Does shelf preparation have efficacy on immediate loading of 4 implants supporting screw-retained full-arch dental prosthesis?

Background: Bone reduction and shelf preparation is a common procedure to establish a new alveolar plane before implant surgery, which might effect the primary stability. Aim: Primary stability was questioned in terms of bone reduction and shelf preparation. The suitability of immediate loading was compared between the implants placed on crests, which underwent alveoloplasty, and the implants placed on a naturally healed alveolar bone. Patients and Methods: We designed and implemented a retrospective cohort study. Twenty patients (mean age 49.2 years) were treated with 160 dental implants. The primary predictor variable was extraction and bone reduction. The secondary predictor variables were bone density and the implant surface. The outcome variables were resonance frequency analysis (RFA) and insertion torque (IT) values. Results: There was no statistically significant difference between groups regarding RFA and IT (P > 0,05). Interactions of surface area with the RFA and IT in both groups were not statistically significant; however, bone density presented a statistically significant effect on outcome variables for both groups. Conclusion: IT and RFA are not influenced by bone reduction, shelf preparation, or the implant surface. Primary stability is mostly affected by bone density in the immediate load of 4 implants to support a full-arch prosthesis.

Evaluation of the effects of the surgical removal of impacted third molars on the emotional state of individuals with Beck depression inventory.

AIMS: In this study, using Beck depression inventory (BDI), we aimed to determine alterations in the emotional state of patients who had impacted third molars (M3) extracted owing to postoperative pain, edema, and trismus.In this prospective clinical trial, which was conducted at Tokat Gaziosmanpasa University, Faculty of Dentistry, Department of Maxillofacial Surgery Clinic, we studied 60 patients (30 males and 30 females), who were 18-47 years old (the mean of 25.6 years of age). The patients with M3 with moderate preoperative pain intensities, edema, and maximal mouth opening (MMO) data were recorded, and BDI was applied to determine their emotional states. The patients were re-evaluated using BDI to detect alterations in their emotional state owing to pain intensity, edema, and trismus on postoperative second and seventh day. SUBJECTS AND METHODS: Descriptive statistical analysis, Chi-square, and independent t-test were utilized to interpret the obtained data. RESULTS: According to our findings, a statistically significant relationship was observed between BDI scores and gender on the second postoperative day (P = 0.004), and between MMO and BDI scores on the second and seventh postoperative day (P = 0.012, P = 0.045). Pain intensity scores on the postoperative sixth hour and seventh day were significantly correlated with BDI scores on the postoperative second and seventh day (P = 0.000/ P = 0.000/P = 0.002/P = 0.004/P = 0.010/P = 0.017/P = 0.001/P = 0.000). CONCLUSIONS: Our results suggest that the pain and trismus owing to the M3 surgery were significantly correlated with an increase in the postoperative BDI scores.

Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders.

The purpose of this study was to clinically evaluate the efficacies of three treatment methods and to compare their outcomes in patients with painful disc displacement. The study group comprised 45 patients with unilateral temporomandibular disorders who fell into Axis I group II (with limited mouth opening) of the Research Diagnostic Criteria for Temporomandibular Disorders. Magnetic resonance imaging was used for definitive diagnosis. The patients were divided randomly into three groups according to the treatment method: splint therapy, splint therapy with ultrasound-guided arthrocentesis, and splint therapy with low-level laser therapy. Patients were followed up after treatment for 6 months. The groups were compared in terms of pain and functional jaw movements (unassisted mouth opening without pain, maximum unassisted mouth opening, and contralateral movements). At the end of treatment, functional jaw movements were significantly increased while pain values were significantly decreased in all groups (P<0.05). Group 2 had a quicker improvement in terms of mouth opening scores at the end of the first month, and unassisted mouth opening without pain was found to be more than 35 millimetres in all groups at the end of 6 months. All treatment modalities showed effective results on pain and functional jaw movements in the treatment of temporomandibular disorders.

Clinical Evaluation of Three Types of CAD/CAM Inlay/ Onlay Materials After 1-Year Clinical Follow Up.

