Esthetic Challenges in Rehabilitating the Anterior Maxilla: A Case Report.

The rehabilitation of an unesthetic smile in the anterior maxilla is always a clinical challenge, especially when an improper shape and size, old restorations, and unesthetic shading are present. In addition, an irregular gingival zenith contour in the anterior maxilla can affect the smile's harmony. Thus, detailed treatment planning is needed to define a functional and esthetic prosthetic rehabilitation. This study describes a clinical case in which a 55-year-old woman was rehabilitated using Digital Smile Design planning and full ceramic crowns (metal free) in the anterior zone of the maxilla and mandible. To normalize the gingival zenith, a dynamic compression technique was performed using provisional restorations to condition the gingival tissues and harmonize the proportional length of the anterior upper teeth.

Ceramic fragments and metal-free full crowns: a conservative esthetic option for closing diastemas and rehabilitating smiles.

Dental ceramics make it possible to restore anterior teeth that have been esthetically compromised, presenting a high resistance to wear, biocompatibility, color stability, and low thermal conductivity. The development of different types of ceramic and techniques for adhesive cementation have made it possible to produce more conservative restorations without involving the healthy dental structure and with minimally invasive preparation, such as the bonding of ceramic fragments. The purpose of this article is to describe a clinical case in which diastemas were closed by using nanofluorapatite ceramic (e.max Ceram, Ivoclar-Vivadent) fragments on teeth 7 and 10 with minimal tooth preparation and metal-free ceramic crowns (e-max Ceram) reinforced with zirconia copings through a computer-aided design/computer-aided manufacturing system (Lava, 3M-ESPE) on teeth 8 and 9.

Update on treatment of hereditary angioedema.

Hereditary angioedema (HAE) is a rare disease characterized by recurrent, self-limiting episodes of swelling. New research and therapies have recently emerged and are now available; however, many physicians are not aware of the new developments in HAE. To update immunologists and other health care providers on new advances in HAE therapies, a PubMed, OVID and Google literature search were used to develop this manuscript. English language peer-reviewed angioedema articles were selected. High quality clinical trials were reviewed and summarized. Acute therapy in the past often consisted of symptom relief with narcotics, hydration and fresh frozen plasma (FFP). Androgens and FFP are frequently used despite multiple, significant side-effects. Newer therapies include C1-inhibitor - both human plasma derived and recombinant - as well as contact system modulators such as ecallantide and icatibant. These newer products can be used for treatment of acute attacks of HAE, and C1-inhibitors can also be used for prophylaxis. These disease-specific therapies have proven to work by placebo-controlled studies, have minimal adverse effects and can be utilized for the treatment of HAE.

Seasonal tertiary wastewater treatment in California: an analysis of public health benefits and costs.

A number of communities in the Central Valley of California have requested that seasonally based effluent limits be developed for their wastewater treatment facilities. These seasonal limits would be based on disinfected secondary treatment during the winter and disinfected tertiary treatment during the rest of the year. Such a request for seasonal limits raises a significant water quality policy question with regard to the costs and relative benefits of tertiary treatment during the winter season. A benefit-cost analysis for winter season tertiary wastewater treatment in California's Central Valley is presented here. The assumed societal benefit of winter tertiary treatment is enhanced water quality for recreational purposes, and thus reduced risk to public health. Based on the results of this analysis, between four and sixteen million recreation events would need to occur annually region-wide during the winter to justify the costs of winter tertiary treatment. A similar method and the information described herein could be used by the state water quality regulatory agency to develop a risk-based policy to consider seasonal limits.

Joint vibration analysis in patients with articular inflammation.

The study of articular sounds using a computerized system (SonoPAK) in patients with temporomandibular disorders (TMD) of inflammatory origin revealed an increase of vibratory energy when compared to asymptomatic individuals. The following conclusions were reached: 1. The amount of vibratory energy registered in these patients ranged from 8.50 to 57.61 Hz. The major vibrations occurred in the middle of the mandibular opening cycle; 2. The mean vibratory energy measured at less than 300 Hz was between 5.70 and 48.64 Hz and at higher than 300 Hz was between 3.70 and 8.99 Hz; 3. The peak amplitude in the patients with inflammation ranged from 0.35 to 3.96 Pascal and the peak of frequency from 83.20 to 120.20 Hz.

Joint vibrations analysis in asymptomatic volunteers and symptomatic patients.

The joint sound is a common sign in TMD. The diagnosis is important to establish the treatment of pathological alterations which occur in the TMJ. In this study, two groups were selected: 1. Asymptomatic volunteers; and 2. Symptomatic patients who were diagnosed in a clinical examination. After the initial examination, they were submitted to evaluation using electrovibratography (SonoPAK II, BioResearch Assoc., Inc., Milwaukee, Wisconsin). The analysis of results indicated that the averages of the vibratory energy in the symptomatic group presented higher values in all stages of the mandibular movement when compared to the averages of vibratory energy registered in the asymptomatic group.