Benefits of the simplified edentulous treatment (SET) method in communicating with the laboratory.

AIM: According to the literature, a high quality prosthetic rehabilitation consists of physical and psychological acceptance of the denture by the patient, an empathic relationship between the clinician and the patient and correct application of complete denture construction principles. To apply these principles correctly, it is important to establish excellent communication with the technician. Interactions between dentists and technical laboratories is typically characterised by minimal communication, which is considered to be the most significant problem for achieving a qualitatively elevated prosthetic manufacture. The aim of the simplified edentulous treatment (SET) method is to correctly transmit clinical data to the laboratory and maintain these data throughout the entire treatment period. METHODS: One hundred twenty-three completely edentulous, Caucasian patients (71 men and 52 women; medium age: 66 years; range 27 to 85 years) were recruited for this study. The inclusion criteria were total edentulism, both maxillary and mandibular, both in patients wearing and not wearing a complete denture. To complete the denture, the patients were entrusted to 65 teams of two students each, attending the fifth year of their degree course in dentistry and performing their first rehabilitation of an edentulous patient, under the supervision of six skilled tutors. The denture manufacturing was performed by 12 technical laboratories. RESULTS: In the rehabilitation of an edentulous patient, transmission of clinical data to the technical laboratory is effective and reliable. CONCLUSION: The data transfer block allows one to transfer all of the necessary information to the laboratory at one time.

SET: simplified treatment of edentulous patients.

A new technique for making complete denture in a reduced number of clinical sessions maintaining high quality standards is described. This method has been named SET, acronymic for simplified edentulous treatment. SET is a flexible method that can be performed in one, or more sittings, to meet the patient's requirements and/or according to the dentist's preference. All the traditional principles in making complete denture are respected, but new and innovative materials have been designed, built, tested and set up: the multilayer impression tray (MIT) and the bone resorption compensating curve (BRCC). In the first sitting the clinician can obtain, without the need of a dental laboratory, all the clinical information necessary for processing and delivering the denture.

Gas tamponade and cyclocryotherapy of a chronic cyclodialysis cleft.

AIMS: To describe a minimally invasive technique to treat a chronic large cyclodialysis cleft that had failed to respond to medical therapy. METHODS: A 51-year-old man with a history of blunt trauma developed a unilateral chronic ocular hypotony. He was treated with topical atropine 1% for 3 months. 12 months later, the patient was referred to our glaucoma service for evaluation and treatment of persistent hypotony. Ultrasound biomicroscopy (UBM) displayed a cyclodialysis cleft extending from the 6 to 12 o'clock positions. B-scan echography revealed a peripheral choroidal effusion. A single bubble of 20% sulfur hexafluoride was injected into the vitreous cavity and transconjunctival cyclocryotherapy was performed. RESULTS: After gas absorption, intraocular pressure increased to 12 mm Hg and became steady during the follow-up. B-scan echography showed the disappearance of choroidal effusion, and UBM displayed a complete closure of the cyclodialysis cleft from the 6 to 8:30 o'clock positions and from the 9:30 to 12 o'clock positions. A small cleft extending from the 8:30 to the 9:30 positions remained after the treatment, but the distance between the scleral spur and the ciliary boby decreased, and the cleft was limited at the back due to the scar formation. CONCLUSION: Gas tamponade with cyclocryotherapy represents a minimally invasive technique that is worth considering for patients with cyclodialysis clefts associated with a shallow anterior chamber and that had failed to respond to medical therapy. This technique should be useful in cases of cyclodialysis clefts that are not amenable to treatment with more conservative efforts.

Comparison of Goldmann applanation tonometry and dynamic contour tonometry in healthy and glaucomatous eyes.