OBJECTIVE: To evaluate the clinical performance and the marginal adaptation of inlay/ onlay restorations made of lithium of a new lithium disilicate strengthened, lithium alumino-silicate glass-ceramic (LAS) material compared with a conventional lithium-disilicate glass-ceramic (LDS) and new-generation polymer-based CAD/CAM resin composite (CS) materials over one year. MATERIALS AND METHODS: Seventy-five inlay-onlay restorations were placed in 35 patients. The restorations were assigned and randomized to three groups as LDS, LAS, and CS. Clinical evaluations were performed after one week, six months, and one year after the cementation, according to the modified United States Public Health Services (USPHS) criteria. The marginal quality analyses of 21 samples (n=7) were assessed under a scanning electron microscope. The data were analyzed by using Friedman, Wilcoxon Signed Ranks, Chi-square and Paired t-tests (p⟨0.05). RESULTS: No statistically significant difference (p⟩0.05) was found between groups in the modified USPHS, gingival index, and plaque index evaluations, and the total success rate was 100% for three groups after one year. Following SEM evaluations in all groups, continuous margin percentages were decreased, but these results were not statistically significant (p⟩0.05). CONCLUSIONS: Lithium disilicate-strengthened lithium aluminosilicate glass-ceramics can be considered a reliable material for an option for posterior onlay/inlay restorations.

Effect of polymer type on characteristics of buccal tablets using factorial design.

A two factor three level factorial design was used to investigate the effects of carbopol and cationic hydrophilic polymers which have a common use in buccal drug formulations. Statistical models with interaction terms were derived to evaluate influence of carbopol (X1) and chitosan (X2) on tablet disintegration (Y1) and dissolution (Y2), mechanical properties (Y3), swelling (Y4). Tablet disintegration studies were carried out using two different pH environments within buccal region pH limits and also two different commonly used dissolution methods for buccal tablets were also investigated to compare the effect of polymer type on dissolution. Polymer type and ratio affect the characteristics of the buccal tablets due to their different physicochemical behavior at buccal pH. Also significant variances between dissolution profiles for buccal tablets, using either USP Paddle or flow through cell methods were found. These results indicate that both polymer type and ratio as well as combination of them effects the drug behavior in different ways.

Lornoxicam injection is inferior to betamethasone in the treatment of subacromial impingement syndrome : A prospective randomized study of functional outcomes.

BACKGROUND: Subacromial impingement syndrome (SIS) is one of the most frequent shoulder pathologies. Initial treatment is conservative. Subacromial injection of drugs achieves a high concentration at the pathologic site with less drug use and fewer systemic side effects. Glucocorticoids are most frequently injected. One concern with steroid use is the wide array of potential systemic and local complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also peripherally acting and can be used locally. Although intraarticular (IA) use of NSAIDs is common in orthopedic practice, it is mostly restricted to the knee joint. Reports of local NSAID for joint pathologies are relatively rare. This study compared the efficacy of single-dose subacromial injections of betamethasone and lornoxicam for treatment of SIS. METHODS: Subacromial injections of either 7.0 mg betamethasone or 8 mg lornoxicam were received by 70 patients with mean age 53 (46-68) years. Treatment outcome was assessed with Constant-Murley and UCLA questionnaires before injection and at 2­, 4­, and 6­week follow-ups. RESULTS: The change in outcome scores compared to pretreatment was higher in the steroid group at all follow-ups (p < 0.001). Patients in the steroid group showed a significant improvement at all follow-ups compared to pretreatment (p <0.001) and previous follow-ups (p <0.05) at all times. Patients in the lornoxicam group showed a significant functional improvement in week 2 (p <0.001), which was not evident in the following weeks (p >0.05). Although functional recovery halted after week 2, outcome scores remained significantly higher than the pretreatment values at all weeks (p <0.001). CONCLUSION: Although a single subacromial lornoxicam injection provides rapid functional recovery, which partially extends into the intermediate term, its results are inferior to betamethasone and it may be an alternative only in patients where corticosteroids are contraindicated.

Serum nesfatin-1 levels in patients with different glucose tolerance levels.

