The multiple oral presentations of multiple myeloma.

PURPOSE: The purpose of this case series is to show the varied oral presentations of multiple myeloma, illustrating the importance of carefully surveying the oral cavity for suspicious lesions that could be indicative of palpable disease and/or recurrence. The diagnostic criteria and prognostic features for multiple myeloma were also reviewed. CASE SERIES SUMMARY: This report focuses on five patients with myeloma manifestations involving the oral cavity, in which the oral presentation of multiple myeloma was an early indication of disease relapse. Although the clinical presentation may be variable, the majority of patients will develop lytic bone lesions and less commonly, extramedullary involvement during the course of their disease. DISCUSSION: The presentation of myeloma can be varied and the oral presentation, although rare, may be the sole manifestation or part of a group of signs of disease progression. Clinical presentations of patients with myelomatous lesions can mimic common dental pathologies, which then, in turn, can lead to delays in diagnosis and treatment. CONCLUSION: As members of an interdisciplinary oncology team, it is essential to be familiar with oral manifestations of multiple myeloma and proper diagnostic/biopsy techniques in order to avoid misdiagnosis and treatment delays.

Retention of CAD/CAM all-ceramic crowns on prefabricated implant abutments: an in vitro comparative study of luting agents and abutment surface area.

PURPOSE: Previous studies considering retention of cast metal restorations to implant abutments incorporated some degree of frictional fit due to internal surface nodules and roughness of the restoration. In comparison, CAD/CAM restorations have minimal surface irregularities, possibly impacting retention. There is insufficient knowledge of retentive force of CAD/CAM restorations to titanium abutments, and therefore the topic warrants further investigation. This in vitro study investigated the retention of all-ceramic CAD/CAM restorations to three different prefabricated implant abutments using five different cements. MATERIALS AND METHODS: A total of 150 Astra Tech dental implant abutments were used, with each group of 50 being subdivided into five groups of 10. An optical impression of each size of abutment was made with the CEREC 3D intraoral camera. A full-coverage restoration was designed and milled with an enlarged, conical-shaped occlusal surface, which served to secure the restoration into a brass jig used with a universal testing machine. Five different cements were used with three different-sized abutments. Following cementation, the implant/abutment/restoration assemblies were stored for 24 hours at 37°C in 100% humidity. A pull-out test using a universal testing machine, set at a 0.5 mm/min crosshead speed, was used to evaluate retention of the individual restorations. The load required to remove each all-ceramic restoration was recorded. Retention values were analyzed using ANOVA and Fisher's PLSD multiple comparisons test at the 0.05 level of significance. RESULTS: Peak loads for two provisional cements and a resin-modified glass ionomer cement ranged from 56 N to 127 N. Peak loads for two resin cements ranged from 184 N to 318 N. Two-way ANOVA showed significant effects upon retentive forces for both the cement and abutment design. Post hoc Fisher's PLSD multiple comparisons test found significant differences in retention for 7 of the 10 pairings of cements at a 0.05 level of significance. In addition, Fisher's PLSD multiple comparisons test found significant differences between Astra Tech Direct Abutments 4 and Astra Tech Direct Abutments 5 as well as Astra Tech Direct Abutments 4 and Astra Tech Direct Abutments 6 at a 0.05 level of significance. No significant difference was found between Astra Tech Direct Abutments 5 and Astra Tech Direct Abutments 6. CONCLUSIONS: Of the five cements tested, the most retrievable CAD/CAM restorations were luted with Temp Bond NE and Improv Temporary Cement. Resin-modified glass ionomer retentive forces were closer to those of the "temporary cements" than those of the permanent adhesive-resin cements. The abutment surface area became less important when using adhesive-resin cements. Retention of CAD/CAM all-ceramic restorations to prefabricated abutments has not been reported in the literature. This in vitro study demonstrated clinically significant variation among the selected cements used to retain all-ceramic CAD/CAM restorations to implant abutments. In addition, abutment size influenced the retention of all-ceramic CAD/CAM restorations.

Oral rehabilitation of a mandibular discontinuity defect: a clinical report.

Patients undergoing surgery to remove cancer resulting in mandibular discontinuity experience certain challenges with respect to function and esthetics. It is important to inform them that prosthetic reconstruction may restore structures and continuity, but it may not restore function.

Leopard (Panthera pardus) status, distribution, and the research efforts across its range.

