An institutional review of treatment outcomes in extraosseous Ewing's sarcoma- the largest Asian experience.

PURPOSE: To analyze the treatment strategies, outcomes and factors impacting these outcomes in extraosseous ewings sarcoma (EOES). MATERIAL AND METHODS: A search of the hospital database yielded a total of 109 EOES patients registered in last 10 years out of which 25 patients were excluded from analysis due to incomplete medical records. Demographic and clinical characteristics were reported using descriptive statistics. Overall survival (OS) was taken from the time of diagnosis to death. Patients who were alive or lost to follow up were censored from the survival analysis. A total of 12 clinical and treatment related variables were taken into univariate analysis and those showing significance or a trend towards significance were taken up for multivariate analysis. Further a cluster analysis was done in a quest to find a subgroup which would have a better survival outcome as compared to other clusters. SPSS version 23 was used for statistical analysis. RESULTS: Chest wall (n=26), lower extremity (n=22) and paraspinal area (n=14) were the common sites involved. Localised swelling (n=43) was the most common presenting symptom and the median time to presentation was 2 months. Overall survival of the entire cohort at 5 years was 52 percent. Stage at presentation had a significant impact (P value<0.001) on estimated median OS (localised 70 months versus 36 months in metastatic stage). Cluster analysis showed that, patients with localised stage at presentation, good response to chemotherapy, negative resection margin and no adjuvant RT had a median survival of 69 months. CONCLUSION: Judicious use of trimodality treatment in EOES yields optimal results and it also adds significantly onto the scarce literature on this subtype of sarcoma.

Immediate flapless implant placement in a smoker patient: A challenge for optimum aesthetics and secondary stability: A case report.

The objective of this case report was to restore the young patient with missing teeth and extruded tooth using an immediate implant and synthetic bone graft material for the esthetic and comfort purpose. A 21-year young man reported extrusion of a tooth as well as missing teeth. Clinical examination revealed missing teeth in relation to (irt) 11 and 21, extrusion of tooth in relation to (irt) 12, patient had generalized fluorosis, and localized marginal gingivitis with melanin pigmentation. The patient is a known smoker, and he was advised the cessation of smoking before the treatment. This paper describes a step-by-step approach to different treatment phases, starting with surgical guide fabrication, immediate implant surgical procedures, bone grafting procedure, and later prosthesis fabrication. Follow-up resulted in a satisfactory outcome.

An association of VDR gene polymorphism in hypovitaminosis D mediated secondary hyperparathyroidism in adolescent girls; a tertiary hospital study in central India.

Vitamin D is required to maintain normal serum calcium and phosphate levels that help normal bone mineralization, nerve conduction, muscle contraction, immune function, cell proliferation, and differentiation. Interventions including vitamin D supplementation may not improve vitamin D deficiency, as various complex genomic actions could contribute to vitamin D deficiency in the Indian population. Thus, we assessed hypovitaminosis D's relationship with vitamin D receptor (VDR) gene polymorphism and evaluated parathyroid hormone (PTH) levels in seemingly healthy adolescent school-going girls. We included 100 school-going girls (aged 12-17 years) studying in four schools of different socio-economic strata of Bhopal, India. The selected participants were divided into four groups based on the school in which they were studying. Blood samples were tested for serum calcium, phosphorus, PTH, ALP, vitamin D 25(OH) D, and albumin levels.VDR polymorphism was detected through the PCR-RFLP. Data were analyzed using the chi-square test, ANOVA, and linear regression. The difference in the age, calcium, ALP, and vitamin D values between the four groups were significant (P < 0.05), whereas high PTH levels (80%) were found. A higher prevalence of homozygous polymorphic allele demonstrates a molecular signature for severe secondary hyperparathyroidism. Hypovitaminosis D ranged from 84.9% to 100%, and a high prevalence of VDR polymorphism was observed. Attention must be paid to the health of this age group of school-going girls as hypovitaminosis D and associated VDR gene polymorphism could be the reason for secondary hyperparathyroidism (SHPT), showing changes in bone mineral density in these adolescent girls to ensure their future health.

A Study of Human Mandibles of Indian Origin for Available Bone After Bone Reduction for Trefoil Concept: A In-Vitro Human Cadaver Mandible Study.

