Autotransplantation of premolars to replace maxillary incisors: a comparison with natural incisors.

The published literature contains no comprehensive studies that compare the outcome of premolar autotransplantation to the maxillary anterior region with natural incisors in the same patients. This article describes the gingival and periodontal conditions around premolars transplanted to the maxillary incisor region, subsequent to restoration. Forty-five premolars autotransplanted to the maxillary incisor region in 40 adolescent patients were evaluated after a mean observation period of 4.0 years. Mean age at surgery was 11.0 years. Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, probing pocket depth, and percussion. Recession and hyperplasia of interproximal gingival papillae were assessed according to a recently proposed index. Standardized radiography was used to evaluate presence of pathosis, pulp obliteration, root length, and crown-root ratios. Clinical variables for transplants did not differ from those of the natural incisors, except for increased mobility and more plaque in a few transplanted premolars. The interproximal gingival papillae adjacent to all transplanted teeth were normal or slightly hyperplastic. Radiographically, all transplants showed varying degrees of pulp obliteration, but no signs of pathosis. Crown-root ratios were similar for natural and transplanted teeth as were distances from cementoenamel junction to marginal bone. The overall status of the transplanted premolars and surrounding tissues indicated that this treatment modality may be recommended when maxillary incisors are missing in adolescents. In addition, tooth transplantation represents an inherent potential for bone induction and reestablishment of a normal alveolar process.

[Excellence in orthodontics. Interview by M. G. Choukroun and O. Sorel]. / L'excellence en orthodontie.

"Excellence is not an act, it is a daily exercise", is a sentence quoted by B. Zachrisson and is the cornerstone of his approach. He explains how, by a careful inspection and an analysis of the facial bone structure, using the patient's movement, he can establish a diagnosis and set the treatment's objectives. He defines the key points of a balanced smile, the rules and guidelines for enamel reproximation, the methods of bonding and the rules governing the stability of orthodontic treatments.

Central assessment of bilateral phlebograms in a major multicentre thromboprophylactic trial. Reasons for inadequate results.

PURPOSE: To determine the cause of inadequate bilateral phlebograms at central assessment. A major antithrombotic trial was evaluated to identify and apply corrective measures for reducing inadequate results in future multicentre trials. MATERIAL AND METHODS: The inadequate results in 253 out of 1,827 patients having undergone bilateral phlebography following total hip replacement were reviewed by two central assessors using strict criteria for evaluability. The reasons for inadequate findings were assessed and ranked. RESULTS AND CONCLUSION: Insufficient contrast filling, especially of the anterior tibial, common femoral and iliac veins, was the most common reason for disqualifying examinations. Unilateral examinations and obscuring metallic devices were the second and third most common reasons, respectively. Efforts should be made to standardize the phlebography technique, to use a large volume of contrast without tourniquets, and to obtain an appropriate number of views to visualize the deep veins.

Effects of mandibular incisor extraction on anterior occlusion in adults with Class III malocclusion and reduced overbite.

The aim of this study was to assess the treatment outcome and changes in mandibular incisor position after extraction of one single incisor in 36 adult orthodontic cases with combined Class III and open bite tendencies. The cases consisted of 21 female and 15 male patients with an average age of 27.8 years (standard deviation [SD], 11.1 years) at the start. Fixed 0.018-inch Edgewise appliances were used in both arches in 19 patients and in the mandibular arch in 17 patients. Average treatment time was 18 months (SD, 7.1 months). Pretreatment ANB was 0.5(o) (SD, 2.7 degrees), overjet 1.4 mm (SD, 1.9 mm), and overbite 1.5 mm (SD, 1.1 mm). The lower incisors were 3.6 mm (SD, 2.8 mm) in front of the APg-line, and the Averaged Irregularity Index was 1.1 mm (SD, 0.6 mm). Records representing pretreatment (T1), posttreatment (T2), and average 4.3 years (SD, 2.3 years) retention (T3) included cephalograms, panoramic films, intraoral and extraoral photographs, and plaster models. All cast measurements were made with digital calipers. On the cephalograms, the lower incisor tips moved posteriorly 1.7 mm (SD, 2.0 mm) and occlusally 1.5 mm (SD, 1.8 mm) from pretreatment to posttreatment. Relative to the x-axis, they tipped lingually 5.9(o) (SD, 5.6 degrees). On the cast analysis, overjet increased 1.0 mm (SD, 1.9 mm) and 1.5 mm (SD, 1.5 mm) for the maxillary central and lateral incisors, respectively, whereas overbite increased 0.6 mm for both the central and lateral incisors. The intercanine width was reduced by 3.3 mm (SD, 2.0 mm), while the intermolar width was unchanged. The Average Irregularity Index was reduced from 1.1 to 0. 2 mm. Arch-length was reduced 3.6 mm from pretreatment to posttreatment, and another 0.3 mm from posttreatment to 4.3-years retention. Other changes from posttreatment to 4.3-years retention were slight. No loss of the interdental gingival papillae was normally observed. It is concluded that the extraction of one mandibular incisor can lead to satisfactory treatment results in adults with mild Class III malocclusion and reduced overbite, particularly when coupled with a large mandibular intercanine width and minor crowding, and some mandibular tooth size excess. However, the orthodontic treatment frequently became more complicated and time-consuming than expected at the start.