The leopard's (Panthera pardus) broad geographic range, remarkable adaptability, and secretive nature have contributed to a misconception that this species might not be severely threatened across its range. We find that not only are several subspecies and regional populations critically endangered but also the overall range loss is greater than the average for terrestrial large carnivores. To assess the leopard's status, we compile 6,000 records at 2,500 locations from over 1,300 sources on its historic (post 1750) and current distribution. We map the species across Africa and Asia, delineating areas where the species is confirmed present, is possibly present, is possibly extinct or is almost certainly extinct. The leopard now occupies 25-37% of its historic range, but this obscures important differences between subspecies. Of the nine recognized subspecies, three (P. p. pardus, fusca, and saxicolor) account for 97% of the leopard's extant range while another three (P. p. orientalis, nimr, and japonensis) have each lost as much as 98% of their historic range. Isolation, small patch sizes, and few remaining patches further threaten the six subspecies that each have less than 100,000 km(2) of extant range. Approximately 17% of extant leopard range is protected, although some endangered subspecies have far less. We found that while leopard research was increasing, research effort was primarily on the subspecies with the most remaining range whereas subspecies that are most in need of urgent attention were neglected.

Survey of currently selected dental implants and restorations by prosthodontists.

PURPOSE: The purpose of this study was to survey the prosthodontists of the American College of Prosthodontists (ACP) and the American Academy of Maxillofacial Prosthetics (AAMP) to identify the most commonly used implant both during their training and currently in practice, and to evaluate overall restorative preference. Participants were asked to rank criteria that make an implant company desirable and important features when selecting an implant. MATERIALS AND METHODS: An electronic survey was emailed to 1,739 members of the ACP and AAMP. RESULTS: The majority of respondents (79%) were trained using Nobel Biocare brand implants, which was also the brand most often selected by participants for use in all regions of the oral cavity (34% to 39%, location dependent). Abutment preferences varied by area: incisors and canines (29%) and highly esthetic areas (53%) were more likely to be restored with custom milled zirconia abutments, while prefabricated titanium abutments were preferred for premolars and molar areas. Conventional loading was most often applied, ranging from 95% in medically compromised patients to 55% in esthetic areas. The majority of participants (86%) used Locator attachments for complete overdenture restorations. Also, respondents selected an implant company based on features and literature support versus cost and customer service. The implant features deemed most important were the design of the internal connection and ease of finding replacement parts; thread design and variety of abutments were deemed least important. Respondents reported that while implant planning software was used, they rarely/never order the concurrent surgical guide. CONCLUSION: Within the study's limitations, the majority of prosthodontists select implants based on training, features, and literature support.

Period between completion of radiation therapy and prosthetic rehabilitation in edentulous patients: a retrospective study.

PURPOSE: The primary purposes of this study were: (1) to describe the number and types of complications patients had before and after insertion of a removable prosthesis (i.e., denture) following radiation therapy to the head and neck and (2) to investigate whether the time between radiation therapy and denture insertion might contribute to those complications. MATERIALS AND METHODS: This research evaluated edentulous patients and those who were rendered edentulous as a result of their cancer treatment. After obtaining institutional approval following HIPAA regulations, a total of 349 charts were identified: 152 patients from Houston Veterans Administration Medical Center (HVAMC) and 197 patients from M. D. Anderson Cancer Center (MDACC). A total of 190 patients met the inclusion criteria with data available for review. RESULTS: No significant differences were found in any of the comparisons made, except when comparing complications that occurred after the dentures were inserted and the amount of time it took for prosthetic rehabilitation. The majority of patients had no complications. The patients who received their dentures in 180 days or less had the same number of complications when compared with those patients who received their dentures in 181 to 365 days and those who had to wait longer than a year for prosthetic rehabilitation. Patients with more pre-insertion complications tended to have delayed prosthetic rehabilitation. Those patients who had complications both before and after denture insertion tended to have bilateral dosing of their radiation treatment. Patients who had received radiation therapy were 1.7 times more likely to have post-prosthesis insertion complications. The majority of patients who experienced complications before and after denture insertion had greater than 5000 cGy. CONCLUSIONS: The numbers of complications reviewed in this retrospective analysis were considerably fewer than the number expected. There appears to be no difference in the number of pre- and post-insertion complications as a function of the time delay from oral surgical procedure to start of radiation treatment (10 to 21 days vs. 22 days or more).