Introduction: Edentulism is closely associated with socioeconomic factors and is more prevalent in poor populations and in women. Gender plays an important role in Residual bone resorption, where a greater bone resorption was reported in women than men. Novum is re-introduced as Trefoil which has been rectifying the technical deficiencies of novum using engineering and clinical technology. The trefoil system also like novum incorporates a pre-manufactured framework designed to the natural arch of the mandible and fixed on three implants. This present study was planned to understand the availability of alveolar bone after reduction of bone to accommodate the trefoil system long with the implants in the mandible of India mandibles. Materials and methods: Seventy dried mandibles were taken of the cadavers from the anatomy department, which included 35 males and 35 females. All the mandibles were duplicated using a silicone duplicating material into wax mandibles. The trefoil bar was also duplicated and casted in metal and also a self-cured acrylic pattern was made in order to use to optimize the mandible width during reduction of the same. Vertical height measurement was recorded for the crestal bone reduced mandibles wax pattern to check for the amount of bone reduction. Results: The alveolar bone height which was measured from the apex of the central incisors till the base of the mandible in the anterior region should an average height of 22.43 mm in males and 19.78 mm in males. Conclusion: It required an average bone reduction of 6.34 mm in males and 5.86 mm in females to achieve the platform required to use the prefabricated Trefoil bar in patients.

Effect of adding silver nanoparticle on physical and mechanical properties of maxillofacial silicone elastomer material-an in-vitro study.

PURPOSE: The purpose of this study was to evaluate the impact of silver nanoparticle incorporation into maxillofacial silicone material on its hardness, tear strength and color stability. METHODS: A total of 180 silicone specimens were fabricated according to the specification of American society for material and testing (ASTM) No. D142 and No. D624. The control samples were fabricated without silver nanoparticles and test samples were fabricate with 20 ppm concentration of silver nanoparticles. For outdoor weathering specimens were placed in a metal cage, which was suspended from the roof for a period of one month. Digital shore A hardness tests (Yuzuki, DIN 53505, ASTM D2240) was used to measure hardness, for tear strength the specimen was placed in the jaws of the universal testing machine (Lloyd instruments, LR 50 K) and stretched at a rate of 500 ram/rain, for color stability Spectrophotometer had been employed and the data recorded in the CIE L*a*b* system. The independent sample's "t" test was used to test significant differences. RESULTS: The mean difference for hardness between control and test group was 0.54 and t value was 2.08 and (p < 0.05).tear strength 0.66 and "t" value was 0.93 and (p < 0.05) and for color stability it was -0.02 and t value was -0.92 and (p < 0.05). CONCLUSION: The present study findings suggest that addition of silver nanoparticles at 20 ppm concentration decreased the hardness of Teksil 25(S25) silicone elastomer, and it did not affect tear strength and color stability.

Early Loaded Single Implant Reinforced Mandibular Overdenture.

Rehabilitating atrophied mandible with two-implant supported denture is a common treatment modality for implant retained removable overdenture in mandible. This paper aims to design a treatment modality where single implant reinforced overdenture is fabricated for a severely atrophied mandibular ridge with early loading protocol. Results of studies have shown that a single implant mandibular overdenture significantly increases the satisfaction and quality of life of patients with edentulism. Midline fracture of the prosthesis is the most common complication related to single implant and two-implant retained mandibular overdentures. To manage such complication, a thin metal mesh is used to reinforce the overdenture and also to make the prostheses lighter and cost effective as compared to conventional cast metal framework.

Hunting for tularaemia - a review of cases in North Carolina.

Human infections with Francisella tularensis can be acquired via numerous routes, including ingestion, inhalation, arthropod bite or direct contact with infected animals. Since 1991, there have been 25 reported cases of tularaemia in North Carolina, most of which were associated with rabbit hunting or cat bites. We present two adults cases of pulmonary and oropharyngeal tularaemia and review the reported cases since 1991-2013. We also present the fifth case of pulmonary empyema. While cavitary pneumonias are primarily treated with drainage, we illustrate a case of cavitary pneumonia associated with tularaemia successfully treated with oral ciprofloxacin after drainage. Tularaemia should be considered in patients with a perplexing radiographic image, animal exposure and lack of response to conventional empiric broad-spectrum antibiotics. Even in serious cases of pneumonic tularaemia, fluoroquinolones may provide a suitable alternative to aminoglycosides.