[Renal artery stenosis--an underestimated cause of hypertension and renal failure?]. / Njurartärstenos--underskattad orsak till hypertoni och njursvikt?

Although renovascular hypertension is associated with substantial cardiovascular morbidity, ultimately it is a curable disease. Early identification and appropriate treatment of renovascular hypertension may save years of antihypertensive therapy, reduce the morbidity associated with long-standing hypertension, and help to minimise the risk of renal failure. However, the main problem is to identify patients with renovascular disease suitable for treatment. This requires alertness in the clinician, and renographic screening of renal function or duplex-ultrasound scanning of renovascular circulation to augment the yield of angiographic procedures. The predominant treatment of renovascular disease today is percutaneous transluminal angioplasty, which can be used as a repeat procedure or in combination with endoluminal stenting of the stenotic renal artery.

Improved orthodontic bonding to silver amalgam. Part 2. Lathe-cut, admixed, and spherical amalgams with different intermediate resins.

Flat rectangular tabs (n = 270) prepared from spherical (Tytin), admixed (Dispersalloy) or lathe-cut amalgam (ANA 2000) were subjected to aluminum oxide sandblasting with either 50-mu or 90-mu abrasive powder. Mandibular incisor edgewise brackets were bonded to these tabs. An intermediate resin was used, either All-Bond 2 Primers A + B or a 4-META product--Amalgambond Plus (AP) or Reliance Metal Primer (RMP)--followed by Concise. All specimens were stored in water at 37 degrees C for 24 hours and thermocycled 1000 times from 5 degrees C to 55 degrees C and back before tensile bond strength testing. The bond strength of Concise to etched enamel of extracted, caries-free premolars was used as a control. Bond failure sites were classified using a modified adhesive remnant index (ARI) system. Results were expressed as mean bond strength with SD, and as a function relating the probability of bond failure to stress by means of Weibull analysis. Mean tensile bond strength in the experimental groups ranged from 2.9 to 11.0 MPa--significantly weaker than the control sample (16.0 MPa). Bond failure invariably occurred at the amalgam/adhesive interface. The strongest bonds were created to the spherical and lathe-cut amalgams (range 6.8 to 11.0 MPa). Bonds to the spherical amalgam were probably more reliable. The intermediate application of the 4-META resins AP and RMP generally created significantly stronger bonds to all three basic types of amalgam products than the bonds obtained with the All-Bond 2 primers. The effect of abrasive-particle size on bond strength to different amalgam surfaces was not usually significant (p > 0.05). The implications of these findings are discussed in relationship to clinical experience bonding orthodontic attachments to large amalgam restorations in posterior teeth.

Serum levels of IgG antibodies against Tamm-Horsfall protein and urinary excretion of NAG and alpha-1-microglobulin as possible markers for tubular damage in patients with a continent ileal reservoir for urinary diversion.

Serum IgG antibodies against Tamm-Horsfall protein and urinary excretion of NAG and alpha-1-microglobulin were measured in 26 patients with a Kock reservoir for continent urinary diversion or orthotopic bladder reconstruction in order to detect any signs of tubular damage. None of these markers for tubular damage was correlated to the postoperative observation time ranging between 2 and 16 years. No correlation was found between these markers and signs of renal scarring or upper urinary tract dilatation as judged from urographies. A positive correlation was demonstrated between NAG excretion and antibodies against Tamm-Horsfall protein. The annual reduction in GFR was increased in patients with elevated alpha-1-microglobulin excretion but not in patients with elevated titres of antibodies against Tamm-Horsfall protein or increased NAG excretion. Patients with previous or present reflux nipple problems had elevated excretion of alpha-1-microglobulin. Regular determinations of alpha-1-microglobulin excretion appear to be of value in the follow-up of these patients.

Optimization of ascending phlebography of the leg for screening of deep vein thrombosis in thromboprophylactic trials.