PURPOSE: To compare the measurements of intraocular pressure (IOP) with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in healthy and glaucomatous eyes and to evaluate the influence of corneal thickness (CCT), corneal curvature (CC), axial length (AL), and age on these tonometric alternatives. METHODS: Three hundred eyes of 100 healthy subjects, 100 patients with primary open angle glaucoma, and 100 patients with primary angle-closure glaucoma underwent IOP evaluation with DCT and GAT, and measurements of CCT, CC, and AL. Bland-Altman plots were used to evaluate the agreement between tonometers. Regression analysis was used to evaluate the influence of ocular structural factors on IOP measurements obtained with both tonometers. RESULTS: Bland-Altman plots indicated that the 95% limits of agreement between tonometers were -1.4 to 6.6 mmHg. DCT values measured 2.6+/-1.9 mmHg higher than GAT readings (P<0.001). The mean IOP difference between DCT and GAT (DeltaIOP) was higher in healthy than in glaucomatous eyes and the magnitude of difference increased with increasing CCT. A significant reduction of DeltaIOP with an increase in both CCT (P<0.001) and IOP values (P<0.001) was found. Regression analysis showed no effect of CC, AL, and age on both DCT and GAT readings. In contrast to GAT (P<0.001), DCT measurements were not influenced by CCT (P=0.43). CONCLUSIONS: IOP readings obtained by DCT were higher and less affected by CCT than those by GAT. The DeltaIOP was higher in healthy than in glaucomatous eyes and decreased in relation to increased CCT and IOP values.

CCL16 enhances the CD8+ and CD4+ T cell reactivity to human HER-2 elicited by dendritic cells loaded with rat ortholog HER-2.

T cells from HLA-A2+ healthy donors were co-cultured with autologous dendritic cells (DC) loaded with apoptotic tumor cells expressing rat neu, and were induced to mature by tumor necrosis factor (TNF)alpha and interleukin (IL)-1beta (mDC(neu)) or by the CCL16 chemokine (CCL16/mDC(neu)). Priming by CCL16/mDC(neu) induces a larger population of T cells that express cytoplasmatic interferon (IFN)gamma, TNFalpha, perforin and granzyme B compared to those primed by mDC(neu). T cells primed by CCL16/mDC(neu) release IFNgamma in response to human HER-2+ cells and kill human HER-2+ target cells more efficiently than those primed by mDC(neu). Our results show that both the loading of DC with xenogeneic rat neu and their maturation by CCL16 are two issues of critical importance for the elicitation of an effective response to human HER-2 in T cells from normal donors.

Simultaneous bilateral retinal detachment following coronary artery bypass graft: case report.

PURPOSE: To present an unusual case of simultaneous bilateral retinal detachment (RD) following a coronary artery bypass graft in a patient with acute myocardial infarction (AMI). METHODS: A 78-year-old man was first seen for bilateral sudden visual loss after surgical treatment of AMI. The patient underwent ultrasound biomicroscopy (UBM) and ocular B-scan echographic examination. RESULTS: The ocular assessment showed a bilateral seclusion of the pupil with bombe of the iris, an anterior chamber without cells or flare, and hypotonia. The evaluation of the visual acuity revealed no light perception in the right eye (RE) and uncertain light perception in the left eye (LE). The UBM analysis of the anterior segment confirmed the presence of bilateral pupillary block due to the seclusion of the pupil and a peripheral serous choroidal detachment involving the RE. The echographic B-scan analysis of the posterior segment showed a bilateral closed funnel-shaped RD and confirmed the presence of the peripheral flat serous choroidal detachment in RE. CONCLUSIONS: The cause for simultaneous bilateral RD remained unclear. It may have been a consequence of a persistent choroidal detachment with multiple swelling and 'kissing' of retinal surface. The increased venous pressure caused by congestive heart failure due to AMI could have caused a bilateral uveal effusion. Alternatively, the absence of retinal tears, the presence of a closed funnel-shaped morphology, and seclusion of the pupils allowed us to suspect an exudative pathogenetic mechanism due to a previous unrecognized ocular inflammatory state.

Non carious cervical lesions. A review.

Non-carious cervical lesions (NCCL) are characterized by a loss of hard dental tissue near the cement-enamel-junction. Commonly, their shape is like a wedge with the apex pointing inwards. Other times, they appear as regular depressions, like a dome or a cup. Their main characteristic is the presence of hard-mineralized tissue. According to the literature, the prevalence of cervical lesions is 85%, while their incidence is about 18% among permanent teeth. NCCL are currently classified as erosion, abrasion, or abfraction. Their etiology seems to be related to different factors: hexogen and endogen acids, mechanical abrasive action, tooth flexion under axial and non-axial loads. Moreover, it seems that a fundamental role is ascribable to tooth bending phenomena due to the strength components parallel or oblique to the occlusal level, which occur during the normal function as well as during parafunctions. The frequent therapeutic failures are probably due to the same factors causing the onset of the original lesion. Several materials have been proposed to restore NCCL: amalgam (abandoned), glass-ionomer cements, compomers, and composite resins. Early failures of these restorations have often been reported in the literature, probably due to the same factors which originally caused the lesions. Further investigations are required to determine more reliable restorative therapies.