Comparison of fracture toughness of all-ceramic and metal-ceramic cement retained implant crowns: an in vitro study.

To evaluate the fracture toughness of cement-retained implant-supported metal-ceramic molar crown with that of all-ceramic crowns, fabricated using IPS Empress 2 and yttria-stabilized zirconia copings. An dental implant and abutment was embedded in a clear polymethyl methacrylate model. A wax pattern reproducing the anatomy and dimension of a mandibular molar was made using inlay wax. Copings were made from the manufacturers guidelines for zirconia, metal ceramic and empress crown, in total of 21 copings, which were built for the crowns with metal layering ceramics specified by the manufacturers. The polymethylmethacrylate block-implant abutment complex was mounted on universal testing machine, and a static continuos vertical compressive load with a crosshead speed of 0.5 mm/min was applied. The breaking load and the peak load (in kilo Newtons) were recorded. The fractures for group I (zirconia-ceramic) and group II (metal-ceramic) occurred on the mesio-buccal aspect of the crowns involving the veneered ceramic layer while the catastrophic/bulk fracture was not observed. The mean value of breaking load for zirconia-ceramic, metal-ceramic and IPS-empress 2 was 3.4335, 3.071 and 1.0673 kN respectively. The mean value of peak load for zirconia-ceramic, metal-ceramic and IPS-empress 2 was 4.7365, 3.2757 and 1.566 kN respectively. It can be concluded that the zirconia-ceramic crown with the fracture toughness of 4.7365 ± 2.2676 kN has sufficient strength to allow clinical testing of these crowns as an alternative for metal-ceramic crowns (3.2757 ± 0.4681 kN).

The osseointegration stimulatory effect of macrogeometry-modified implants: a study in the rabbit.

OBJECTIVE: To investigate the bone stimulatory effect of compression forces through histomorphometric analyses of macrothreaded implants with microthreads in between. MATERIAL AND METHODS: Two sets of turned implants with different macrogeometries were prepared. The test group possessed microthreads in between macrothreads, and the control group had macrothreads only. The two-implant groups were placed in both the femur and the tibiae of 10 rabbits. After 4 weeks, the animals were sacrificed and were subjected to histologic processing and histomorphometry. On the prepared stained sections, the total bone area (BA), new BA and bone-to-implant (BIC) were calculated. RESULTS: The mean new BA% (SD) for the test group in the femur presented significantly higher values compared with the control group, being 32.84 (32.5) ± 6.04 and 27.31 (28.19) ± 5.66, respectively (P = 0.04). There were no differences for the new BA in the tibia or the total BA% for both bone types (P = 0.86, P = 0.131, and P = 0.131, respectively). The mean BIC% (SD) in the femur was 13.66 (11.49) ± 6.86 for the test group and 8.48 (7.92) ± 3.31 for the control group and in the tibia, 11.4 (11.88) ± 4.21 for the test group and 13.91 (12.06) ± 6.07 for the control group, respectively. There was no statistical significance among the groups tested. CONCLUSION: The modified implant macrogeometry with microthreads in between promoted effect in the femur. However, no statistical differences could be seen in the tibia, suggesting that the modification may be more effective in bone with poor bone quality, such as in the maxillary bone.

Dental implants in growing children.

The replacement of teeth by implants is usually restricted to patients with completed craniofacial growth. The aim of this literature review is to discuss the use of dental implants in normal growing patients and in patients with ectodermal dysplasia and the influence of maxillary and mandibular skeletal and dental growth on the stability of those implants. It is recommended that while deciding the optimal individual time point of implant insertion, the status of skeletal growth, the degree of hypodontia, and extension of related psychological stress should be taken into account, in addition to the status of existing dentition and dental compliance of a pediatric patient.

Accuracy of impressions with different impression materials in angulated implants.

