The effects of teriparatide on acceleration of bone healing following atypical femoral fracture: comparison between daily and weekly administration.

We compared the effectiveness of promoting bone healing between two teriparatide preparations for atypical femoral fracture (AFF). A total of 45 AFFs were included in this study, and we compared the duration of bone union. Teriparatide administered by daily injection enhanced bone union more than weekly administration in complete AFFs. INTRODUCTION: The efficacy of teriparatide for atypical femoral fracture (AFF) has been recently reported. Although two different teriparatide preparations can be used to treat osteoporosis in Japan, daily or weekly injection, all previous reports on the effectiveness of teriparatide for AFF only examined daily injection formulations. Therefore, we compared the promotion of bone healing between the two teriparatide preparations for AFF. METHODS: A total of 45 consecutive AFFs in 43 Japanese patients were included in this study. They received either a daily 20-µg teriparatide injection (daily group; n = 32) or a once-a-week 56.5-µg teriparatide injection (weekly group; n = 13). We compared the clinical background and duration of bone union between these two groups. RESULTS: When all patents were included, the fracture healing time was not significantly different between the two groups. Only patients with complete AFFs had significantly fewer daily bisphosphonate or denosumab injections than the weekly group (P < 0.05). The fracture healing time in the daily group (6.1 ± 4.1 months) was significantly shorter than that in the weekly group (10.1 ± 4.2 months) (P < 0.05). Even if the influence of bisphosphonate or denosumab usage was excluded, a similar significant difference was observed in the fracture healing time (P < 0.05). There was no significant difference between the two groups among patients with incomplete AFFs. CONCLUSIONS: Daily teriparatide injections enhance bone union more than weekly injections in complete AFF patients.

Microleakage of composite resins in cavities of upper primary molars.

OBJECTIVE: To improve the quality of resin restorations, studies are necessary not only of the physical properties of materials but also of the cavity geometry. We have evaluated marginal microleakage for two types of photo-curing composite resin applied to cavities with different marginal structures. SAMPLE AND METHODS: The test materials were 91 extracted upper primary molars. The two composite resins used in this experiment were Liner Bond II (LBII) and Photo Clearfil A (PCA). A class I cavity was created in each tooth; the cavity configuration was a round bevel, a straight bevel and a butt joint. The tooth was then restored with each composite resin. Each tooth was exposed to thermal cycles, followed by immersion in 0.2% basic fuchsin solution. Three sections, through the mesial, central and distal areas of each tooth were taken. The penetration of the dye was examined with a stereoscopic microscope. The sites of observation for examination of microleakage were awarded scores of between 0 and 7. RESULTS: LBII-among the three marginal forms, absence of leakage was observed most frequently in the straight bevel group followed by the round bevel and the butt joint groups, in the mesial and distal sections. In the central section, the straight bevel did not show any scores of 0, 6 or 7. PCA-an absence of leakage in the mesial section occurred most frequently for the round bevel group. However, the absence of leakage in the central and distal sections was most frequent for the straight bevel group. Microleakage of the central section (with scores from 1 to 7) was frequently lower than that for the mesial and distal sections. Scores of 5 and above in the central section were observed only in the butt joint group. The frequency and mean score of leakage were clearly higher in LBII than in PCA, with one significant exception. For both composite resins, the butt joint group showed higher-mean scores of leakage than did either the round or straight bevel group, but for PCA, the mean score of the central section was lower than the other two sections in all groups. CONCLUSION: Our study shows that beveling does reduce marginal leakage. This leakage was more frequently observed with the use of LBII than with PCA. However, the amount of tooth ground away was greater for the bevel-treated cavity. In considering these features, special care is necessary in selecting the bur for treating a bevelled cavity.

New cavity forms in second deciduous molars which maximize dentin thickness between cavity and pulp chamber.