PURPOSE: Comparison of 2 phlebographic techniques in achieving adequacy of deep venous filling. MATERIAL AND METHODS: Sixty consecutive patients with a clinical suspicion of deep vein thrombosis (DVT) were examined by 2 different techniques. A according to GREITZ and B according to LEA THOMAS. All deep veins were scored according to a protocol as DVT, normal or inadequate. Venous evaluability and DVT rates were compared. Bilateral phlebograms according to the A-technique from 92 asymptomatic patients in a different trial were reviewed to allow comparison with the symptomatic subjects. RESULTS: The A-technique resulted in a significantly higher degree of overall evaluable patients compared to the B-technique, 95% vs 47%. A vein-by-vein analysis showed that the A-technique was significantly better than the B-technique in filling the gastrocnemius muscular (82% vs 38%), anterior tibial (85% vs 43%), and deep femoral (28% vs 18%) veins. No significant difference was found in the other veins. The DVT rates were 42% and 40% respectively for the A- and B-techniques. About 94% of the phlebograms in the asymptomatic patients were adequate. CONCLUSION: The A-technique resulted in better venous opacification and would seem to be a more suitable screening method for asymptomatic persons.

Need and desire for orthodontic (re-)treatment in 35-year-old Norwegians.

Long-term outcome of orthodontic care systems may be studied by examining malocclusion and treatment need in groups of treated and untreated adults. The objective of the present work was to investigate the professionally defined need as well as the need perceived by the individuals in an attempt to study the outcome of orthodontic services. The material comprised data from 111 individuals collected from a random sample of 35-year-olds from Oslo, Norway. From a clinical examination and measurements on dental study casts, the subjects were classified into either of 4 levels of need according to the Need for Orthodontic Treatment Index (NOTI) used by the Norwegian Health Insurance System. Perceived need for treatment was analyzed from responses to questions about satisfaction with dental appearance and desire for orthodontic treatment presented in a questionnaire. Satisfaction with dental appearance was recorded in 85% and 92% of untreated and previously treated, respectively. Desire for treatment was expressed by 19% of the untreated and 3% of the treated individuals. Occlusal anomalies were present among both the treated and untreated subjects, and the clinical significance of the malocclusion traits observed is discussed.

Percentage of inadequate phlebograms and observer agreement in thromboprophylactic multicenter trials using standardized methodology and central assessment.

This study examines inadequacy rates for phlebography in two multicenter trials for the prevention of post-operative DVT and determines inter-and intra-observer variability in evaluating phlebograms. A total of 991 (I) and 385 (II) patients underwent bilateral phlebography in two studies of thromboprophylaxis. Phlebography was performed using a standard method designed to visualize and assess all deep veins. Each vein was scored as normal, DVT or inadequate by both local and central assessment. The study showed low inadequacy rates for phlebograms of 12.2% (121/991) and 6.5% (25/385). Inter-observer agreement (local vs. central assessment) was moderate in both studies (I: 74.8%, Kappa-value 0.41; II: 82.6%, Kappa-value 0.51). Good intra-observer agreement (within the central assessment group) was observed (I:88.8%, Kappa-value 0.75). This study demonstrates low inadequacy rates for phlebograms using a standardized methodology and superior intra-observer agreement compared to inter-observer agreement and supports the importance of central assessment of phlebograms in thromboprophylactic multicenter trials to reduce observer variability.

Surface preparation for orthodontic bonding to porcelain.

This study evaluated the effect of various porcelain surface treatments on the tensile strength of orthodontic brackets bonded to a feldspathic metal ceramic porcelain. The porcelain was fused to flat gold alloy tabs and divided into six groups that were subjected to sandblasting, silane application, intermediate resin, or etchants (9.6% hydrofluoric acid or 4% APF gels). Two brackets were bonded onto each porcelain/metal tab (n=60) with Bis-GMA resin (Concise, 3M Corp., St. Paul, Minn.) or 4-META resin (MCP-bond, Sun Medical Co. Ltd., Tokyo, Japan). The samples were stored in 37 degrees C water, thermocycled 1000 times from 5 degrees C to 55 degrees C and tested in tension. Alignment and uniform loading during testing were secured by engaging a hook in a circular ring soldered onto the bracket slot before bonding. Similar control brackets (n=12) were bonded with Concise to extracted caries-free mandibular incisors. Bond failure sites were classified according to a modified Adhesive Remnant Index (ARI) system. Silane application to the sandblasted porcelain surface significantly increased the bond strengths according to analysis of variance and Duncan's multiple range test. The quality of the bonds was further enhanced by the addition of the intermediate resin. Etching the porcelain with 9.6% hydrofluoric acid provided similar bond strengths, but the 4% APF gel was less effective. The MCP-bond was not significantly better than Concise in bond strength to sandblasted porcelain. Several difficulties associated with the clinical interpretation of laboratory data on bonding to dental porcelains are discussed, and clinical trials are necessary for final evidence of efficacy.