Adhesive restorations: comparative evaluation between the adhesion of the glass-ceramics to the composite cement and the adhesion of the ceromer to the composite cement.

AIM: The aim of this work is to compare the adhesion of the glass-ceramic (empress II) to the composite cement and the adhesion of the ceromer to the composite cement. METHODS: From each of the above materials, 10 little blocks, of 8 x 6 x 2 mm size, have been prepared. All the surface treatments suggested by the manufacturing industry have been performed: sandblasting and acid-etching of the ceramic, ceromer surface roughening with diamond bur and silanization and bonding application on both materials. A homogeneous layer of cement has been placed between couples of blocks of the same material and photopolymerised. Every sample, consisting of 2 bonded blocks, has been submitted to a traction force on a universal test machine connected with a computerized measure system (SINTEC D/10). Samples have been anchored to the machine binding devices by a bicomponent epoxy glue. Data on the breaking charge have been recorded and an analysis of the broken surfaces has been performed in order to classify the breaking modalities. RESULTS: The results ontained showed that the composite-glass-ceramic adhesion force (mean value 64 Mpa) was remarkably higher than the composite-ceromer adhesion (mean value 37.21 Mpa). CONCLUSIONS: The analysis of the broken surfaces by SEM showed that a mixed fracture occurred in all samples (both partly adhesive and cohesive).

Management of prosthetic abutments respecting peri-implant soft tissues.

Periodontal and peri-implant soft tissues are very similar in many aspects (phenotype, mucosal dimensions, biological width). In peri-implant tissue, the mucosal seal is localized apically to the gap existing between the fixture and the prosthetic abutment. This is due to mechanical trauma created by screwing and unscrewing the prosthetic components, to mechanical deformation produced under functional stress and to bacterial colonization. To reduce the effects of this gap on peri-implant soft tissues stability several options are available: supracresta fixture positioning, reduction of the fixture-abutment gap, and minimizing the prosthetic steps. A clinical case was illustrated. Abutments (Gingi-hue 3I with a fixture-abutment gap less than 2 mm and a fixture abutment angle rotation of 0.4 degrees ) were screwed on the fixtures after the second stage surgery and used as impression transfer. These abutments were prepared in the laboratory and definitively screwed after the impression session. The use of definitive abutments as transfer reduces the session number and allows the peri-implant soft tissues to heal without beeing troubled by screwing and unscrewing of the prosthetic components.

Relation between length of fiber post and its mechanical retention.

AIM: The aim of this paper is to verify how the length of the fiber post may influence its retention in an insertion site. METHODS: Forty double conicity posts were used: 20 were inserted in epoxy resin cubes, the other 20 were inserted in extracted teeth at 2 different depth (5 mm and 10 mm). The samples were tractioned by an Instrom machine registering the postsite detach value. The root canals were examined by SEM. Statistical evaluation was made using the t-test. RESULTS: The results of the sample with resin cubes show a direct proportionality between the insertion length and the post retention. This relation was not appreciated in the sample which used extracted teeth: the differences between the 5 mm and 10 mm insertion are not statistically significant. The extracted posts observation show that the fixing cement stays on the post. CONCLUSIONS: In ideal conditions the retention is directly proportional to the insertion length. The weakest interface of the adhesive system is the one between dentin and fixing cement.

Cephalometric evaluation of the upper airway in patients with complete dentures.

AIM: Obstructive sleep apnea syndrome (OSAS) is a disorder characterised by repeated obstructions of the upper airway, with consequent episodes of apnea and hypopnea during sleep, snoring, and daytime sleepiness. Recently, a role of edentulism in the occurrence or in the worsening of this disorder was suspected. The aim of the study was to assess, through a cephalometric analysis, if the removal of denture induces, and where, modifications that can favour the pharynx collapse. METHODS: A total of 27 subjects with complete or partial loss of teeth and with heavy loss of the vertical dimension, were examined. The patients were submitted to radiographs of the cranium in supine position, to simulate as much as possible the night condition, with the denture in intercuspal position (ICP), and in relaxed position both with denture (D-RP) and without it (edentule-relaxed position, E-RP). The radiographs were analysed through specific measures for OSA evaluating the parameters that could be modified by the denture. RESULTS: The pharyngeal airway space (PAS) decreases, at the level of uvula, from ICP (6.7 mm) to RP (5.3 mm) (P< 0.05). The distance between the base and the tip of the tongue significatively decreased both from ICP vs E-RP (7.35 mm vs 6.87 mm; P< 0.05), both from D-RP to E-RP (7.22 mm vs 6.87 mm; P< 0.005). CONCLUSIONS: From the data obtained from the cephalometric analysis it seems that wearing denture induces modifications in the position of the tongue, of the jaw and of the pharyngeal airway space that can favour the reduction of apnea episodes.

