Attached gingival width and gingival sulcus depth in three dentition systems

Objectives: Attached gingival width [AGW] is an important marker for diagnosis of periodontal disease and normal gingival sulcus depth [GSD] is a sign of healthy periodontium

The aim of this study was to determine the AGW and GSD in3-15 year-olds with three dentition systems in Isfahan in 2001

Methods: A total of 360 students [120 students in each system] eligible for this cross sectional study were randomly chosen from 30 schools and examined clinically. Data were registered in a questionnaire by two professional examiners. The GSD [the distance from the free gingival margin to the deepest part of the pocket] was measured by a probe. Keratinized gingiva [the distance between the attached gingiva and mucogingival junction] was measured by a vernier caliper or probe and the AGW was measured by subtracting the two amounts in primary and permanent dentition systems

These amounts were registered in a questionnaire and compared using ANOVA and Tukey's test

Results: The AGW in the primary, mixed and permanent dentition systems was 2.60 [7.02], 2.56 [7.23] and 2.73 [1.3] mm, respectively. The lingual surface of the posterior mandible had the greatest amount of attached gingiva in the three dentition systems. Also, the GSD in permanent dentition system in the anterior, middle and posterior areas of both jaws and in the buccal, lingual and palatal surfaces was more than in the primary dentition system

Conclusion: Based on the results, the AGW in permanent dentition was more than in primary and mixed dentition systems. The AGW increases with age and is not affected by gender. Also, the AGW was less in the lower jaw compared to the upper jaw and was more in lingual surface than in buccal surface

Clinical features and outcomes of treatment for fourth nerve palsy

To evaluate the clinical features, etiology and outcomes of treatment for superior oblique [SO] palsy over a 10-year period at Labbafinejad Medical Center. A complete ophthalmologic examination with particular attention to forced duction test [FDT] and tendon laxity was performed in all patients preoperatively. The palsy was divided into congenital and acquired types. Overall, 73 patients including 45 male [61.6%] and 28 female [38.4%] subjects with mean age of 19.7 +/- 11.7 [range, 1.5-62] years, were operated from 1997 to 2007. SO palsy was congenital in 56 [76%] and acquired in 17 [24%] cases. The most common chief complaint was ocular deviation [52.1%]. FDT was positive in only 7 [9.7%] cases. Other clinical findings included amblyopia [19.2%] head tilt [13.7%], chin down position [4.1%], facial asymmetry [6.8%] and tendon laxity [2.7%]. Mean preoperative vertical deviation was 16.1 prism diopters [PD] which was decreased to 1.9 PD postoperatively. Mean exotropia and esotropia were 15 and 13.9 PD respectively before the operation and both decreased to 1.5 PD of horizontal deviation postoperatively. The most common type of SO palsy based on Knapp's classification was type 3 [42.5%]. The most common operated muscle was the inferior oblique [83.6%] and the most common type of operation was inferior oblique myectomy [83.6%]. The success rate for initial surgery was 84% and was increased to 96% with a second intervention. The most common form of SO palsy requiring surgical intervention was congenital which occurred most frequently in young males. Most cases of SO palsy can be successfully treated with a single surgical procedure

Outcomes of surgical and non-surgical treatment for sixth nerve palsy

To report the outcomes of surgical and non-surgical treatment in sixth nerve paresis and palsy. This retrospective study was performed on hospital records of 33 consecutive patients [37 eyes] with sixth nerve dysfunction who were referred to Labbafinejad Medical Center from September 1996 to September 2006, and underwent surgical procedures or botulinum toxin injection. Patients were divided into three groups: group A had muscle surgery without transposition, group B underwent transposition procedures and group C received Botulinum toxin injection. Overall, 33 patients including 19 male and 14 female subjects with mean age of 20.4 +/- 17.2 years [range, 6 months to 66 years] were studied. Eye deviation improved from 50.3 +/- 16.8 to 6.0 +/- 9.8 prism diopters [PD] after the first operation and to 2.5 +/- 5.0 PD after the second operation in group A, from 56.9 +/- 24.3 to 5.5 +/- 16.0 PD after the first procedure and to almost zero following the second in group B, and from 44.3 +/- 10.5 to 15.0 +/- 20.0 PD 6 months following botulinum toxin injection in group C. Head posture and limitation of motility also improved significantly in all three groups. The overall rate of reoperations was 21%. Various procedures are effective for treatment of sixth nerve dysfunction; all improve ocular deviation, head turn and abduction deficit. The rate of reoperation is not high when treatment is appropriately selected according to clinical condition

