Implant placement after marsupialization of a dentigerous cyst.

This paper presents a case of a dentigerous cyst accompanied by a history of inflammation, resorption of the roots of the first molar and the lingual aspect of the distal root of the second molar, and devitalization of the 2 premolars. The treatment option chosen was marsupialization of the cyst, extraction of the involved teeth, endodontic treatment of both premolars, and implant insertion in the area of the first mandibular molar at a later stage. Twelve months postsurgery the area of interest was almost flattened and the radiographic examination revealed total disappearance of the radiolucency. An implant of 15 x 4 mm was inserted in the area of the first mandibular molar. Despite the excellent implant stability achieved, a thin central zone of the defect remained void of bone. After complete excision of soft tissue the defect was filled with an alloplastic bone substitute. Eight months later (20 months postsurgery), the implant was uncovered and the restorative procedure completed. The implant and the crown have been functioning sign and symptom free for 48 months. Marsupialization was preferred instead of enucleation due to (1) proximity of the cyst to the mandibular canal; (2) need for apicectomy of both premolars to gain good access for enucleation; (3) refusal of the patient to undergo a second surgery for bone harvesting; (4) lower probability for postoperative contamination; (5) need of small quantity of bone substitute; (6) easier extraction of the impacted second molar due to its coronal movement. The disadvantages of the treatment were the long healing period and the discomfort of the patient at the early stages of marsupialization. It was judged that the advantages outweighed the disadvantages in this case. We discuss the findings of other authors who support the conservative approach to jaw cysts in a young population, and the concerns that exist in the literature about the ability of osseoconductive graft materials to generate vital bone and achieve implant-to-bone contact.

Simultaneous determination of flunitrazepam and its metabolites in plasma and urine by HPLC/DAD after solid phase extraction.

A high performance liquid chromatography (HPLC) assay was developed for the determination of flunitrazepam (FNZ) and its metabolites in urine and plasma. The analytes and the internal standard (triazolam, TRZ) were extracted by Sep-Pak C18 SPE-cartridge and separated utilizing a 5 microm ChromSpher C8 glass column with a gradient mobile phase containing methanol and 0.125% (v/v) of isopropylamine in water. Diode array detection (DAD) was carried out at a monitoring wavelength of 240 nm and a reference wavelength of 550 nm. Standard curves were linear from their quantitation limits until 200 ng ml(-1) urine or 250 ng ml(-1) plasma for 7-amino-desmethyl-flunitrazepam (ADF), 7-amino-flunitrazepam (AF), 7-acetamino-flunitrazepam (ACF) and until 400 ng ml(-1) urine or 500 ng ml(-1) plasma for FNZ, 1-desmethyl-flunitrazepam (DF), and 3-hydroxyl-flunitrazepam (HF). The intraday and interday coefficients of variation ranged from 2.04 to 9.07% and from 2.64 to 14.10%, respectively in urine and from 5.13 to 8.60% and from 7.27 to 10.46%, respectively in plasma. The developed method is used in forensic toxicology and is also applicable to pharmacokinetic studies in man.

Determination of benzodiazepines in forensic samples by HPLC with photo-diode array detection.

A high-performance liquid chromatographic (HPLC) method has been developed for the analysis of several benzodiazepines and some of their metabolites in blood, plasma and urine. The method included a liquid-liquid extraction with n-hexane:ethylacetate, a gradient elution on a C8 reversed phase column with a non-electrolyte eluent and a photo diode array detection. This allowed a rapid detection, a purity check, and identification as well as quantitation of the eluting peaks. The detection limit was 10 to 30 ng and the limit of quantitation was 0.05 microgram/mL, using 1 mL of blood, plasma or urine. The procedure is applied routinely in forensic toxicological analyses involving blood, stomach content, urine and organ samples. About 30 positive cases are reported. The avoidance of the use of an electrolyte buffer in the eluent resulted in a robust procedure, free of technical problems and of long rinsing periods, suitable for routine use in forensic toxicology analysis involving blood, urine, stomach content and tissue samples.

Radiopacity of elastomeric impression materials.

The purpose of this study was to measure and classify the radiopacity of various elastomeric impression materials available on the open market and to compare their appearance in radiographs of the oral tissues. In order to measure and classify their radiopacity, twenty-eight specimens of various materials were placed and exposed on film together with an aluminium stepwedge. A dummy head was used to investigate the radiographic density of the above specimens in comparison with that of simulated oral tissues.

Dry socket: frequency of occurrence after intraligamentary anesthesia.

