Carbon fibre versus metal framework in full-arch immediate loading rehabilitations of the maxilla - a cohort clinical study.

Frameworks made of carbon fibre-reinforced composites (CFRC) seem to be a viable alternative to traditional metal frameworks in implant prosthodontics. CFRC provide stiffness, rigidity and optimal biocompatibility. The aim of the present prospective study was to compare carbon fibre frameworks versus metal frameworks used to rigidly splint implants in full-arch immediate loading rehabilitations. Forty-two patients (test group) were rehabilitated with full-arch immediate loading rehabilitations of the upper jaw (total: 170 implants) following the Columbus Bridge Protocol with four to six implants with distal tilted implants. All patients were treated with resin screw-retained full-arch prostheses endowed with carbon fibre frameworks. The mean follow-up was 22 months (range: 18-24). Differences in the absolute change of bone resorption over time between the two implant sides (mesial and distal) were assessed performing a Mann-Whitney U-test. The outcomes were statistically compared with those of patients rehabilitated following the same protocol but using metal frameworks (control group: 34 patients with 163 implants - data reported in Tealdo, Menini, Bevilacqua, Pera, Pesce, Signori, Pera, Int J Prosthodont, 27, 2014, 207). Ten implants failed in the control group (6·1%); none failed in the test group (P = 0·002). A statistically significant difference in the absolute change of bone resorption around the implants was found between the two groups (P = 0·004), with greater mean peri-implant bone resorption in the control group (1 mm) compared to the test group (0·8 mm). Carbon fibre frameworks may be considered as a viable alternative to the metal ones and showed less marginal bone loss around implants and a greater implant survival rate during the observation period.

Gastric and masticatory performances in full-arch immediate loading rehabilitated patients.

Full-arch immediate loading implant rehabilitations provide patients with compromised dentition an effective treatment to improve their aesthetic and function. Aim of this prospective cohort study was to investigate the correlation between masticatory ability and gastric emptying rates among these patients. Ten subjects (five men and five women) with compromised dentition were tested in two occasions: before treatment and 30 days after the immediate loading rehabilitation. Masticatory ability was evaluated using the sieves test, and the gastric half emptying time (T(1/2)) was assessed by means of the 13C-octanoic acid breath test. A statistically significant increment (P < 0.005) in masticatory ability was found only in reference to the particles smaller than or equal to 4.75 mm, whereas the gastric emptying rate showed a statistically significant reduction between pre- and post-treatment (P = 0.003). A moderate negative correlation (rho = 0.64, P = 0.048) between the percentage change in masticatory ability and the percentage change in gastric emptying rate was evidenced. Patients with compromised dentition rehabilitated with full-arch immediate implant prostheses present a significant improvement of the gastric process.

Combination therapy including serratiopeptidase improves outcomes of mechanical-antibiotic treatment of periimplantitis.

This study was designed as a retrospective analysis of clinical outcomes of cases of periimplantitis treated by mechanical debridement and the administration of antibiotics combined or not with the administration of either the proteolytic enzyme serratiopeptidase (SPEP) or non-steroidal anti-inflammatory drugs (NSAIDs). Clinical charts of 544 partially edentulous patients treated for periimplantitis between June 1996 and December 2010 were analyzed to obtain clinical data of the affected implants just before the beginning of treatment and 12 months later to evaluate the outcomes of combined mechanical antibiotic treatment alone or in combination with the co-administration of the anti-inflammatory SPEP or NSAIDs. The comparative analysis revealed that therapeutic outcomes were significantly different in the three groups. Failure rate in the group that received SPEP (6 percent) was significantly lower compared to the group that received NSAIDS (16.9 percent; P less than 0.01) and to the group that received no anti-inflammatory therapy (18.9 percent; P less than 0.01). Treatment including SPEP was associated with significantly better healing also when successful treatments alone were considered. The data reported in this paper strongly support the hypothesis that SPEP is a valid addition to protocols for the combined therapy of peri-implantitis. In fact, it allows to enhance success rates significantly and also favors better tissue repair around successfully treated implants as compared to other regimens.

In vitro adhesion of commensal and pathogenic bacteria to commercial titanium implants with different surfaces.

Although dental implants have undergone impressive evolution in recent years, periimplantitis still remains a relevant problem and information on the susceptibility of commercial implants to bacterial colonization is insufficient. This work evaluated the susceptibility of different commercial implants to bacterial colonization, to identify key features for good performances. Twenty-four implants, produced with different technologies, were colonized with 9 bacterial strains following pre-conditioning with culture medium, or saliva or serum proteins and adherent bacteria were enumerated by Real Time quantitative PCR. The studied implants differed significantly for susceptibility to bacterial adhesion. Pre-conditioning of surfaces affected adhesion assays in a species specific manner. Although surface topography influenced bacterial adhesiveness, implants produced by different manufacturers with comparable technologies showed great variability of results. These data demonstrate that susceptibility of implants to bacterial colonization is influenced by productive technologies (in a surface topography proportional manner) and by the productive environment. In choosing an implant the clinician should rely upon specific experimental studies, because surface characteristics alone cannot predict susceptibility to colonization by pathogenic bacteria. Tests should include assays performed in the medium of culture and in the presence of serum proteins.