The aim of this study was to compare the levels of nesfatin-1 in healthy subjects with those in prediabetic and diabetic patients who have different glucose tolerance levels. Overall, 100 subjects were divided into 5 groups healthy control (C), impaired fasting glycemia (IFG), impaired glucose tolerance (IGT), metabolic syndrome (MS) and type 2 diabetes mellitus, (Type 2 DM). Glycated hemoglobin (HbA1c) assessed the glycemic control. Homeostasis model assessment of insulin resistance (HOMA-IR) was determined using computer analyses. Nesfatin-1 levels were measured using ELISA method. IFG and IGT (prediabetic groups) from MS and Type 2 DM (diabetic groups) differed significantly in HOMA-IR. The nesfatin-1 levels were lower, although not statistically significant, in IFG (0.937+/-0.03 ng/ml, p=0.07) and IGT (1.039+/-0.06 ng/ml, p=0.5) groups compared to healthy subjects (1.094+/-0.07 ng/ml). However, the nesfatin-1 levels were lower in patients with Type 2 DM (0.867+/-0.02 ng/ml, p=0.007) and MS (0.885+/-0.01 ng/ml, p=0.01) compared to healthy subjects. Nesfatin-1 levels were significantly lower in diabetic patients compared to healthy subjects. This study supports the role of insulin resistance in decreased nesfatin-1 levels in patients with Type 2 DM and MS.

Assessment of nasal mucociliary activity in patients with Behçet's disease.

OBJECTIVE: To investigate nasal mucociliary clearance in patients with Behçet's disease. METHODS: Thirty patients with Behçet's disease, diagnosed on the basis of criteria defined by the International Study Group for Behçet's Disease, and 30 healthy individuals were recruited. In both groups, individuals with conditions that could affect nasal mucociliary clearance were excluded. Nasal mucociliary clearance time was evaluated using saccharin tests. The time between placement of a saccharin tablet and the tasting of the saccharin was measured and recorded as the saccharin clearance time. RESULTS: The mean nasal mucociliary clearance time was significantly longer in the Behçet's disease patients than in the control subjects (p < 0.001). Furthermore, there was a positive correlation between Behçet's disease duration and nasal mucociliary clearance time (p < 0.001, r = 0.882). CONCLUSION: The results suggest that nasal mucociliary clearance time is longer in Behçet's disease patients than in control subjects, and is positively correlated with disease duration.

The role of diffusion weighted MR imaging for differentiation between Graves' disease and Hashimoto thyroiditis.

OBJECTIVE: The aim of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DWMRI) for differentation between Graves' disease and Hashimoto's thyroiditis. PATIENTS AND METHODS: Fifty patients (27 Graves diseases and 23 Hashimoto thyroiditis) and twenty healthy volunteers were examined using T1, T2 and DWMRI. The patients were diagnosed on the basis of physical findings and the results of thyroid function tests and serological tests. Circular ROIs were positioned on the bilateral thyroid lobes and isthmus. All measurements were repeated three different b values including 100, 600 and 1000 s/mm2 in all cases. ADC (Apparent diffusion coefficient) maps were calculated automatically with the MR system. RESULTS: Mean ADC values were 2.93 × 10-3, 1.97 × 10-3 and 1.62 × 10-3 mm2/s in the healthy volunteers; 3.47 × 10-3, 2.25 × 10-3 and 1.64 × 10-3 mm2/s in Graves' disease; 2.53 × 10-3, 1.76 × 10-3, 1.28 × 10-3 mm2/s in Hashimoto thyroiditis for b100, b600 and b1000, respectively. The ADC values of the Graves diseases were higher than healty volunteers and Hashimoto thyroiditis. ADC values were statistically significant for differentation between Hashimoto thyroiditis and Graves' disease all b values (p < 0.05). CONCLUSIONS: DWMRI is fast sequence and does not require contrast agent. Quantitative assessment of the lesion is possible using ADC map. So, DWMRI may be useful differentiation of the Hashimoto thyroiditis and Graves' disease.

The protective effects of taurine on experimental acute pancreatitis in a rat model.

