CAD/CAM generated all-ceramic primary telescopic prostheses.

Computer-aided design and manufacturing (CAD/CAM) systems have proven effective not only for the manufacture of crown and bridge frameworks, inlays, onlays and veneers, but also for the generation of all-ceramic primary telescopic prostheses in more than 10 years of use in dental technology. The new InLab 4.0 software generation makes it possible to design and mill primary telescopic prostheses with CAD/CAM technology. The computer-generated raw crowns for these restorations require very little manual adaptation. The secondary crowns are manufactured by electroforming and bonded onto the tertiary structure or framework.

Nucleic acid testing (NAT) of organ donors: is the 'best' test the right test? A consensus conference report.

Nucleic acid testing (NAT) for HIV, HBV and HCV shortens the time between infection and detection by available testing. A group of experts was selected to develop recommendations for the use of NAT in the HIV/HBV/HCV screening of potential organ donors. The rapid turnaround times needed for donor testing and the risk of death while awaiting transplantation make organ donor screening different from screening blood-or tissue donors. In donors with no identified risk factors, there is insufficient evidence to recommend routine NAT, as the benefits of NAT may not outweigh the disadvantages of NAT especially when false-positive results can lead to loss of donor organs. For donors with identified behavioral risk factors, NAT should be considered to reduce the risk of transmission and increase organ utilization. Informed consent balancing the risks of donor-derived infection against the risk of remaining on the waiting list should be obtained at the time of candidate listing and again at the time of organ offer. In conclusion, there is insufficient evidence to recommend universal prospective screening of organ donors for HIV, HCV and HBV using current NAT platforms. Further study of viral screening modalities may reduce disease transmission risk without excessive donor loss.

New implant software abutments for inLab 3.65.

The "Implants for inLab" implant software is based on a polyvalent bonding base which can be used on different types of implant. The modifiable part is a zirconium dioxide block with a prefabricated connection configuration for accurate coupling to the bonding base. The software offers different design possibilities which are especially suitable for implant restorations with high esthetic requirements.

Coronally Advanced Flap with Different Designs in the Treatment of Gingival Recession: A Comparative Controlled Randomized Clinical Trial.

The aim of this parallel double-blind randomized controlled clinical trial was to describe a modified approach using the coronally advanced flap (CAF) with triangular design and to compare its efficacy, in terms of root coverage and esthetics, with a trapezoidal type of CAF. A sample of 50 isolated Miller Class I and II gingival recessions with at least 1 mm of keratinized tissue apical to the defects were treated with CAF. Of these recessions, 25 were randomly treated with trapezoidal CAF (control group) while the other 25 (test group) were treated with a modified triangular CAF. The clinical and esthetic evaluations, made by the patient and an independent periodontist, were performed 3 months, 6 months, and 1 year after the surgery. No statistically significant difference was demonstrated between the two CAF groups in terms of recession reduction, complete root coverage, or 6-month and 1-year patient esthetic scores. Better 3-month patient esthetic evaluations and better periodontist root coverage, color match, and contiguity assessments were reported after triangular CAF. Trapezoidal CAF was associated with greater incidence of keloid formation. Single-type gingival recessions can be successfully covered with both types of CAF. The triangular CAF should be preferred for esthetically demanding patients.

Isolation of pepsin-resistant laminin fragments from human placenta: effect on epithelial cells cultured from the kidneys of patients with autosomal dominant polycystic kidney disease (ADPKD).

Laminin isolated from human placenta was subjected to prolonged pepsin digestion. Seven peptide fragments (designated N1 to N7) were separated by ion-exchange chromatography and gel filtration and characterised by SDS-polyacrylamide gel electrophoresis and immunoblotting. The molecular size of the laminin fragments varied from approx. 900,000 (N1) to 28,000 (N7). Epithelial cells obtained from normal kidneys and patients with autosomal dominant polycystic kidney disease (ADPKD) were cultured. The incorporation of [3H]thymidine was measured over 96 h to determine the effect of the addition of the different fragments and whole laminin from EHS tumour to the cells. The rate of growth of both normal and polycystic cells was increased in the presence of the laminin fragments but this effect was more pronounced in the ADPKD cells.