Tilted implants in the immediate loading rehabilitation of the maxilla: a systematic review.

Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.

Sinus floor elevation using osteotomes or piezoelectric surgery.

The aim of this paper is to describe a technique for sinus floor augmentation with a 1-step crestal approach where the residual bone is ≤ 7.5mm. 36 implants were installed in 25 patients in the atrophic posterior maxilla immediately after sinus floor elevation. Sinus floor elevation was performed with a crestal approach using either osteotomes and burs or piezosurgery. Standardized intraoral radiographs were taken prior to surgery and 1 year after surgery. The mean residual bone height was 5.61 mm (range 3-7.5mm). The mean gain of sinus elevation was 6.78 mm (range 3.5-10mm) at 1 year after surgery. Two patients dropped out of the study. Of the 23 patients completing the study, one implant failed, whilst the remaining 33 implants were stable 12 months after surgery (cumulative survival rate 97%). A statistically significantly higher bone height was achieved with tapered implants compared with cylindrical implants (P<0.05). No statistically significant differences were found in bone level using osteotomes or piezosurgery. Piezosurgery was considered to provide less discomfort for the patient and greater convenience for the surgeon.

Short-term effects of exercise on body water distribution of severely obese subjects as determined by bioelectrical impedance analysis.

We have previously shown that a short-term weight (Wt) reduction programme consisting of energy restriction, physical activity and psychological counselling, produces physiological changes of body water distribution (BWD) in obese subjects as detected by bioelectrical impedance analysis. The present study was aimed at testing the contribution of diet and physical activity to the observed changes in BWD. A number of 96 obese inpatients were consecutively enrolled in the study at our Obesity Clinic. During a 3-wk period, they underwent a body Wt reduction programme comprising the same dietary strategy and psychological counselling. The programme differed as far as physical activity is concerned, with 52 subjects randomized to a baseline exercise programme (BEP), 22 to a cardiovascular exercise programme (CEP) and 22 to a cardiovascular and strength programme (CSP). Absolute and percent Wt reduction was significantly higher in CSP than BEP subjects (p < 0.05) and the same hold for the changes in impedance (Z) at frequencies of 5, 50 and 100 kHz (p < 0.05). The change in the Z5/Z100 ratio did not show however any between-group difference (p = NS). The average values of Z changes were 1.5 to 2 times higher in CEP and 5.0 to 5.5 times higher in CSP than BEP subjects. We conclude that the type of exercise performed does influence the absolute changes of total body water and extracellular water but not BWD in severely obese subjects undergoing Wt loss.

[Surgical procedures in mouth, jaw and facial surgery in Thiel embalmed body donors]. / Operative Verfahren der Mund-, Kiefer- und Gesichtschirurgie an nach Thiel fixierten Körperspenden.

METHODS: This study investigates whether human cadavers embalmed according to Thiel can be used for research and education in oral-maxillo-facial surgery. Different surgical approaches were tested on such cadavers. The usability of the specimen was judged jointly by anatomists and surgeons. Color, structure, and consistency of the different tissues were comparable to vital conditions. Thiel's embalming technique applied to human cadavers provides an optimal basis for research and for basic and postgraduate medical education.

Traumatic complications of acupuncture. Therapists need to know human anatomy.

OBJECTIVES: To review the traumatic injuries that have been associated with acupuncture and to discuss how these adverse effects may be reduced by increased awareness of normal anatomy and anatomical variations. METHODS: Literature search accompanied by postmortem anatomical studies. RESULTS: Traumatic lesions after acupuncture have been described in thoracic and abdominal viscera, in the peripheral and central nervous systems, and in blood vessels. Deaths have been recorded from pneumothorax and cardiac tamponade. The anatomical structure of the body at several acupuncture points is such that needles can reach vulnerable structures. CONCLUSION: While the frequency of adverse effects of acupuncture is unknown and they may be rare, knowledge of normal anatomy and anatomical variations is essential for safe practice and should be reviewed by regulatory bodies and those responsible for training courses.

[Clinical anatomy as an integrating element in teaching surgical subjects]. / Klinische Anatomie als integrierendes Element in der Lehre der operativen Fächer.

