Evaluation of Dimensional Changes and Ridge Contour Around Ovate Pontics Inserted Immediately After Extraction with Alveolar Ridge Preservation in the Esthetic Zone.

Alveolar ridge preservation (ARP) is indicated to attenuate anatomic and physiologic changes following tooth extraction. A properly contoured ovate pontic placed immediately into an extraction socket may be adequate to maintain alveolar ridge architecture for improved esthetic results. This prospective clinical study evaluated the ability of immediately placed ovate pontics in conjunction with ARP to attenuate postextraction tissue dimensional changes in the esthetic zone and maintain alveolar ridge contour. Ten patients (11 sites) completed the study. All subjects received a combination of socket grafting with allogeneic particulate graft material and socket sealing with an ovate pontic provisional restoration. A set of clinical linear and volumetric outcomes were assessed after a 6-month healing period. At 6 months postoperative, the linear measurements for the mean ridge dimensional loss were 0.9 ± 0.6 mm (range: 0.2 to 1.8 mm) in height and 1.4 ± 0.6 mm (range: 0.1 to 2.4 mm) in width. The mean volumetric tissue loss observed was 24.4 ± 15.4 mm3 (range: 2.6 to 50.1 mm3) at 3 months postoperative and 32.2 ± 14.2 mm3 (range: 3.8 to 50.5 mm3) at 6 months postoperative. Resorption pattern assessment showed the overall cervical area to have less resorption than the apical areas at 6 months postoperative, with the least amount of resorption in the midbuccal cervical section. When compared to the data of a previous pilot study, no statistically significant difference was seen between the dimensional losses when using ovate pontics with and without ARP. This may be evidence that the use of an ovate pontic provisional restoration immediately after extraction effectively attenuates postextraction dimensional changes.

Achieving appropriate design for developing world heath care: the case of a low-cost autoclave for primary health clinics.

In developing world health clinics, incidence of surgical site infection is 2 to 10 times higher than in developed world hospitals. This paper identifies lack of availability of appropriately designed, low-cost autoclaves in developing world health clinics as a major contributing factor to the dramatic gap in surgical site infection rates. The paper describes the process of developing a low-cost autoclave that addresses the unique challenges faced by developing world primary health clinics and discusses how appropriateness of design was determined. The resulting pressure cooker-based autoclave design was fabricated and tested against the CDC specifications. Twelve partnering clinics in Nepal trialed these autoclaves from July until December 2012.