Accuracy of prenatal ultrasonographic diagnosis of duplex renal system.

Duplex renal system is a rare congenital anomaly of the urinary tract that can be diagnosed in utero. The purpose of this study was to establish the optimal diagnostic criteria for fetal renal duplication in a population undergoing prenatal sonographic screening. Between January 1989 and June 1997 we found 11 cases of duplex renal system, 10 of which were correctly identified in utero at a median gestational age of 28 weeks (range, 20 to 38 weeks), and one of which was a false-negative diagnosis. Prenatal diagnosis of duplex renal system can be made in utero during the second half of pregnancy in the presence of two or more of the following signs: hydronephrosis limited to one pole in a kidney with two separate, noncommunicating renal pelves; ipsilateral megaureter; and ureterocele.

Best second trimester sonographic markers for the detection of trisomy 21.

We analyzed all genetic sonograms obtained during a 6 year period to establish the independent ability of the following sonographic markers of aneuploidy in the diagnosis of trisomy 21: structural anomalies, cardiac abnormalities, nuchal fold thickness of 6 mm or greater, bowel echogenicity, choroid plexus cysts, and renal pyelectasis. With the exception of bowel echogenicity and choroid plexus cysts, the sonographic markers were more common in trisomy 21 than euploid fetuses (all P < 0.001). Logistic regression analysis demonstrated that cardiac anomalies (odds ratio = 255; 95% confidence interval, 25, 2592), other structural anomalies (odds ratio = 25; 95% confidence interval, 6, 97), and nuchal fold thickness of 6 mm or greater (odds ratio = 13; 95% confidence interval, 3, 50) were the only independent predictors of trisomy 21. The false-positive rate and sensitivity were 5.3% (48 of 898) and 59.2% (13 of 22), respectively, when any of the sonographic markers significant at univariate analysis was considered, and 3.1% (28 of 898) and 54.5% (12 of 22), respectively, when any of the predictors at multivariate analysis was present. Because a considerable overlap of sonographic markers exists among trisomy 21 fetuses, use of those that are not independent predictors leads to an increase in false-positive rate without a gain in sensitivity.

Ultrasonographic differential diagnosis of fetal intracranial interhemispheric cysts.

OBJECTIVE: Ultrasonographic differentiation between intracranial supratentorial interhemispheric pathologic cystlike lesions and those related to physiologic median structures is essential because the latter have no clinical relevance, whereas the former may carry a poor prognosis. We reviewed our experience with 19 consecutive cases of interhemispheric hypoechoic lesions without parenchymal involvement diagnosed between January 1990 and June 1997 to establish their clinical significance and provide prenatal ultrasonographic criteria to distinguish between pathologic cystlike lesions and those related to physiologic midline structures. STUDY DESIGN: All patients underwent targeted prenatal scans of intracranial anatomy to establish the relationship between the fluid collections and the surrounding parenchymal and ventricular structures. In addition, a detailed anatomic survey was performed to rule out associated malformations. Follow-up, including neurologic examination, imaging, autopsy evaluation, or a combination was performed in all cases. Statistical analysis used the Wilcoxon rank sum test, the Fisher exact test, and the chi2 test for trend. P <.05 was considered significant. RESULTS: Cystlike lesions related to physiologic median structures (n = 12) included enlargement of the cavum septi pellucidi (n = 3), enlargement of the cavum vergae (n = 2), and cysts of the velum interpositum (n = 7). These lesions were unilocular and had a median size of 10 mm (range 10-30 mm); they resolved in 5 cases and remained stable in the remainder. They were not associated with overt abnormalities, other than borderline ventriculomegaly in 2 cases. Pediatric follow-up (median 26 months, range 3-84 months) showed normal neurodevelopment in all cases. Pathologic cystlike lesions (n = 7) were significantly larger (median 40 mm, range 10-80 mm, P =.004) and had a significantly worsening trend, growing more at serial prenatal ultrasonographic examinations (P =.039) than fluid collections related to physiologic median structures. Moreover, prenatal ultrasonographic evidence of associated intracranial abnormalities, in the form of partial or total agenesis of the corpus callosum and overt hydrocephalus, was present in 5 of 7 cases of pathologic cystlike lesions and in none of the 12 related to physiologic structures (P =.002). Median gestational age at diagnosis was not different between those with cystlike lesions related to physiologic median structures and those with pathologic lesions (30 and 31 weeks, respectively). Among the latter group, 1 pregnancy was voluntarily terminated, 1 infant died at 4 months of age, 2 infants had neurodevelopmental delay, and 3 infants were neurologically healthy at a mean follow-up of 43 months. Cyst shunting was necessary in 5 of 6 cases. CONCLUSIONS: Interhemispheric cystlike lesions related to physiologic structures can be prenatally distinguished from pathologic fluid collections on the basis of location, cyst size, change in size with time, and absence of associated anomalies.