To determine whether the use of intraligamentary anesthesia increases the incidence of dry socket, results of 305 extractions of mandibular molars in two groups of patients were studied. In the first group, inferior alveolar nerve block was applied, and, in the second, intraligamentary anesthesia was applied. A solution of 2% lidocaine with 1:80,000 epinephrine was used. Statistical analysis of the postoperative occurrence of dry socket indicated that the use of intraligamentary anesthesia did not result in a higher frequency of dry socket than did conventional anesthesia.

Conventional radiographs vs digitized radiographs: image quality assessment.

OBJECTIVES: The aim of this study was to compare image quality characteristics of conventional radiographs and their digital counterparts. METHODS: 100 conventional radiographs (E-speed) were used for the evaluation of density and contrast. The radiographs were made using a range of exposures under standardized conditions and were compared with digital images that resulted from scanning the above radiographs with a commercially available scanner. Resolution was evaluated with an experiment using 50 film packets and a resolution target exposed with different exposure times, using both the original radiographs and their scanned equivalents. RESULTS: The digitized radiographs appeared to be of higher density than the conventional ones. Moreover, they demonstrated a narrower density range. Resolution was similar for both types of images. CONCLUSIONS: Although there is an agreement with the literature that the digitized radiographs are of higher density, further investigation is required to detect the various factors that may have an effect on the quality of the digitized images.

CH50 and C3 component of complement in Hansen's disease.

Although a variety of complement values have been reported in leprosy, we found no difference in the CH50 and C3 in the sera of 30 normal persons and 233 lepromatous patients. No statistically significant difference was observed in CH50 and C3 values between healthy controls and lepromatous patients taken as a whole or separated into the different types of the disease spectrum (P greater than 0.1). A statistical difference in C3 titers was found between health controls and borderline patients (P less than 0.05 greater than 0.01) but the sample number is too small to be valid. An important number of sera tested had low and an equally important number had high complement values. Sera with high and low values are important because high values are found in acute inflammatory reactions and low values demonstrate complement activation. Discrepancies in reported results are probably due not only to differences in the methods used, storage and limited number of sera tested, but mainly to the stage of the disease and the drug's administration.

Nuchal nevus flammeus as a skin marker of prognosis in alopecia areata.

In this work, the incidence of nuchal nevus flammeus was studied in 205 patients suffering from various forms of alopecia areata, as well as in a group of 555 volunteers without alopecia areata examined in our outpatient clinic. The incidence of nuchal nevus flammeus in the totalis-universalis form of alopecia areata was 58.2% (examined patients, n = 79), in ophiasis-extensive forms 22.8% (examined patients, n = 70) and in simple forms of alopecia areata 3.6% (examined patients, n = 56). In the group of 555 volunteers without alopecia areata the incidence of nuchal nevus flammeus was 4.5%. Our results show that nuchal nevus flammeus could be a valuable skin marker indicating a more severe course of alopecia areata.

Hepatitis B virus (HBV) serum markers in Greek leprosy patients.

The prevalence of HBsAg, anti-HBs, and anti-HBc in the sera of 217 patients with the two polar types of leprosy and 382 hospital controls was studied in order to investigate the degree of exposure of Greek leprosy patients to HBV and the ability of these patients to clear HBV from the blood. Two distinct serological patterns were analyzed: effective exposure, characterized by the presence of one or more of the three serological markers, and active infection, characterized by the presence of HBsAg. From the statistical analysis it was found that TT as well as LL cases had a higher prevalence of effective exposure in comparison to controls (p less than 10(-5) and p less than 10(-6)). No significant difference was found between the two polar leprosy types (p greater than 0.30) or between bacteriologically positive and negative LL cases (p greater than 0.30). As far as the prevalence of active infection is concerned among the effectively exposed subjects of all groups, no significant difference existed between TT cases and controls, LL cases and controls, the two polar leprosy cases combined and controls, the two polar leprosy groups, and LL cases positive and negative for Mycobacterium leprae (p for all comparisons greater than 0.30). It is concluded that leprosy cases are at a high risk of HBV infection, but the prevalence of active infection among those effectively exposed does not differ between leprosy cases and hospital controls.

Autonomic neuropathy in leprosy.

The integrity of the autonomic control of the cardiovascular system was studied in 21 patients with lepromatous leprosy and in ten normal people using several simple tests based on cardiovascular reflexes. Impairment of both parasympathetic and sympathetic function was demonstrated in the lepromatous patients.