Effect of horizontal rectus surgery on clinical and paraclinical indices in congenital nystagmus

To determine the effect of horizontal rectus muscle surgery on visual acuity, head posture and electronystagmographic indices in patients with congenital nystagmus. This prospective comparative case series was conducted on 58 patients with congenital nystagmus over a period of three years. Patients were divided into three groups: the first group [29 cases] had head posture less than 20D, binocular visual acuity [BOVA] less than 20/30 and tropia less than 30D and underwent large recession of all four horizontal rectus muscles; the second group [23 cases] had head posture less than 20D, BOVA < 20/30 and tropia more than 30D who underwent large recession of two horizontal rectus muscles; and the third group [6 cases] had head posture more than 20D with any BOVA or tropia who underwent Kestenbaum-Anderson surgery. Mean age of the patients was 18.7 +/- 9.1 years and mean follow-up period was 17.5 +/- 7.4 months. Visual acuity improved in all three study groups and was statistically significant in the 2-rectus group [P < 0.001]. The speed and amplitude of nystagmus waves decreased in all groups which was statistically significant in the 4-rectus group [P values, 0.02 and 0.04, respectively]. A small myopic shift was seen in the 2-rectus and 4-rectus groups and a small hyperopic shift was found in the Kestenbaum-Anderson group. Statistically significant improvement was achieved in eye deviation in the 2-rectus group and in head posture in the Kestenbaum-Anderson group [P < 0.001]. Horizontal recti surgery in congenital nystagmus can improve visual acuity, ocular deviation and abnormal head posture, which is particularly marked with 2-rectus recession. Electronystagmographic indices improve especially with 4-rectus recession

Double elevator palsy, subtypes and outcomes of surgery

To describe the clinical manifestations of subtypes of double elevator palsy and to report the outcomes of surgery in these patients. This retrospective study was conducted on hospital records of patients with double elevator palsy at Labbafinejad Medical Center over a ten-year period from 1994 to 2004. Patients were classified into three subgroups of primary elevator muscle palsy [9 subjects], primary supranuclear palsy with secondary inferior rectus restriction [4 subjects] and pure inferior rectus restriction [7 subjects] according to forced duction test [FDT], force generation test [FGT] and Bell's reflex. Patients in the first group underwent Knapp procedure, the second group received Knapp procedure and inferior rectus recession simultaneously and in the third group vertical recess-resect or mere inferior rectus recess operation was performed. Success was defined as final residual deviation of 5 PD or less and 25% improvement or more in restriction after all operations. Overall 20 subjects including 10 male and 10 female patients with mean age of 12.6 +/- 9.3 [range 1.5-32] years were operated during the mentioned period which included 9 cases of primary elevator muscle palsy, 4 patients with primary supranuclear palsy and secondary inferior rectus restriction, and 7 subjects with pure inferior rectus restriction. Mean follow-up was 22.0 +/- 20.0 [range 3-63.5] months. Mean pre and post-operative deviation was 32.0 +/- 8.0 PD and 3.8 +/- 8.0 PD [P < 0.001] respectively, and mean restriction before and after the operation[s] was -3.5 +/- 0.7 and -2.3 +/- 1.2 [P < 0.001], respectively. Success rate was 77% for correction of deviation and 80% for improvement in muscle restriction. Surgery for double elevator palsy must be individualized according to FDT, FGT and Bell's reflex. The outcomes are favorable with appropriate surgical planning