This study was designed to devise configuratively ideal cavity formations using 49 second deciduous molars, consisting of 25 extracted from the maxilla and 24 from the mandible. A cavity having at least 1 mm subcavitary (below the cavity) dentin thickness at any point of measurement and having an appropriately formed and positioned retention was defined as an ideal cavity. The same methods were used as in our previous study of first deciduous molars. The following results were obtained: 1. In upper second deciduous molars, the subcavitary dentin thickness was thin at the mesiobuccal side of the cavity; it measured 0.9 mm. In lower second deciduous molars, the subcavitary dentin thickness was thin at the mesiobuccal, distolingual sides of the cavity, and central fossa, where the retentional groove was provided; it measured 0.8-0.9 mm. The other measured values exceeded 1.0 mm. All thickness measurements were very close to the values considered as ideal. 2. In upper second deciduous molars, the margins of the cavity were positioned medially to the summits of respective cusps, 1.8-2.0 mm at the buccal side and 1.5 mm at the lingual side. The entire cavity was located lingually. 3. In lower second deciduous molars, the buccal margin of the cavity was positioned 1.7 mm medially to the summit of the distobuccal cusp and 1.2-1.3 mm medially to the summits of the other buccal cusps. The lingual margin was positioned 1.4-1.5 mm medially to the summits of respective cusps. medially to the summits of respective cusps. 4. The buccolingual width of the cavity amounted to 1/3 of the distance between the summits of the buccal and lingual cusps in both upper and lower second deciduous molars. 5. At the mesial side, the depth of cavity was 1.4 mm at the buccal wall and 1.5 mm at the lingual wall in upper second deciduous molars, and 1.4 mm at the buccal wall and 1.6 mm at the lingual wall in lower second deciduous molars. 6. The width of gingival wall in the proximal box measured 1.0 mm in both upper and lower second deciduous molars.

New cavity forms in first deciduous molars which maximize dentin thickness between cavity and pulp chamber.

Using a total of 60 human extracted first deciduous molars (30 upper molars and 30 lower molars), we contrived a variety of ideal cavities having dentin thicknesses below the cavity (subcavitary dentin) that measure approximately 1 mm in thickness from the pulp chamber at any point of measurement and also having a retentional groove prepared in such a way that detachment of a filling material is prevented. The transparent specimens prepared from the cavity-containing teeth were cut into serial sections of 93 microns. These sections were reconstructed using a personal computer. The thickness of dentin below the cavity was measured in randomly selected sections. Results obtained were as follows: 1. An ideal thickness of the subcavitary dentin was preserved for upper first deciduous molar by preparing a retentional groove lingually or by providing a dovetail-like shape to mesio-distolingual sides in the cavity; for lower first deciduous molar, any form of cavitation worked. 2. In the upper first deciduous molars, the margins of the cavity were displaced medially to the summits of the respective cusps 1.9 mm at the buccal side and 1.2 mm at the lingual side. In the lower first deciduous molars, the buccal margin medially measured 0.9 mm and the lingual margin measured 0.6 mm at the mesial side. At the distal side, the buccal and lingual margins measured 1.2 mm and 1.0 mm, respectively. 3. The ratio of cavity width to the distance between the summits of the buccal and lingual cusps was 1/3 in upper deciduous first molars and 2/5 in the lower first deciduous molars. 4. In the upper first deciduous molars, the depths of the buccal and lingual walls of the cavity at the center of the central groove were both 1.1 mm. In the lower first deciduous molars, the cavity formed with its center at the middle of the transverse ridge had a depth of 1.5 mm at the buccal wall and a depth of 1.7 mm at the lingual wall. The cavity formed with its center at the central fossa had a depth of 1.2 mm at the buccal wall and 1.1 mm at the lingual wall. 5. The width of the gingival wall in the proximal box measured 0.6-0.7 mm in upper and lower first deciduous molars.

[Clinical study of enamel hypoplasia and its causes. 1. Primary teeth].