PURPOSE: To evaluate the dimensional accuracy of the resultant (duplicative) casts made from two different impression materials (polyvinyl siloxane and polyether) in parallel and angulated implants. MATERIALS AND METHODS: Three definitive master casts (control groups) were fabricated in dental stone with three implants, placed at equi-distance. In first group (control), all three implants were placed parallel to each other and perpendicular to the plane of the cast. In the second and third group (control), all three implants were placed at 10° and 15 o angulation respectively to the long axis of the cast, tilting towards the centre. Impressions were made with polyvinyl siloxane and polyether impression materials in a special tray, using a open tray impression technique from the master casts. These impressions were poured to obtain test casts. Three reference distances were evaluated on each test cast by using a profile projector and compared with control groups to determine the effect of combined interaction of implant angulation and impression materials on the accuracy of implant resultant cast. RESULTS: Statistical analysis revealed no significant difference in dimensional accuracy of the resultant casts made from two different impression materials (polyvinyl siloxane and polyether) by closed tray impression technique in parallel and angulated implants. CONCLUSION: On the basis of the results of this study, the use of both the impression materials i.e., polyether and polyvinyl siloxane impression is recommended for impression making in parallel as well as angulated implants.

Maxillary posterior bone height in relation to maxillary sinus floor in Indian dentulous population.

To establish a ratio of variable bone height (Infrazygomatic alveolar crest height) to constant bone height (Infraorbital zygomatic height) and, to estimate the relative sinus floor position from alveolar crest of maxillary first molar region of dentulous Indian males and females, using Digital panoramic radiographs. Panoramic radiographs of 74 patients were included in the study (37 male, 37 female) to measure maxillary posterior vertical bone height and their ratio in dentulous patients. Measurements were made from reference lines drawn from anatomic landmarks on soft digital versions of standardized panoramic radiographs using Kodak dental imaging software. Later the data were analyzed using normal test (Z-score). When the posterior maxillary bone height and their ratio were evaluated in Indian population, the vertical bone height (x, y, z) of males was more than the females. Ratio of Infrazygomatic-alveolar crest distance (y)/Infraorbital-zygomatic distance (x)-was 0.74 for Indian males and females. The relative sinus floor for Indian males was found to be 8.1 mm and that of Indian females to be 7.8 mm. The results are of significant value as "baseline" data, in serial studies where alveolar bone height for a single patient is compared at different times before and after tooth loss. The relative sinus floor position from alveolar crest can help in implant length selection. This study can be used as a diagnostic and predictive tool in implant treatment planning but further long-term evaluation is still required to prove the efficacy of this study.

Comparison of Stress Dissipation Pattern Underneath Complete Denture with Various Posterior Teeth form: An In Vitro Study.

To evaluate the pattern of stress dissipation underneath the complete denture with various angled posterior teeth in both maxillary and mandibular arch. A 3D finite element models of residual ridge, mucosa, denture base in the coronal section were created from the dentures obtained from a patient, which were scanned and modeled. The coronal portion of the teeth was altered to stimulate the cuspal inclination of 0°, 20° and 33°, thus making the models. Special area of interest in bone, denture were selected to record the stresses. An vertical static load of 100N was applied through the mandibular model to the maxillary model. von Mises stresses developed in all the models were interpreted. Statistical analysis for comparison of stress values with different variables (0°-20°, 0°-33°, and 20°-33°) in various predefined areas of coronal section model was done using Student's t test (paired). Stress of greater magnitude were observed with cuspal teeth i.e. 33° and 20°, where as 0° showed slightly less magnitude of stresses.

A survey on the use of techniques, materials in dental implantology practice.

PURPOSE: To present results of a survey on the status of an implantology amongst implant-practicing dentist across the world in 2009. MATERIALS AND METHODS: A questionnaire was sent to the members of EAO (European Association of Osseointegration), ICOI (International Congress of Osseointegrated Implants), ISOI (Indian Society of Oral Implantologists), Asian Academy of Osseointegration (AAO), Deutsche Gasellschaft Fur Orale Implantologie (DGOI), Philippines Implant Organization, Korean Society of Oral Implantologist, Japanese Association of OralIimplantologists, Chinese Dental Association, Pakistan Dental Association, asking for the personal (anonymous) background data and their implantology concepts. Specific questions dealt with level of recognition of implants, use of implants, superstructures, techniques followed, and materials used. RESULTS: A total of 1500 (63.6%) of the 2358 questionnaires were answered. Dental implants were the most preferred treatment modality for restoring the missing teeth. Threaded implants were the most preferred. Cement retained implant prosthesis was the most preferred restoration procedure. Dentists believe that the general dentist should practice dental implant treatment modality, preferably teamwork. Immediate loading was the much-accepted concept among the dentists of the developed nations. CONCLUSION: Dental implants were much accepted treatment modality for the replacement of missing teeth. Most the dentists follow the well documented technique and proven materials, which have been documented in the literature, an evidenced based practice, thus, delivering the best to their patients. Dentists from the developing nations agreed to have standardization in implants.