Novel and known protein tyrosine kinases and their abnormal expression in human melanoma.

We have used the polymerase chain reaction and Northern blotting to identify protein tyrosine kinases that may play an important role in the process of melanoma initiation and progression. Degenerate primers from the conserved catalytic domain of tyrosine kinase genes were used to amplify and clone partial cDNA sequences from a human melanoma cell line (DX3-LT5.1) and normal human melanocytes. When the melanoma reaction products were sequenced, 13 distinct clones were found, of which one is novel to date and has provisionally been named MEK (for melanocytic kinase). Of the remaining 12 known kinases, only two, ERB-B2 and IGF1-R, have previously been reported in pigment cells. Reaction products from melanocytes included only eight of these 13 sequences. To test for quantitative differences in tyrosine kinase expression between normal and malignant cells, a panel of eight melanoma lines and normal melanocytes was analyzed by Northern blotting. Two tyrosine kinases (JTK-14/TIE and TYRO-9) were detected in some melanomas but were not found in normal melanocytes, whereas others, including MEK, appeared to be overexpressed in some malignant lines. A minority of kinases showed either no change or a reduction in the level of mRNA. Expression of tyrosine kinases varied independently, and individual lines contained various combinations of these enzymes. Our findings are consistent with an increased overall expression of these putative growth factor receptors during melanoma development.

General overview of rehabilitation in the rheumatoid patient.

This article provides a general overview of rehabilitation in the rheumatoid patient. It discusses the physical therapy management of both the systemic musculoskeletal involvement of RA and of the specific postoperative rehabilitation associated with total joint arthroplasty. It is intended to highlight the major components of treatment and to guide the clinician in assessing these challenging, yet rewarding cases. Its emphasis is to support a multidisciplinary approach to patient care.

A tool for measuring functional outcomes after total hip arthroplasty.

PURPOSE: To describe a functional milestone scale (FMS) for measuring functional progression following total hip arthroplasty and to demonstrate that this scale meets accepted standards of scale construction. METHODS: Inter-observer reliability of the scale was determined for 30 patients using a kappa coefficient of concordance (k) for ordinal data, representing 221 pairs of observations. There were 79, 54, 44, and 44 pairs of observations for transfer, walker, crutch, and stair ambulation, respectively. RESULTS: The k coefficient ranged from 0.82 to 0.91. Agreement between therapists was almost perfect according to the criteria of Feinstein. CONCLUSIONS: The FMS exhibits substantial inter-observer reliability and moderate to substantial validity. We have demonstrated its clinical applications as well as showing it to be a useful management and research tool.

Cerebral metabolism in opiate-dependent subjects: effects of methadone maintenance.

BACKGROUND: The long-term effects of opiate use on human brain are not known. The goal of this preliminary study was to determine whether human subjects with histories of opiate dependence have persistent differences in brain function as compared with individuals without substance use disorders, and whether methadone maintenance reverses or ameliorates the potential abnormality. METHOD: Positron emission tomographic (PET) [18F]fluorodeoxyglucose (FDG) method was used to compare the regional cerebral metabolic rate for glucose(rCMRglc) in three groups: four opiate-dependent subjects currently receiving methadone maintenance therapy (MM), four opiate-dependent subjects not receiving methadone maintenance therapy (MW), and a comparison group of five subjects without substance use disorders. RESULTS: A significant difference in rCMRglc in the anterior cingulate gyrus was found between the MW and Control groups (Mann-Whitney U=2.0, p=0.05). Generally speaking, rCMRglc's in MM subjects were intermediate between those of MW and Control groups, although the difference did not reach statistical significance. CONCLUSIONS: The results of this study suggest that neurobiological abnormalities can persist in the brain of a chronic opiate user several years after detoxification from methadone. Future research is needed to replicate these results and to determine whether the observed rCMRglc differences are related to opiate use or to neurochemical abnormalities that play a role in developing addictive behavior.