A nation-wide field survey was undertaken to examine clinical causes for hypoplasia of primary teeth in 141 children above 3 years of age with primary dentition having enamel hypoplasia. The survey was carried out by visual examination, photographic evaluation and questionnaire survey. The controls consisted of 120 children without enamel hypoplasia. The following results were obtained: 1. Hypoplastic teeth due to inflammation, trauma or radiation were not found. 2. Based on the configuration of the hypoplastic teeth, the place of birth and type of nursing, the teeth that developed enamel opacity could not necessarily be regarded as to mottled teeth. 3. No correlation was found between the unbalanced diet of the mothers during pregnancy and the occurrence of the hypoplastic teeth. 4. The development of enamel hypoplasia was estimated to have occurred from the neonatal to infantile stage for the primary canines and from the fetal stage to the early stage of birth or 6 months after birth for second primary molars. 5. Hypoplasia seemed to have begun from the stage of the matrix formation in many cases. 6. Among the mothers during embryogenesis, threatened abortion, severe hyperemesis gravidarum, anemia and drugs used in the treatment of these symptoms seemed to be responsible for the development of hypoplasia. Among the children, diseases occurring within one year after birth, exanthematous diseases such as exanthema submonia, common cold and pneumonia, Jaundice, intussusception and asthma seemed to be responsible. 7. The number of enamel-hypoplastic teeth per child increased, as the frequency of diseases in both mothers and children increased. 8. The kind of teeth susceptible to damage, the time of damage, the sensitivity of individuals, and the kind and severity of damage seemed to interact in the etiology of hypoplasia.

[Clinical study of enamel hypoplasia and its causes. 2. Permanent teeth].

A nation-wide field survey was carried out to investigate the etiology of enamel hypoplasia for permanent teeth in 286 subjects below 20 years of age with permanent dentition having enamel hypoplasia. Visual examination, photographic evaluation and questionnaire survey were used. The same questionnaire survey was also carried out in 111 subjects without hypoplastic teeth as controls. The following results were obtained. 1. The number of hypoplastic teeth ranged from 1 to 28 per subjects. 2. Upper central incisors were frequently involved, especially in subjects with few permanent teeth. Enamel hypoplasia in these teeth appeared symmetrically. 3. Only a few hypoplastic teeth seemed due to local causes. Hypoplastic teeth were not considered to be mottled teeth caused by fluoride. 4. Unbalanced diet (food liked and disliked) during pregnancy was not related to dental hypoplasia. 5. In subjects with many colored teeth, maternal diseases during embryogenesis and drugs administered for treatment were considered to be etiologically involved in the development of hypoplasia. 6. Viral infection during childhood seemed to be involved in the development of hypoplasia. 7. Many of the subjects with more than 7 hypoplastic teeth or colored teeth had contracted diseases during childhood. Moreover, the development of both viral infection and other disease was frequent. 8. The kind of teeth liable to damage, time of damage, sensitivity of individual subjects, multiple stimulation.

[Blood pressure changes in children during minor oral surgery].

The purpose of this study was to evaluate the influence of minor surgery conducted in the oral cavities of children. Changes in blood pressure and pulse during minor surgery were measured using a Pulse-Wave Korotokoff Sound Record Meter GP-303S (PARAMA). The subjects consisted of 28 children (15 boys and 13 girls) who underwent minor surgery at the pediatric dental clinic of Iwate Medical University. An examination of 16 of the 28 children to determine the relationship between their physique, personality, and blood pressure was made. The following results were obtained: 1) The maximum blood pressure formed a peak at the time of the impacted supernumerary teeth extraction. This was more conspicuous in boys than in girls. The pulse rose to the highest values with the infiltration of the anesthesia, the incision, and stripping. However, no significant values based on sex difference were demonstrated. 2) The maximum blood pressure changed more intensely during surgery in boys than in girls. This was distinctly observed during extraction of the impacted supernumerary tooth. 3) Both the maximum blood pressure and pulse increased with the progress of the surgery. After the surgery, it returned nearly to the presurgical level. With extraction of a supernumerary tooth and marsupialization, the return of the blood pressure to the preoperative level was more delayed in boys than in girls. 4. The changes in blood pressure and pulse seemed to be mostly induced by mental disquietude and stress such as anxiety and fear of surgery. 5. The physique and personality were related to the changes in blood pressure and pulse during minor surgery in the oral cavity.

[Effect of adhesive composite resin on pulp and capping of pulp with calcium hydroxide base (Dycal) in deciduous teeth of young dogs].

