Survival characteristics of 771 resin-retained bridges provided at a UK dental teaching hospital.

OBJECTIVE: To analyse the factors affecting the clinical performance and those influencing the survival of resin-retained bridgework provided at a UK dental teaching hospital between 1994 and 2001. DESIGN: A prospective analysis of restorations provided at a single centre using case notes with all patients invited for review to corroborate findings. SETTING: Department of Restorative Dentistry, University of Bristol Dental Hospital and School, Bristol, United Kingdom. SUBJECTS AND METHODS: Between January 1994 and December 2001, data regarding 1,000 consecutive resin-retained bridges provided at Bristol Dental Hospital and School were recorded. Data was available for 805 patients at the time of the study. Following invitation, 621 patients attended for a review appointment. Life table and Kaplan-Meir survival analysis were carried out for all restorations provided. RESULTS: The five-year and ten-year survival rates estimated by the life-table method are 80.8% (95% confidence interval 78.0-83.6%) and 80.4% (95% confidence interval 77.6-83.2%) respectively. The median survival cannot be estimated for this study as the survival probability remains above 80% even at the longest follow-up. Analysis of clinical variables influencing survival revealed that design of the restoration and experience of the operator providing the restoration were significant factors. Resin-retained bridges made with minimal tooth preparation are shown to be superior in terms of longevity than those for which other types of tooth preparation is made. Patient satisfaction with their treatment was high.

Markers for implant placement in CBCT: a technical overview.

Cone beam computer tomography (CBCT) is becoming a more accessible modality of imaging within dentistry. It has particular application in the diagnostic treatment planning for dental implant placement. The use of radiographic surgical stents with CBCT can help to provide important information about bone position and therefore placement of implants and final restorations. This article looks at a novel technique, which allows a variety of different marker positions that can be quickly and easily placed and removed. It allows the use of a current prosthesis that can be adapted to act as a surgical stent during CBCT.

The use of ureteral stents and suprapubic catheter in vesicoureteric reflux surgery.

The use of ureteric stents in reimplantation surgery is important. The younger the patient, the more important the stenting of ureters post reimplantation becomes, because even minimal oedema following surgery will produce ureteric obstruction unless stents are in place. JJ stents are now the preferred method of choice in ureteric reimplantation surgery, but in the past the patient required another admission to hospital and general anaesthetic to have the stents removed endoscopically. We describe a technique whereby the stents are attached to the suprapubic catheter and are therefore removed prior to the patient's discharge from hospital, thus obviating the need for a second admission and second anaesthetic for the stent removal. We have studied 23 patients with this technique and find that it is a reliable and safe method to use.

Androgen and oestrogen receptor status of the human appendix testis.

Since the human appendix testis is a Mullerian duct derivative it has been theorised that rising oestrogen levels in puberty result in enlargement of this organ and consequent predisposition to torsion. This study sought to establish the presence or absence of both androgen and oestrogen receptors in the human appendix testis. Bilateral appendix testis specimens surgically excised from ten patients undergoing scrotal exploration for acute scrotum were stained immunohistochemically for androgen and oestrogen receptors. These were examined by light microscopy. The human appendix testis was found to express both oestrogen and androgen receptors. Marked regional variation of androgen and oestrogen receptor positivity was demonstrated. The surface epithelium and some stromal cells were androgen receptor positive, whereas oestrogen receptors were confined to ductular invaginations, gland-like structures and some stromal cells. Rising levels of androgens and oestrogens in pubertal boys may account for enlargement and the predisposition of the human appendix testis for torsion since this structure contains receptors for both.

Clinical evaluation of a carbon fibre reinforced carbon endodontic post.

This study reports a prospective clinical trial comparing a carbon fibre reinforced carbon (CFRC) endodontic post with a conventional prefabricated post. Twenty-seven single rooted maxillary anterior teeth in 18 patients (nine males and nine females; age range 18-60 years) were restored either with a CFRC post or a wrought precious alloy control. Cast type III gold alloy cores were used in conjunction with both post groups. The CRFC posts (n = 16) were cemented with a composite luting agent and the conventional posts (control) were cemented with zinc phosphate. Four failures were recorded in the CFRC post group at 24, 29, 56 and 87 months, compared with one failure in the control group at 84 months. These results suggest that post-retained crowns utilizing a CFRC material and a composite resin luting agent do not perform as well as conventional wrought precious alloy posts.

A prospective comparison of tissue glue versus sutures for circumcision.

The safety of wound closure with tissue glue after surgery has been well established. The efficacy of its use in circumcision is poorly documented. The aim of this study was to carry out a comparative study of tissue glue versus suture closure after circumcision. The duration of the operative procedure, pain score, cosmesis and postoperative complications were evaluated. There were no complications in either group. There was no statistically significant difference in the pain score in both groups. However the mean time taken for tissue glue was 16.6 minutes and the mean time taken for sutures was 23.7 minutes. (p < 0.0001) which was statistically significant. The cosmetic appearance was found to be superior in the tissue glue group as there were no suture marks on the join of the shaft skin and foreskin base.

Home resistance training in an elderly woman with coronary heart disease.

In the current report, a home-based resistive exercise training program was designed for an older woman with coronary artery disease and chronic heart failure, who was unable to participate in a center-based program. With intermittent on-site instruction, the patient was able to learn and perform the designed exercise program. After 6 months of exercise, muscle strength (handgrip and leg extension) and lean body mass were increased, and indicators of physical functional performance were improved. We conclude that a home resistive-based exercise program, with intermittent on-site exercise counseling, may be an effective method for physical training in older coronary patients unable to travel to a rehabilitation center. Further study of this intervention in a controlled clinical trial appears warranted.

Multiple atresias in a low-birth-weight twin.

