal portion of the test implants consisted of an acid-etched surface (type A), a machined surface with a circumferential groove (type C) and a surface prepared by mild anodic oxidation (type D). The control was a standard machined surface (type B). In order to determine the response to the different surfaces, plaque control was carried out twice weekly following placement of the implants for the entire period of the experiment. At 6 months, gingival biopsies and plaque samples were obtained. The area of inflammatory infiltrate and the nature of the infiltrating cell types were determined using immunohistology. Real-time polymerase chain reaction was used to identify putative periodontal pathogens. RESULTS: Inflammatory infiltrates were associated with all implant surfaces and were commonly found subepithelially and perivascularly. T cells were the predominant infiltrating cell type in all lesions, associated with the different surfaces. In all lesions the CD4 : CD8 ratio was approximately 2 : 1. Statistical analysis showed that the type C surface (machined surface with a groove) had significantly larger inflammatory infiltrates than the type B surface (machined surface without a groove; P<0.05). No statistically significant differences were found with respect to the size of the inflammatory infiltrates or in terms of the nature of infiltrating cells. However, despite the intensive plaque control regime, plaque was present on all implant surfaces at the time of biopsy 6 months after placement. All implants had similar numbers of Tannerella forsythia, Fusobacterium nucleatum and Porphyromonas gingivalis. Actinobacillus actinomycetemcomitans, was not detected in any sample. CONCLUSIONS: These results suggest that the development of inflammation associated with implants is independent of surface type, but is nevertheless associated with the presence of plaque. The different surfaces had no influence on the nature of the infiltrate, with T cells being the predominant cell type in all lesions. Finally, the different implant surface types seemed not to influence the peri-implant microbiota. However, the presence of the circumferential groove tended to be associated with larger infiltrates. Whether this is due to increased plaque accumulation remains to be determined.

A prospective study of immediately loaded single implant-retained mandibular overdentures: preliminary one-year results.

STATEMENT OF PROBLEM: The cost of rehabilitation of the problematic mandibular complete denture with implant-retained overdentures or implant-supported fixed prostheses is beyond the financial scope of many compromised denture patients. Therefore, a more affordable treatment alternative is desirable. PURPOSE: The purpose of this preliminary study was to investigate the predictability of simplifying mandibular overdenture treatment using single-stage surgery and immediate prosthetic loading of a single implant. MATERIAL AND METHODS: Twenty-eight patients with a mean age of 69.8 years and problematic mandibular dentures were treated. The primary complaints among the patients referred to the clinic for treatment related to poor retention of the mandibular denture, instability, denture sores, and phonetic problems. A single implant (Branemark TiUnite Mk III) was placed into the mandibular midline, achieving primary stability. A ball attachment was placed and the retentive cap incorporated into the existing denture. The patients were recalled at 3 and 12 months. Clinical assessments, radiographs made with custom film holders, and stability measurements by both manual and resonance frequency analysis methods were recorded. All complications, failures, maintenance, and reasons for failure to follow-up were noted. Visual analogue scale questionnaires were used to record patient satisfaction. A 1-way repeated-measures ANOVA was used to determine differences between means in the following categories: general satisfaction, social life, mastication of hard food, comfort, and fit (P=.05). RESULTS: Three implants did not achieve sufficient primary stability to be immediately loaded and were, therefore, treated with a 2-stage delayed loading protocol. The 25 immediately loaded implants were all surviving at the 12-month recall. Patient satisfaction was high, with a significant increase in all comfort and functional parameters (P values ranged from <.001 to .07). CONCLUSIONS: These preliminary 1-year results indicate that immediate loading of a single oxidized surface implant used to retain a mucosa-borne overdenture is a safe, reliable, and cost-effective treatment.

Oral implant restoration for enhanced oral function.

1. The present paper reviews the clinical applications of implant-anchored restorations replacing teeth and defects of the craniofacial skeleton resultant from congenital, traumatic and surgical tissue loss. 2. Different categories of tooth and tissue loss were treated in controlled multicentre prospective clinical trials. More recent developments have been the subject of limited pilot studies. 3. Long-term results and meta-analysis reviews have shown that osseointegrated implant-supported restorations were at least equal to, and in some applications superior to, traditional treatment methods. 4. Based on the outcome of a 30 year research and development programme and validation in numerous clinical trials, osseointegrated implant dental rehabilitation has become a viable treatment alternative for missing teeth and, for some applications, is considered to be a standard of care.