Prevention of deep-vein thrombosis after total hip replacement: direct thrombin inhibition with recombinant hirudin, CGP 39393.

BACKGROUND: The frequency of thromboembolism after major orthopaedic surgery continues to be high despite prophylaxis. New agents such as CGP 39393, a recombinant form of hirudin, may be more effective than existing therapies. METHODS: In this double-blind, multicentre, European study the efficacy of three doses of CGP 39393, in comparison with unfractionated heparin, were examined in 1119 patients undergoing elective hip surgery. Patients were randomly allocated to receive by subcutaneous injection either 10, 15, or 20 mg of CGP 39393 twice daily or 5000 IU of heparin three times daily. All treatments were started just before surgery and continued for 8-11 days, until bilateral venography was performed. FINDINGS: The occurrence of thromboembolism was significantly reduced in patients treated with CGP 39393 compared to heparin. The frequency of deep-vein thrombosis was 34.2% in the heparin group as compared to 23.9% (p=0.0113), 18.4% (p=0.0003), and 17.7% (p=0.0001) in the 10 mg, 15 mg, and 20 mg CGP 39393 groups, respectively. At all dose levels, CGP 39393 was more effective than heparin in preventing proximal deep-vein thrombosis. The frequency of proximal thrombosis was 19.6% in the heparin group as compared to 8.5% (p<0.001), 3.1% (p<0.001), and 2.4% (p<0.001) in the 10 mg, 15 mg, and 20 mg CGP 39393 groups, respectively. All treatments were well tolerated. INTERPRETATION: This study indicates that specific inhibition of thrombin by prophylactic CGP 39393 significantly reduces thromboembolic complications in patients undergoing total hip replacement.

Clinical implications of recent orthodontic-periodontic research findings.

During the past 15 years, advances in basic science related to periodontal biology, and clinical trials on prevention and treatment of periodontal disease, have dramatically changed many treatment concepts in periodontics. The most pertinent information for orthodontic practice from these studies is summarized. Also, recent advances in orthodontics, particularly regarding bonding of attachments to artificial tooth surfaces and improved long-term stabilization of orthodontic treatment results in adults by means of bonded lingual retainers have significant implications. This article outlines how recent research information from both dental specialties may be used by orthodontists to improve treatment planning, clinical management, and retention of their adult and elderly patients in whom different malocclusions are complicated by moderate to advanced periodontal destruction.

Treatment of renovascular hypertension: one year results of renal angioplasty.

During the ten year period from 1981 to 1991, percutaneous transluminal renal angioplasty (PTRA) was performed in 180 renal arteries in 137 patients, where the underlying renovascular disease was fibromuscular dysplasia (FMD) in 30 patients (22%) and arteriosclerotic vascular disease (AVD) in 107 (78%). A preinterventional work-up and a re-evaluation of the patients after one year was designed for the assessment of the clinical, functional and technical outcome. Successful technical dilatation was achieved in 97% of procedures with FMD patients and in 82% of procedures with AVD patients. A beneficial effect on the blood pressure and the renal function was registered in both groups. The overall cure and improvement rate for hypertension was 86% in the FMD group and 64% in the AVD group after one year's follow-up. A significant gain in the total renal function was registered in both groups, the average increase in glomerular filtration rate being 13% (P < 0.001) for the FMD group and 11% (P < 0.001) for the AVD group one year after PTRA. Renal function was improved or unchanged in 89% of FMD patients and 74% of AVD patients. The improvement in renal function was made by the revascularized kidney. Renal vein renin investigation predicted the clinical outcome with an excellent diagnostic accuracy as no renin negative patient became normotensive, and renin positive patients, who did not turn normotensive, were in almost 90% of the cases affected by technical failure or restenosis/contralateral stenosis. Thus, the sensitivity of renal vein renin investigation was 95% and the specificity 75%. The outcome for patients with hypertension and renal insufficiency was considerably poorer than for the whole group of patients, with only a 20% success rate for hypertension, but 50% in this group had increased or unchanged GFR after intervention. The angiographic one-year follow-up revealed a recurrence rate of 6.7% for FMD and 15.1% for AVD. For the entire series of patients, the incidence of major complications was 5.4%, including one indirect fatality, while the incidence of minor complications was 5%. In conclusion, PTRA will cure or improve blood pressure in most patients with renovascular hypertension, and it preserves and even improves renal function in these patients. Complications and recurrence are in fact not very common and PTRA appears be the best first approach in all but ostial lesions for treatment of renovascular hypertension.