This report describes a case of 16 small bowel atresias in a twin who was born at 31 weeks' gestation, weighing 1,690 g. All atresias and intestinal segments of 5 cm or less in length were resected, resulting in nine primary anastomoses, preserving 75% (107 cm) of his initial small bowel length. The baby went home on full oral feedings after 10 weeks. Multiple anastomoses in the low-birth-weight neonate can be tolerated with the functional benefit of maximal bowel length. The time taken to tolerate feedings appears to be independent of the number of anastomoses. Vascular anastomoses associated with monochorionic twinning may place both fetuses at risk of intestinal atresia in the event of an ischemic insult, either concurrently or with the demise of one affecting the other. Prenatal ultrasound scan appears to be useful for monitoring the evolution of intestinal atresia. However, the risks of extreme prematurity preclude the delivery of the affected baby at the time of initial diagnosis, and as yet it is unknown whether early delivery will alter the number, type, or prognosis of multiple atresias.

Adhesive techniques.

This paper describes the use of adhesive techniques to restore teeth previously affected by tooth surface loss so avoiding the need to remove sound tooth tissue.

Sewing-pin perforation of the appendix into the bladder.

We report a 2.5-year-old child who presented with an acute abdomen caused by the perforation of a sewing pin through her appendix that had started to penetrate the wall of the bladder.

The use of adhesive restorations in the management of localised anterior toothwear.

Toothwear appears to be increasingly common, particularly in the younger age groups, and will often require restorative intervention to provide satisfactory appearance and function. Well established conventional restorative techniques can be relatively complex and time-consuming and as a consequence may not be accessible for many patients. This paper, with the help of the literature, discusses the alternative application of a variety of adhesive materials and techniques used in the restoration of moderate to severe anterior toothwear.

Embryo research: the challenge for public policy.

Complete moral consensus on the status of the human embryo is neither feasible nor necessary for the formulation of ethically acceptable public policy for human embryo research. Significant consensus on permissible human embryo research can rest upon diverse but overlapping moral traditions. Thus, human embryo research policy should do more than reflect mere abstract assertions about the moral status of human embryos. Rather, the moral underpinnings of human embryo research should be derived from a range of values, including the facilitation of human procreation, the advancement of applied scientific knowledge, the reduction of human suffering, and the protection of vulnerable persons from coercion and exploitation.

Intravesical therapy for the treatment of neurogenic bladder in children.

BACKGROUND: Oral pharmacotherapy has been commonly used as an adjunct to clean intermittent catheterization (CIC) in the treatment of neurogenic bladder in order to achieve continence, but may be associated with unacceptable side effects. The authors' experience with sterile intravesical preparations of oxybutynin hydrochloride and ephedrine in children is reported here. METHODS: Patients requiring CIC for neurogenic bladder but with incontinence that was unresponsive to standard oral therapy or that was associated with severe systemic side effects were studied over a 1-year period. Clinical, radiological and urodynamic assessments were made prior to commencing treatment with intravesical oxybutynin hydrochloride. Patients who remained incontinent with poor internal sphincter muscle tone had intravesical ephedrine added. RESULTS: Seven patients were involved in the study over a 1-year period. Two patients became continent and one patient had an improvement in upper tract dilatation. One patient had a limited improvement with oxybutynin alone but became continent with the addition of ephedrine. Three patients had no response to treatment. There were few side effects. CONCLUSION: Intravesical agents have a role in the management of paediatric neurogenic bladder for those children with significant adverse sequelae from oral pharmacotherapy who would otherwise require surgical intervention. Intravesical therapy is a safe technique in children with sterile preparations. Further investigation of this modality should be pursued.

An in vitro evaluation of a carbon fiber-based post and core system.

STATEMENT OF PROBLEM: A self-contained post and core system, Composipost, comprising an epoxy-based carbon fiber post, a composite core material, and a low viscosity Bis-GMA bonding resin, has recently been marketed for the restoration of pulpless teeth. PURPOSE: This study compared the in vitro performance and the failure characteristics of the Composipost system against existing post and core combinations. MATERIAL AND METHODS: Using extracted human teeth, three post and core test groups and one control group were then tested to failure with an obliquely applied compressive load at 130 degrees in a Hounsfield testing-machine with a crosshead speed of 5 cm/minute. RESULTS: The mean stress values at failure (MNm.2) with standard deviations for each group were as follows: Composipost system 8.89, SD 2.40; stainless steel post and composite core 14.18, SD 3.49; cast gold alloy post and gold alloy core 15.25, SD 4.07; and endodontically treated tooth only 24.84 SD 4.58. CONCLUSION: The specimens restored with the Composipost system exhibited inferior strength properties in comparison to the other post and core systems tested (p < 0.01). Teeth without post and core foundations tested significantly stronger than the other comparison groups (p < 0.01).

Retrospective survey of resin-retained cast-metal palatal veneers for the treatment of anterior palatal tooth wear.

Anterior palatal tooth wear is easily recognized, but its precise pathogenesis remains unknown. Treatment of this condition with cast-alloy palatal veneers used in combination with an adhesive cement is described. Forty-eight patients, aged 11 to 71, were treated with a total of 210 cast metal veneers over a period of 56 months. Twenty-three of the restorations failed, resulting in an overall success rate of 89%. All failures were confined to 13 patients. A glass polyalkenoate cement was less effective than a chemically active resin composite luting agent. Nickel-chromium veneers cemented with activated resin composite recorded a survival probability of 0.74 at 56 months. Adhesive cast-alloy veneers provided a useful method of restoring maxillary anterior teeth affected by acid erosion.

Treatment of an aggressive haemangiomatous lesion with alpha-interferon.

We report an infant who presented with an aggressive haemangiomatous lesion of the right thigh that was treated successfully with α-interferon.