The aim of this study was to investigate the protective effects of taurine (Tau) on experimental acute pancreatitis (AP) in a rat model by measuring cytokines and oxidant stress markers. Forty rats were randomly divided into four groups: sham, AP, Tau and AP + Tau. AP was induced with sodium taurocholate. No treatment was given to the AP. All rats were killed 5 days later. Pancreatic tissues of rats and blood samples were obtained. Tau treatment significantly decreased serum amylase activity (p < 0.001), total injury score (p < 0.001), malondialdehyde levels (p < 0.001) and myeloperoxidase (MPO) activity (p < 0.001). There was no significant difference between the Tau and AP + Tau groups in serum and pancreatic tumor necrosis factor-α, interleukin (IL)-1ß and IL-6 levels (p = 1.000). Histopathologic scores in the AP + Tau and Tau groups were significantly lower compared with the AP group (both p < 0.001). These results showed that Tau reduces lipid peroxidation, amylase and MPO activities and the concentrations of proinflammatory cytokines secondary to AP and also increases superoxide dismutase and glutathione peroxidase activities in rats with sodium taurocholate-induced AP. It also has a marked ameliorative effect at histopathologic lesions. With these effects, Tau protects the cells from oxidative damage, reduces inflammation and promotes regression of pancreatic damage.

The influence of occlusion on masticatory performance and satisfaction in complete denture wearers.

Complete dentures should satisfy patients' needs for comfort, function and aesthetics. Thirty edentulous patients were enrolled in this study. Two sets of complete dentures were made for each patient: one with bilaterally balanced occlusion and the other with lingualised occlusion. The patients used each type of denture for 6 months. A single-blind study design was used in which the patients were not aware of the exchange of dentures. In each 3-month period, electromyographic measurements of the anterior temporalis and masseter muscles were performed. At the end of 6 months, patient satisfaction was evaluated. The second measurement of lingualised occlusion showed the greatest muscle activity, while chewing gum in both the anterior temporalis and masseter muscles (174·5 and 208·19 µV, respectively). The greatest maximum voluntary contraction was also found for the second measurement of lingualised occlusion for both the anterior temporalis and masseter muscles (142·91 and 187·55 µV, respectively). The mean chewing time decreased with lingualised occlusion. The percent distribution of the patients' ratings of their complete dentures and patient satisfaction with lingualised occlusion were higher than those for bilaterally balanced occlusion. Complete dentures with lingualised occlusion increased masticatory performance, maximum voluntary contraction and patient satisfaction and decreased chewing time.

Prevalence of femoroacetabular impingement in asymptomatic contralateral hips in patients with unilateral idiopathic osteoarthritis.

Radiographic findings of femoroace tabular impingement in the contralateral asymptomatic hip of patients who had undergone total hip arthroplasty because of primary osteoarthritis (n = 44) were compared with controls (n = 40). The centre-edge angle and caput-collum-diaphyseal angle were measured and the presence of crossover sign and a prominent ischial spine noted on anteroposterior radiographs of the pelvis. The α-angle and offset ratio were measured on cross-table lateral radiographs of the hip. The centre-edge angle and offset ratio were significantly lower and the α-angle significantly higher in the study group compared with controls. While the number of cases with an abnormal centre-edge angle was similar in both groups, the numbers with an α-angle > 50° and the number with an offset ratio ≤ 15 were significantly higher in the study group. It was concluded that morphological anomalies associated with femoroacetabular impingement are seen more frequently in the asymptomatic contralateral hip of patients who have undergone hip replacement for primary osteoarthritis than in controls.

The effects of zoledronic acid and hyperbaric oxygen on posterior lumbar fusion in a rabbit model.