This study was designed to investigate the effect of adhesive composite resin (Clearfil SC Bond) on dental pulp and the effect of calcium hydroxide base (Dycal) on the protection of the pulp, using 66 deciduous teeth of young dogs. After forming a cavity (class 5) on the labial aspect in each tooth, the teeth were divided by the modes of plugging into 4 groups; stopping alone (Group S), stopping and capping with Dycal (Group D+S), capping with Dycal and resin (Group D+R) and capping with resin alone (Group R). After decalcification, the specimen was embedded in celloidin, sliced into thin sections and stained with hematoxylin and eosin for histopathological examination. Histological changes were examined at 3 days, 1 week, 2 weeks and 4 weeks. The following are the results obtained. 1. In Group S, slight histological changes were observed at 3 days and 1 week. However, the changes began to diminish after the 2nd week and disappeared in the 4th week. 2. In Group R, the severest histological changes persisted throughout the course of observation. The changes were not diminished even in the 4th week. Thus, the resin seemed to exert a strong and long-lasting stimulative effect against the pulp. 3. In Group D+S and D+R, the histological changes were more serve at 3 days and 1 week compared to those found in Group S, but these were diminished after the 2nd week. This seemed to suggest that the pulp was stimulated to a certain degree by Dycal but also, Dycal protected the pulp from stimulation of the resin. 4. Capping of the pulp seemed necessary in vital teeth with resin restoration.

[Clinical study of ectopic eruption of permanent incisors and first molars].

UNLABELLED: Using the X-ray films, plastic models and pathological photograph of 4824 patients seen at the Department of Pedodontics of Iwate Medical University, the patterns of ectopic eruptions of permanent incisors and first molars (restricted to these teeth in this study) were classified into 4 groups (I-IV) to investigate the conditions of its incidence, size of the teeth and dental arch, and conditions at the stage of the mixed and permanent dentitions. RESULTS: 1. The total frequency of ectopic eruptions was 5.6%. No difference based on sex was found. 2. By classification, ectopic eruptions of the upper and lower permanent central incisors (Group I) amounted to more than half of the total frequency. The incidence of ectopic eruptions of the upper and lower permanent first molars (Group III) was very low and amounted to only 4.6% of the total frequency. 3. In Groups I and III, the incidence was higher in the maxilla than in the mandible. 4. Based on sex, the incidence was higher in boys in Group III and in girls in group II. 5. Ectopia of the permanent central incisors was frequently bilateral and those of the lower permanent lateral incisors and upper permanent first molars were frequently unilateral. 6. The mesiodistal width of the ectopically erupted permanent teeth tended to be somewhat enlarged, but showed no significant differences from Ono's mean value. 7. In ectopic eruptions at the area of the incisors, the C-C distance was narrowed with an increase in the ectopically erupted permanent teeth. 8. In patients in whom the permanent dentition was formed without occlusal guidance, the basal arch length and dental arch length were large and basal arch width and dental arch width were small. 9. In cases which were followed from the deciduous dentitions to permanent dentitions, the anterior tooth area at the stage of the mixed dentition was frequently crowded. Occlusal guidance was carried out in more than half of these cases.

Serum zinc and copper changes after gastrectomy in aged patients with gastric cancer.

Serum zinc and copper levels were evaluated in patients with gastric cancer who had undergone gastrectomy. These patients were divided into two age categories; namely, the aged group, comprising 39 patients over the age of 70 years, and the younger group, comprising 23 patients younger than 50 years. The data before and after surgery were compared between the two groups. Serum zinc levels in the aged group were significantly lower than those in the younger group, both before and after surgery. Serum copper levels, however, did not differ significantly between the two groups. The serum Cu/Zn ratio was also analyzed according to the histological stages of cancer (stages I to IV), and compared between the two age-classified groups. The aged group showed a higher Cu/Zn ratio at all stages, whereas in the younger group, the ratio was significantly higher at stage IV than in the earlier stages. Preoperative serum zinc, copper, and the Cu/Zn ratio were studied in relation to the complication of anastomotic leak after surgery. The Cu/Zn ratio in the aged patients with this complication was significantly higher than that in the aged patients without it. These results suggest that the Cu/Zn ratio may be an important factor in determining nutritional parameters in the aged.