Congenital toxoplasmosis: efficacy of maternal treatment with spiramycin alone.

PROBLEM: The evidence supporting an additional benefit of a combined regimen of pyrimethamine-sulfonamides compared with spiramycin alone in the secondary prevention of congenital toxoplasmosis was critically evaluated. METHOD OF STUDY: We reviewed the series of cases published in the English literature on antiparasitic treatment of acute toxoplasmosis infection in pregnancy, using spiramycin until fetal infection is documented, then using cycles of spiramycin alternated with combined pyrimethamine-sulfonamide therapy. We then compared the occurrence of overt disease among infected offspring (both severe, represented by ophthalmologic or cerebral abnormalities, and mild occurrences, represented by asymptomatic intracranial calcifications and retinal scars without visual impairment) between the published case series and our consecutive series of cases treated during a 10-year period (January 1986-December 1995) with spiramycin alone. RESULTS: The prevalence of fetal infection in our series was 7.8% (12/154), similar to that reported after alternated regimens (7.0%). The rate of overt disease among infected fetuses is not different after treatment with alternated regimens than after continuous antibiotic spiramycin therapy [23% (19/82) vs. 10% (1/10); relative risk, 2.3; 95% confidence interval, 0.4, 47.0]. The pharmacokinetics of the drugs used may account for this finding. CONCLUSION: The treatment of acute toxoplasmosis in pregnancy with an alternated antibiotic regimen of pyrimethamine-sulfonamide is not more efficacious at preventing overt neonatal disease than treatment with continuous spiramycin alone.

Clinical outcome of mild fetal ventriculomegaly.

OBJECTIVE: Our purpose was to evaluate the outcome of fetuses with mild cerebral ventriculomegaly. STUDY DESIGN: We prospectively collected all cases of mild cerebral ventriculomegaly (transverse diameter of the atrium of the cerebral lateral ventricles between 10 and 15 mm) diagnosed antenatally between January 1990 and December 1996. Associated ultrasonographic abnormalities including markers of aneuploidy, presence of chromosomal anomalies, structural malformations detected at birth, and neurologic outcome were recorded. Outcome information was available on all cases. In addition, published series of cases of fetal mild cerebral ventriculomegaly were reviewed to identify prognostic indicators. RESULTS: Eighty-two cases fulfilled the inclusion criteria: 48 were isolated and 34 were associated with other ultrasonographic markers or anomalies. Among the 45 surviving euploid isolated cases, neurologic follow-up was normal at a mean age of 28 months (range 3 to 72 months). Male fetuses and those with a transverse atrial size <12 mm had a good prognosis. Ventricular atria > or =12 mm were more often associated with other anomalies (56% vs 6%) and, when isolated, with abnormal postnatal neurodevelopment (23% vs 3%). Aneuploidy was present in two cases of isolated mild cerebral ventriculomegaly, both of which were associated with advanced maternal age, and in seven cases associated with other anomalies. CONCLUSIONS: Mild cerebral ventriculomegaly should prompt targeted ultrasonographic examination, inclusive of markers of aneuploidies, visualization of the corpus callosum, and echocardiogram as well as serologic evaluation for congenital infections. In isolated mild cerebral ventriculomegaly genetic counseling should take into account clinical, laboratory, and ultrasonographic findings. A review of the published series suggests that cognitive or motor delay is predominantly mild and that it occurs in about 9% of cases of isolated mild cerebral ventriculomegaly.