A clinical evaluation of the Zygoma fixture: one year of follow-up at 16 clinics.

PURPOSE: To evaluate treatment outcome with Zygoma fixtures (Nobel Biocare, Göteborg, Sweden) with regard to fixture survival, patient satisfaction, and function of prosthesis replacement. MATERIALS AND METHODS: The treatment outcome of 76 patients treated with 145 Zygoma fixtures at 16 centers was evaluated. Patient's and dentist's evaluations of the functional and aesthetic outcome of the treatment were assessed at delivery of prosthesis and at the 1-year follow-up visit. At the 1-year follow-up visit, the status of the peri-implant mucosa around the abutments and the amount of plaque were registered. RESULTS: Sixty-six of the 76 patients, with 124 Zygoma fixtures supporting the prosthetic restorations, were evaluated at the 1-year follow-up. The overall survival rate for the Zygoma fixtures was 97.9% after 1-year of follow-up. Eighty percent of the patients were fully satisfied with both aesthetic and functional outcome at the time of prosthetic insertion and at the 1-year follow-up. All reported data from the dentists, with the exception of one restoration with several abutment screw loosenings, scored from acceptable to excellent for the aesthetic and functional outcome of the treatment. The status of peri-implant mucosa was recorded as normal in approximately 60% of the sites. Plaque, when present, was more often detected on the palatal surfaces compared with the buccal surfaces. CONCLUSION: This 1-year follow-up of Zygoma fixtures has shown good results with an acceptable number of minor complications and a majority of satisfied patients.

Prospective multicenter study on immediate rehabilitation of edentulous lower jaws according to the Brånemark Novum protocol.

BACKGROUND: During recent years a new treatment concept, Brånemark Novum, has been developed in which implants are inserted in the edentulous lower jaw and immediately connected to a prefabricated titanium bar. A fixed prosthesis is then attached to the bar during or immediately following surgery. PURPOSE: The aim of the present study was to investigate the application of this concept under various settings, to determine technique sensitivity, and to evaluate the clinical outcome after 1 year of follow-up. MATERIALS AND METHODS: Fifty-one patients were included in a prospective multicenter investigation and followed up for 1 year. Cumulative implant survival rates were evaluated by life table analysis. In addition, clinical comparisons were performed to evaluate implant loss in relation to patient characteristics. Questionnaires were used to evaluate the treatment protocols and to obtain patients' opinions. RESULTS: The prosthetic treatment was completed on the same or the following day in 76% of the patients. The cumulative implant survival rates for implants and prostheses were 91% and 94%, respectively, after 12 months. CONCLUSIONS: The present study demonstrated that single-stage surgery and immediate loading of implants with prefabricated bridgework in the mandible can result in high implant success and significant reduction in treatment time, with patient satisfaction.

A review of guidelines for implant rehabilitation of the edentulous maxilla.

This review suggests some guidelines and protocols for treatment of the edentulous maxilla with osseointegrated implants. Evidence-based treatment options are discussed with reference to risk assessment. Developing technologies applicable to diagnosis, clinical procedures, and laboratory techniques are also discussed. Osseointegrated implants are increasingly advocated as a treatment option for maxillary edentulism and in many situations are the treatment of choice.

Do interleukin-1 polymorphisms predict the development of periodontitis or the success of dental implants?

Factors which increase the risk of severe adult periodontitis (AP) may also contribute to the success of dental implants. To determine which cytokines may be relevant, levels of interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta), interleukin-1 receptor antagonist (IL-1ra), interleukin-6 (IL-6) and interferon-gamma (IFN-gamma) mRNA were quantitated in gingival tissue from periodontitis patients and healthy controls. Periodontitis significantly increased levels of IL-1alpha, IL-1beta, IL-6 and IFN-gamma mRNA relative to healthy tissues. IL-1 was selected for further study, as it has inflammatory and bone resorbing properties. We examined IL-1A(-889) and IL-1B(+3953) alleles in Caucasian patients with AP and early-onset periodontitis (EOP), patients with dental implants and healthy individuals. The IL-1B(+3953) polymorphism was associated with AP. This was evident from an increased homozygosity for allele 2 in patients with AP and a decreased heterozygosity in advanced AP patients. IL-1A(-889) and a composite genotype [IL-1A(-889)2 plus IL-1B(+3953)2] showed no association with the incidence of periodontitis, disease onset or disease severity. IL-1A(-889), IL-1B(+3953) and the composite genotype also showed no association with failure of dental implants.