Different conceptions to revise the licensing regulations for physicians (Approbationsordnung für Arzte) aim to interlock preclinical and clinical subjects. Therefore a more practice-oriented anatomy has to be taught in basic and postgraduate medical education. At the Westfalian Wilhelms University of Münster we established an interdisciplinary anatomical education, executed by clinical lecturers in cooperation with the educational staff of the Department of Anatomy. The intergral element is the comprehensive constitution of clinical anatomy: clinical practitioners of different specialties together with anatomists give lessons in applied anatomy accompanying the dissection course. Clinically experienced lecturers of anatomy guide senior medical students in practical courses, refreshing their anatomical knowledge using particular prosections. These courses correlate with the topics of the distinct clinical tutorials. Conjointly clinical practitioners and anatomists plan, and perform meetings in postgraduate medical education.

[Adhesions and interference images of unfixed erythrocytes]. / Adhäsions- und Interferenzfiguren unfixierter Erythrozyten.

For the analysis of deformability in microcirculatory investigations an exact understanding of red blood cell (RBC) geometry is required. To extend knowledge we introduce a new morphological feature of resting unfixed erythrocytes by means of an inverted reflection contrast microscope (RCM). By assessing the interference patterns caused by RCM erythrocytes can be classified according to the depth of their central concavity which depends on the flexibility of the RBC. Moreover, the RBC adhesion can be directly observed. We found out that: 1. Five types of normocytes can be distinguished in RCM. 2. In phase contrast the size distribution of RBC without central concavity (type 5, 11.53% of all normocytes) shows peaks at 48 microns2 and 52 microns2. 3. Image analysis reveals two size categories of relative adhesion areas. One category consists of type 1 and 2 (relative adhesion area 25.63%), the other of the types 3 to 5 (relative adhesion area 39.91%). Besides, RCM allows the reliable identification of pathologic erythrocytes in unstained specimens.

Detection and localization of autofluorescent substances in thymus tissue of sheep.

An oxygenated sterol was detected by chemical analysis of sheep thymus lipid extracts. It was characterized as 7 beta-hydroxycholesterol, which is well known for its biological activity. Using fluorescence microscopy, attempts were made to correlate this substance to particular histological structures of the thymus tissue. Microscopy revealed an intense yellow-green primary fluorescence distributed throughout the entire thymic parenchyma, which was predominant in the cortico-medullary junction, the vicinity of the Hassall's bodies and the subcapsular space. This indicated an accumulation of the fluorogenic substance in special tissue structures of sheep thymus. This result can be assumed as specific for the thymus, since such primary fluorescence was absent from other simultaneously investigated organs, such as the adrenal.

Reflection contrast microscopy within chrome-alum haematoxylin stained thick tissue-sections.

This paper introduces two innovations in reflection contrast microscopy (RCM): (1) an extended application for qualitative light microscopic investigations; and (2) a novel method for quantification in cytochemistry. (1) We found out that RCM cannot only be used for surface characterizations and in thin sections but also within thick tissue-sections. The use of the RCM technique is demonstrated on slides of the supraoptic nucleus (SON) of the rat stained with chrome-alum haematoxylin: Among all the stained structures only neurosecretory granules are found to cause reflections. The visualization of the neurosecretion and its distribution is more distinct and of sharper contrast than in bright field microscopy. (2) The improved differentiation allows the quantification of neurosecretion in tissue-sections by combining RCM with grey-scale image analysis.

Changes in TSH-immunoreactivity in the pars tuberalis and pars distalis of the fetal rat hypophysis following maternal administration of propylthiouracil and thyroxine.

The pars tuberalis (pt) of the adenohypophysis is unique in its close spatial relationship to the neurohemal contact area of the median eminence. The morphology of pt-specific secretory cells does not resemble cell types of the pars distalis (pd); the functional role of these cells within the endocrine system is still unknown. One group of young mature female Wistar rats received propylthiouracil (PTU), a second group thyroxine (T4) (10 mg/l each in drinking water) from about 3 weeks prior to the expected pregnancy and throughout the experiment. On gestation day 20, the fetuses were obtained by laparatomy. Serial sections from the rostral portion of the pt and from the pd were immunostained using the peroxidase-antiperoxidase method. TSH concentrations were determined by RIA in serum and pituitaries; T4 was measured in serum. An antiserum against rat (r) TSH revealed a moderate positive reaction of nearly all cells of the pt in the control group. In both experimental groups the pt-specific cells showed weak or no immunoreactivity. Sections of all groups were negative with anti(r)-LH, -GH, -PRL. In contrast to controls, only a few immature TSH-cells could be found in sections of the pd in the T4-group, while concentrations of TSH in blood and hypophysis were very low. TSH-cells in the PTU-group were enlarged and less intensely stained. TSH-concentrations were decreased in the hypophysis, blood levels were elevated. All sections of the pd-specific cell populations showed positive immunoreactions with anti-r)-LH, -GH, -PRL.(ABSTRACT TRUNCATED AT 250 WORDS)

Photoperiod-dependent changes in TSH-like immunoreactivity of cells in the hypophysial pars tuberalis of the Djungarian hamster, Phodopus sungorus.