Physical therapy management of familial dysautonomia.

This paper describes physical therapy programs to assist physical therapists in the rehabilitation of patients with familial dysautonomia. There have been no reports in the literature about a physical therapy program for patients with this disease. A retrospective analysis of the clinical manifestations in 80 patients in a dysautonomia clinic was performed. Scoliosis and kyphosis were found in 92 percent of the patients, 93 percent had ataxia, 74 percent had feeding difficulties, 69 percent had frequent pneumonias, and 63 percent exhibited delayed developmental milestones. Cardiovascular, gastrointestinal, pulmonary, musculoskeletal, and neurological symptoms and treatments are discussed.

Epidural infusions of bupivacaine and fentanyl do not improve rehabilitation following one-stage bilateral total knee arthroplasty.

Epidural analgesia with local anaesthetic minimizes the catabolic response to surgery. To determine whether this could enhance the rate of recovery following orthopaedic surgery, 51 patients undergoing bilateral one-stage total knee arthroplasty were allocated to receive infusions of either continuous epidural bupivacaine/fentanyl or continuous intravenous fentanyl to compare the efficacy of these modes of pain relief on postoperative clinical outcomes and rates of rehabilitation. Infusions were maintained for 36 to 48 hours in a post-anaesthesia care unit (PACU). Postoperatively, pain relief (visual analogue scale), attainment of physical therapy goals and cardiopulmonary complications were measured daily for 7 days. Epidural analgesia with a combination of bupivacaine and fentanyl did not result in any measurable improvement in rehabilitation milestones or reduction in postoperative complications following bilateral total knee arthroplasty than with fentanyl infusions alone.

Replacing a failed resin-bonded fixed partial denture with a single tooth implant.

When adequate width and height of remaining alveolar bone is present, the implant-supported fixed prosthesis is an excellent alternative in replacing a missing tooth. The prosthetic tooth, supported by an endosseous implant, emerges from the tissue in a manner which resembles the natural tooth it replaces better than any other treatment option available. This article presents one clinical case history, preclinical treatment phase, and actual clinical treatment.

Mandibular tori as a source for onlay bone graft augmentation: a surgical procedure.

Conventional dentistry has provided acceptable treatment alternatives for the partially or fully edentulous patient for decades. Recent innovations have provided clinicians with an assortment of new techniques to restore the function of these patients. Established treatment alternatives have been significantly enhanced, resulting in increased acceptance of predictable dental implant restorations. However, implant dentistry cannot be successfully utilized in all edentulous patients, and augmentation measures are often necessary to enhance the alveolar bone, requiring autogenous donor sites. While bone tissue has been harvested from numerous sites, the mandibular tori may provide sufficient graft material. The teaching objective of this article is to describe a clinical implant placement procedure, utilizing bilateral tori as the donor sites of the autogenous grafting material. A clinical case is utilized to document the tori removal and the augmentation procedures.

Practical implant dentistry--the mandibular removable overdenture prosthesis.

The fully edentulous mandible presents functional, esthetic, and psychological challenges for the patient and the dentist. The mandibular overdenture supported by endosseous implants can provide a superior treatment modality, overcoming many of the difficulties inherent in the conventional denture. Advantages cited are increased denture retention, improved chewing efficiency, maintenance of bone height, replacement of lost anatomy, increased denture stability, reduction of soft tissue coverage and extension of the prosthesis, and easy access for hygiene maintenance. The major disadvantage rests with the patient's intolerance of a removable prosthetic design.

"What is the single most important aspect of implant dentistry"?

The world of implant dentistry is exciting and challenging. We are all on the great learning curve of excellence. With careful planning, and knowledge of the anatomical structures which are missing, we have in our hands the ability to create reproductions which are indistinguishable from nature. Remember, the tooth is the goal, not the implant!