Re-osseointegration of loosened implant in a splinted fixed prosthesis.

Various studies have proved the success of the osseointegration concept, if proper and strict protocols are followed for the success. In clinical practice, certain situations arise that makes the clinician to modify his treatment modality to favor the final outcome of the treatment. This paper presents a clinical case report of re-osseointegration of the loosened bead implant occurred during the torque application to tighten the abutment during cementation, which was splinting along with the adjacent well-osseoingrated implant by using fixed partial denture prosthesis. The clinical outcome suggests that proper stabilisation of a loosened implant can re-osseointegrate the implant.

Rehabilitation of recurrent unicystic ameloblastoma using distraction osteogenesis and dental implants.

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. Surgical resection of the ameloblastoma is well-documented and an accepted treatment modality. Vertical distraction of the alveolar process is an efficient method for augmentation. This method of providing additional bone and soft tissue for implant placement is becoming more common. This clinical report describes the use of distraction osteogenesis and fixed implant supported prosthesis to treat a post-surgical alveolar defect as a result of the resection of a unicystic ameloblastoma in the anterior mandibular region. As a result of alveolar distraction a segment of mature bone was transported vertically in order to lengthen the crest, for better implant anchorage. Further clinical and experimental studies of the technique with long-term follow-up are needed, to confirm bone and implant stability, as it relates to alveolar height.

Marginal strength of collarless metal ceramic crown.

Metal ceramic restorations have been implicated for the discoloration in area of labiogingivalmargin. Attempts to rectify this, by altering the design of metal frameworkswill lead to decrease in fracture strength atmargin. This in vitro study compared the fracture strength at margins of metal ceramic crowns cemented to metal tooth analogs. Crowns evaluated with different marginal configurations, shoulder and shoulder bevel with 0 mm, 0.5 mm, 1 mm, and 1.5 mm, were selected. Methods. Maxillary right canine typhodont tooth was prepared to receive a metal ceramic crown with shoulder margin. This was duplicated to get 20 metal teeth analogs. Then the same tooth was reprepared to get shoulder bevel configuration. These crowns were then cemented onmetal teeth analogs and tested for fracture strength atmargin on an Instron testing machine. A progressive compressive load was applied using 6.3 mm diameter rod with crosshead speed of 2.5 mm per minute. Statisticaly analysis was performed with ANOVA, Student's "t" test and "f" test. Results. The fracture strength of collarless metal ceramic crowns under study exceeded the normal biting force. Therefore it can be suggested that collarless metal ceramic crowns with shoulder or shoulder bevel margins up to 1.5 mm framework reduction may be indicated for anteriormetal ceramic restorations. Significance. k Collarless metal ceramic crowns have proved to be successful for anterior fixed restorations. Hence, it may be subjected to more clinical trials.

A systematic review of impression technique for conventional complete denture.

The importance of an in depth review of impression making for complete dentures lies in the assessment of the historical value of all the factors related to physical, biologic and behavioral areas and the time in which they were discussed and taught as well. This review documents the historical development of knowledge associated with scientific advancement from 1845 to the present year, i.e. 2009 related to impression procedures in conventional complete denture prosthesis. Search for articles was done through electronic media the Pubmed.

Alteration of estrogen-regulated gene expression in human cells induced by the agricultural and horticultural herbicide glyphosate.

Gene expression is altered in mammalian cells (MCF-7 cells), by exposure to a variety of chemicals that mimic steroid hormones or interact with endocrine receptors or their co-factors. Among those populations chronically exposed to these endocrine disruptive chemicals are persons, and their families, who are employed in agriculture or horticulture, or who use agricultural/horticultural chemicals. Among the chemicals most commonly used, both commercially and in the home, is the herbicide glyphosate. Although glyphosate is commonly considered to be relatively non-toxic, we utilized in vitro DNA microarray analysis of this chemical to evaluate its capacity to alter the expression of a variety of genes in human cells. We selected a group of genes, determined by DNA microarray analysis to be dysregulated, and used quantitative real-time PCR to corroborate their altered states of expression. We discussed the reported function of those genes, with emphasis on altered physiological states that are capable of initiating adverse health effects that might be anticipated if gene expression were significantly altered in either adults or embryos exposed in utero.