Certain secretory cells in the hypophysial pars tuberalis of the Djungarian hamster display marked circannual structural alterations. The present investigation deals with the immunohistochemical properties of this cell group. A distinct TSH-like immunoreactivity was found in secretory cells of this type in the pars tuberalis of animals exposed to long photoperiods, whereas under short photoperiods the TSH-like immunoreactivity was nearly absent. In the pars distalis, the number and distribution of TSH-positive cells did not differ significantly between animals maintained under long and under short photoperiods. LH- and FSH-positive cells could not be detected in the pars tuberalis, but they are clearly present in the pars distalis of both groups of hamsters. Our immunocytochemical results suggest that photoperiodic stimuli influence the secretory activity of TSH-like immunoreactive cells in the pars tuberalis. A connection with the neuroendrocrine-thyroid axis is discussed.

Indirect spectrophotometric determination of silicate.

An indirect spectrophotometric method has been developed for trace determination of silicate in aqueous samples. The silicate is converted into silicomolybdic acid and extracted into a mixture of 1-butanol and butyl acetate. The silicomolybdic acid is then decomposed with sodium hydroxide and the molybdenum(VI) reduced to molybdenum(III) with a Jones reductor, followed by reoxidation to molybdenum(VI) with iron(III). The resulting iron(II) is complexed with ferrozine, and the absorbance of the complex measured at 562 run. In this manner, submicroamounts of silicate can be determined.

Size, form and orientation of the neuronal perikarya and nuclei in the nucleus infundibularis of the male rat.

Size, form and orientation of nerve cells of the Nucleus infundibularis have been analyzed in frontal, horizontal and sagittal semithin sections of Vestopal-embedded hypothalami of the male rat. Morphometric studies were performed with a semiautomatic image analyzing system. By combining data from three different planes of section the three-dimensional size, shape and orientation of perikarya and nuclei in the different parts of the Nucleus infundibularis as well as gradients in mediolateral, rostrocaudal and ventrodorsal directions were examined. Additionally, cell density, volume and relation of the volumes of nucleus and perikaryon were determined. In all parts of the Nucleus infundibularis there occur cells exhibiting different sizes, forms and orientations. The mean values, however, show a rostrocaudal decrease and a mediolateral increase of the cell volumes with a maximum in the rostral, ventral and lateral parts and a minimum in the caudal, ventral and medial parts. In the entire Nucleus infundibularis there is a preferred orientation of the cell axes parallel to the wall of the third ventricle. Spherically-formed cells occur mainly in the rostral and basal parts, elongated and flattened cells in the caudal and dorsal parts. The nucleus-perikaryon relation is small in the rostral, lateral and ventral parts, large in the caudal, medial and dorsal parts. The cell density increases from rostral to caudal and decreases from medial to lateral. The results are discussed with respect to histochemical and immunohistochemical localization of substances relevant to neuroendocrine and neurotropic processes. This investigation exemplarily shows that different planes of section may lead to different descriptions of number and morphology of cells, and that a morphological analysis of nerve cells is only reliable from three-dimensional reconstruction using more than one direction of sectioning.

[Results of clinical and radiologic mass-screening tests of the locomotor system of miners in Hungary]. / Ergebnisse einer klinischen und radiologischen Reihenuntersuchung der Bewegungsorgane bei Bergleuten in Ungarn.

Clinical and radiological screening tests on the locomotor system of 250 workers being active in mines were accomplished by the authors. The test results of 125 miners working underground were compared with those of a control group consisting of equally 125 workers of the same age category, but engaged in open mining. As a result of the investigation it could be stated that miners working in underground mines were affected by diseases of the organs of motion at a very early stage, and in a greater proportion. The most serious deformations were observed with development irregularities and development variations. The development of degenerative locomotor diseases is promoted in Hungary by the working conditions prevailing underground. The completion of the examination procedure of fitness for work by clinical and radiological examinations of the locomotor system is important and highly recommended. The investigation carried out by the authors may serve as a model for the screening tests to be made on the locomotor system of industrial workers.

Differential pulse polarographic determination of orthophosphate in aqueous media.

The determination of orthophosphate in aqueous media by differential pulse polarography is described. It is based on determination of the molybdenum in 12-phosphomolybdic acid. High sensitivity is achieved by measuring the polarographic wave due to the catalytic reduction of perchlorate or nitrate in the presence of molybdenum(VI). The method is suitable for samples as small as 3.5 ml which contain as little as 9 ng of phosphorus per ml. The average relative deviation is 3.0% at the 0.045 mg/l. phosphorus level and 1.6% at the 1.2 mg/l. level. Results for the analysis of EPA quality-control water and real surface-water samples are reported.