RESUMO
It is well documented that the anterior repositioning of the mandible achieved by mandibular advancement prosthesis has a potent effect on relieving the signs and symptoms of obstructive sleep apnea [OSA]. However, little is known about the degree of vertical opening that has to be made by those appliances to achieve the best possible results. The objective of the present article is to assess the validity of increasing the vertical dimension induced by the mandibular advancement prosthesis in treatment of OSA. Six patients with diagnosed OSA were chosen to carry out this study. Each patient received two forms of the same adjustable mandibular advancement prosthesis. The two forms were designed with the same amount of mandibular protrusion but with different vertical dimensions. A wash out period was allowed between using the two forms to avoid carryover effects. The effect of changing the vertical opening was assessed through both Polysomnographic and cephalometric evaluations. Results obtained seemed to favour the fabrication of mandibular advancement prosthesis at the minimal possible vertical dimension necessary to accommodate this appliance
RESUMO
Recent reports have demonstrated that immediate loading of dental implants is a clinically feasible concept with results similar to those for two-stage procedures, at least in good bone qualities. However, documentation of the outcome of immediate loading in the totally edentulous maxilla especially when opposed with natural dentition is scarce. This prospective study presents results from immediate loading of 24 newly designed one stage flapless dental implants [Mini Osteocare] for overdenture restorations in 6 patients with single edentulous maxillary arches. Implants were all placed at the anterior maxillary region, a region of questionable prognosis. Clinical and radiographic records of participated patients were reviewed during a follow up of one year. As compared to those reported from immediate loading of standard-sized implants in edentulous maxilla, the results achieved by the use of Mini implants in this challenging situation could be encouraging. Total implant survival rate was 75%. Six implants were lost at the subsequent observation stages. The results suggest that immediate loading of Mini implants should be revised with further long term studies before attempting to generalize this treatment alternative to solve both functional and esthetic problems in single maxillary edentulism
RESUMO
Background : Endothelial dysfunction appears to be a generalizedprocess that is not necessarily confined to vessels with overt atheroscle-rotic alterations. This assumption is strengthened by the finding of a cor-relation between coronary and peripheral endothelial dysfunction
Objective:To assess if flow-mediated vasodilation [FMD%] of the bra-chial artery, could be used as a diagnostic screening test in patients withcoronary artery disease.Patients: Three groups of patients will be included in the study:Group A:Twenty patients had no chest pain, normal ECG and neg-ative stress ECG.Group B: Twenty patients had chest pain, normal ECG, negativestress ECG and normal coronary angiogram.Group C:Twenty patients had documented coronary artery dis-ease [CAD] by coronary angiogram
Methods:Complete history taking and through clinical examination,laboratory investigation, ECG, stress ECG, coronary angiogram and B-mode ultrasound images of the brachial artery
Results:There was no statistically significant difference between thethree groups regarding age, sex, hypertension, hypercholesterolemia,presence of diabetes mellitus smoking and family history of CAD[P>0.05]. In comparing group A with group B, there was no statisticallysignificant difference between the two groups regarding flow mediateddilatation [FMD%, NTG mediated dilatation % and ratio of FMD to NTGmediated dilatation [P>0.05], but there was a highly statistically significant difference between group A and group C regarding FMD% and FMD:NTG ratio [P<0.01] and statistically significant difference between thetwo-groups regarding NTG% [P<0.05]. In comparing group B and C, therewas statistically significant difference between the two groups regardingFMD%, NTG% and FMD to NTG% ratio [P<0.05]. The sensitivity, specificityand positive predictive value of FMD% <4.5% in relation to coronary angiogram for detection of CAD was [75%, 80% and 88%] respectively. Re-garding the effect of risk factors on FMD%, FMD% was significantly de-creased in smokers, diabetic and hypertensive [P<0.05]. Also it wasdecreased in hypercholesterolemic [P<0.01]. However it was decreased inobese and those with positive family history but the difference was notstatistically significant [P>0.05]
Conclusion: The determination of endothelial dysfunction expressedby FMD% was found to be a sensitive and specific screening test to pre-dict the presence of CAD. Because this is non invasive, non-radioactiveand cost-effective approach, it warrant further evaluation to determine itis value in daily clinical practice as an additional screening test in diag-nosis of CAD