We studied the effects of hyperbaric oxygen (HBO) and zoledronic acid (ZA) on posterior lumbar fusion using a validated animal model. A total of 40 New Zealand white rabbits underwent posterior lumbar fusion at L5-6 with autogenous iliac bone grafting. They were divided randomly into four groups as follows: group 1, control; group 2, HBO (2.4 atm for two hours daily); group 3, local ZA (20 µg of ZA mixed with bone graft); and group 4, combined HBO and local ZA. All the animals were killed six weeks after surgery and the fusion segments were subjected to radiological analysis, manual palpation, biomechanical testing and histological examination. Five rabbits died within two weeks of operation. Thus, 35 rabbits (eight in group 1 and nine in groups 2, 3 and 4) completed the study. The rates of fusion in groups 3 and 4 (p = 0.015) were higher than in group 1 (p < 0.001) in terms of radiological analysis and in group 4 was higher than in group 1 with regard to manual palpation (p = 0.015). We found a statistically significant difference in the biomechanical analysis between groups 1 and 4 (p = 0.024). Histological examination also showed a statistically significant difference between groups 1 and 4 (p = 0.036). Our results suggest that local ZA combined with HBO may improve the success rate in posterior lumbar spinal fusion.

The risk factors for mortality in elderly patients with hip fractures: postoperative one-year results.

INTRODUCTION: Hip fractures in the elderly are associated with significant mortality. This study aimed to investigate the risk factors for mortality in elderly patients with hip fractures during a one-year period. METHODS: This was a prospective study which included consecutive isolated nonpathologic hip fractures in 74 (52 female, 22 male) patients in a level-1 trauma centre. These patients were 65 years or older and were ambulatory before the fracture. The patients were treated with hemiarthroplasty. The factors investigated were age, gender, nutritional status determined by blood albumin and total lymphocyte count, haemoglobin levels on the day of admission, mobilisation time after surgery, length of hospital stay, comorbidities, American Society of Anaesthesiologists (ASA) rating of operative risk, and the time period between injury and surgery. The patients were followed up for one year after surgery, or until death. RESULTS: In total, 15 patients died during the one-year period. Patient survival was 94.6 percent at 3 months, 81.1 percent at 6 months and 79.7 percent at 12 months. There were two in-hospital deaths. The factors significantly associated with mortality were patients with more than two comorbidities, an ASA score of III-IV, a blood albumin level of less than 3.5 g/dl and a total lymphocyte count of less than 1500 cells/ml on admission. However, after the multivariate analysis, an ASA score of III-IV, low total lymphocyte count, female gender and low haemoglobin levels on admission remained the independent and significant risk factors associated with a one-year mortality. CONCLUSION: This study confirms that a high ASA score, female gender, a lower lymphocyte count and low haemoglobin levels on admission are significant factors in assessing the one-year mortality in elderly patients with hip fractures. Predicting these risk factors improves the case management.

Evaluation and comparison of the antimicrobial efficacy of teicoplanin- and clindamycin-coated titanium implants: an experimental study.

We studied the effects of coating titanium implants with teicoplanin and clindamycin in 30 New Zealand White rabbits which were randomly assigned to three groups. The intramedullary canal of the left tibia of each rabbit was inoculated with 500 colony forming units of Staphylococcus aureus. Teicoplanin-coated implants were implanted into rabbits in group 1, clindamycin-coated implants into rabbits in group 2, and uncoated implants into those in group 3. All the rabbits were killed one week later. The implants were removed and cultured together with pieces of tibial bone and wound swabs. The rate of colonisation of the organisms in the three groups was compared. Organisms were cultured from no rabbits in group 1, one in group 2 but from all in group 3. There was no significant difference between groups 1 and 2 (p = 1.000). There were significant differences between groups 1 and 3 and groups 2 and 3 (p < 0.001). Significant protection against bacterial colonisation and infection was found with teicoplanin- and clindamycin-coated implants in this experimental model.

The effects of human amniotic membrane and periosteal autograft on tendon healing: experimental study in rabbits.

In this study, the effects of periosteal autograft and human amniotic membrane on tendon healing were compared. Forty-two New Zealand rabbits were divided into three groups. Flexor digitorum fibularis tendons were cut and repaired with a modified Kessler technique and circumferential sutures in all groups. Tendon repair alone was carried out in group 1, tendon repair and application of human amniotic membrane was done in group 2 and tendon repair and application of periosteal autograft was done in group 3. Biomechanical and histopathological examinations were done 2 and 6 weeks postoperatively. Biomechanical examination showed that group 3 was the strongest at weeks 2 and 6. Adhesion, inflammation and new bone formation showed no difference between groups at week 2. However, adhesion formation was found to be less in groups 2 and 3 than group 1 at week 6. The application of periosteal autograft might be useful in repair of tendon injuries.

Increased tryptophan degradation in patients with bronchus carcinoma.

Expression of tryptophan-degrading enzyme indoleamine (2,3)-dioxygenase in tumour tissue is proposed to represent an important tumour immunoescape mechanism. To further investigate the potential role of activated indoleamine (2,3)-dioxygenase in bronchus carcinoma, we examined serum tryptophan and kynurenine concentrations in nine patients with small cell lung cancer and in 27 patients with non-small cell lung cancer. Tryptophan metabolic changes were compared with markers of inflammation and immune activation namely C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and neopterin. Compared with controls, patients presented with lower tryptophan concentrations (P < 0.01) and with higher serum kynurenine to tryptophan ratios (P < 0.01), an index of tryptophan degradation. Also ESR and CRP and neopterin concentrations were increased in the patients (all P < 0.001), and there was a weak correlation between kynurenine to tryptophan ratio and ESR, CRP and neopterin concentrations. We conclude that in the majority of patients with non-small cell lung cancer and small cell lung cancer, enhanced tryptophan degradation can be observed. It seems to relate to an inflammatory response and may reflect activation of indoleamine (2,3)-dioxygenase at the tumour site. The capacity of the tumour to escape normal host immune defence may be influenced by tryptophan degradation. Results of this pilot study deserve further confirmation.

Effect of orlistat on the total ghrelin and leptin levels in obese patients.

Obesity, characterized by hyperleptinemia and hypoghrelinemia, has become a major health problem all over the world and is associated with an increased risk of complications including insulin resistance, hypertension, dyslipidemia, diabetes mellitus and atherosclerosis. The use of the pancreatic lipase inhibitor Orlistat can help seriously overweight people to achieve and maintain weight loss. The aim of our study was to compare the serum leptin and ghrelin levels in obese subjects who take orlistat with those receiving only dietary treatment. Twenty-one obese patients and 10 control subjects participated. The obese patients were divided into two groups; one group (n=11) took orlistat (120 mg, 3 times daily) and received dietary treatment and the other (n=10) only received the dietary treatment. The study lasted twelve weeks. The concentrations of serum ghrelin, leptin, insulin and C-peptide, and routine biochemical parameters, were measured in both groups. The serum ghrelin level was higher in control (183+/-62 fmol/ml) than obese (59+/-30 fmol/ml) subjects while the plasma leptin level was lower in control (8.7+/-12 microg/L) than obese (36.7+/-19 microg/L) subjects (all p<0.001). BMI and the total blood cholesterol, LDL and triglyceride levels fell significantly after both orlistat and dietary treatment in the obese subjects (all p<0.01), and the plasma ghrelin level rose (p<0.01). The leptin level demonstrated the opposite trend in both groups but only the patients taking orlistat showed a significant change (p<0.05).Taken together, these results show that orlistat has no effect on body weight in obese subjects additional to that conferred by a non-pharmacological life-style intervention. We therefore conclude that weight lost rather than type of treatment might be more valuable in obesity.

Ghrelin and orotic acid increased in subclinical mastitis.

Hormone ghrelin and orotic acid accelerate wound healing as well as controlling inflammation and immunity. We have, therefore, investigated the serum and milk levels of ghrelin and orotic acid in dairy cows with (n = 21) or without (n = 21) subclinical mastitis. Acylated and des-acylated ghrelin as well as orotic acid concentration were detected by using high performance liquid chromatography (HPLC). The results revealed that ghrelin level in milk and serum was significantly higher in dairy cows with subclinical mastitis than that of dairy cows without subclinical mastitis. This was also the case when the orotic acid concentrations in dairy cows with subclinical mastitis were compared with those dairy cows without subclinical mastitis. In conclusion, ghrelin and orotic acid occur in particularly high concentrations in subclinical mastitis, and might, therefore, be required in greater amounts for tissue repair and may be also used as a indicator for subclinical mastitis.