Intra-arterial chemotherapy is reliable in preventing high-risk superficial bladder cancer from recurrence and progression.

The purpose of this prospective study was to evaluate the therapeutic effects of intra-arterial chemotherapy in preventing high-risk superficial bladder cancer from recurrence and progression. from may 2003 to December 2007, 52 patients were divided randomly into 2 groups. Twenty-five patients were given intra-arterial chemotherapy with gemcitabine and cisplatin, and 27 patients received intravesical instillation with epirubicin. After 6-67 months of follow-up (median, 40 months), the overall recurrence-free rates of the intra-arterial chemotherapy and intravesical instillation groups were 83.3% and 33.4%, respectively (p=0.001 log rank). Tumor progression was not found in the intra-arterial chemotherapy group while 7 patients in the intravesical instillation group had tumor progression. The overall tumor progression-free rates were 100% and 58.5%, respectively (p=0.009 log rank). The patients with functional bladders were 100% and 81.5% in the intra-arterial chemotherapy and intravesical instillation groups after 67 months of follow-up, respectively. In conclusion, intra-arterial chemotherapy is more effective than intravesical instillation in preventing high-risk superficial bladder cancer from recurrence and progression.

Radiographic alveolar bone loss in untreated Taiwan Chinese subjects with adult periodontitis measured by the digital scanning radiographic image analysis method.

OBJECTIVES: To determine differences in radiographic alveolar bone loss (RABL) by age group, gender and tooth type in subjects with adult periodontitis using the digital scanning radiographic image analysis (DSRIA) method. METHODS: A total of 4262 teeth were examined for RABL in 178 individuals (96 males and 82 females). Mesial and distal sites were determined by the DSRIA method following scanning of periapical radiographs and using the Microstation 95 image software. RESULTS: Linear assessment of RABL using DSRIA revealed the following results. Mean bone loss of maxillary and mandibular anterior teeth was significantly higher (P<0.001 and P<0.01, respectively) in males compared with females using a two-sample t-test. The highest values of mean RABL occurred most commonly in the maxillary first molars (53.8% and 51.4% for females and males, respectively) and the mandibular central incisors (50.4% and 41.5% for males and females, respectively). Mean RABL was greater in males than in females for both the mandibular and maxillary arches, with the exception of molar sites. CONCLUSIONS: Maxillary first molars and mandibular incisors are the highest risk sites. Moreover, greater loss occurs at the molar site in females compared with males for untreated periodontitis in Taiwan Chinese people.

The consistency and reliability of periodontal bone level measurements using digital scanning radiographic image analysis--a pilot study.

The purpose of the present study was to evaluate the consistency and reliability of alveolar bone height measurement using digital scanning radiographic image analysis (DSRIA). A randomly selected (standardized paralleling technique) periapical radiographs of 20 molar teeth (10 maxillary molars and 10 mandibular molars) from 178 individuals with periodontitis were reporting or referred to the patient population of the dental clinics of the teaching hospital. Radiographic measurements were performed and read by two examiners, with a separation time of three weeks of different tooth groups and as established by double reading of 20 molar teeth in 10 individuals using the DSRIA. The calculating data of radiographic alveolar bone loss (RABL) measured and analyzed by the DSRIA for each molar group were compared based on the inter- and intra-examiners' data. The means and standard deviations were calculated to compare radiographs of the inter- and intra-examiners' groups. The reliability coefficients were computed to assess the consistency and reliability for each molar group. The results revealed that the intra- and inter-examiners' reliability coefficients ranged from 0.986 to 0.995 (p < 0.001, significantly different from 0). An excellent reproducibility was indicated in maxillary molar, mandibular molar and of both arches, respectively. It was concluded that the standard periapical radiograph using the DSRIA has the potential to be a valuable and reliable method in measuring linear alveolar bone defects caused by periodontitis.

Treatment of molar furcation involvement using root separation and a crown and sleeve-coping telescopic denture. A longitudinal study.

Because of the inconsistent results of periodontal and prosthetic therapy, periodontists may choose to treat maxillary molar furcation involvements (FI) with poor root morphology utilizing a root resection technique (RRT). In addition, poor root morphology of the remaining root following RRT is usually considered a high risk factor for long-term periodontal and prosthetic success. The purpose of this retrospective study was to investigate the differences in the clinical periodontal parameters between molar abutments with and without molar root separation and/or resection (RSR) before and after periodontal and prosthetic therapy, using a crown and sleeve-coping telescopic denture (CSCTD). A total of 85 molars (47 maxillary and 38 mandibular) were treated in 25 subjects. There were 33 abutments without root separation/resection and 52 abutments with RSR. Forty-three CSCTD were placed, 23 in the maxillary arch and 20 in the mandibular arch. The mean observation period was 6.7+/-1.9 years (range, 5 to 13 years). The plaque index, gingival index, probing depth, clinical attachment level, and alveolar bone change were recorded. The differences in these parameters before and after periodontal and prosthetic therapy between the advanced furcation-involved molars with and without RSR were evaluated. The results revealed a remarkable improvement in the periodontal parameters in advanced Class II and Class III FI in molars with RSR as compared to those without RSR. It was, therefore, concluded that molar abutments with RSR in conjunction with a specifically designed telescopic device provide a modified approach for treating molars with advanced Class II and III FI.

A new classification of molar furcation involvement based on the root trunk and horizontal and vertical bone loss.

This study presents a new classification of molar furcation involvement based on the root trunk and horizontal and vertical attachments, and relates them to guidelines in diagnosis, prognosis, and treatment of molar furcation involvements. The type of root trunk were classified on the basis of the ratio of vertical dimension of root trunk to root length as types A, B, and C. Based on the results of this study, the authors conclude that consideration of the root trunk type as well as the horizontal and vertical attachment loss in the classification of molar furcation involvements may facilitate prognosis, diagnosis, and treatment planning.

Cervical enamel projection and intermediate bifurcational ridge correlated with molar furcation involvements.

In this study, we investigated the cervical enamel projection (CEP) and intermediate bifurcational ridge (IBR) correlated with localized molar furcation involvement (FI). Study samples consisting of 87 hopeless permanent mandibulars (56 first and 31 second molars), which required extraction for periodontal therapy, were randomly collected from the School's Dental Clinic. The furcal defects, CEPs, and IBRs of molars were diagnosed via clinical probing, periapical radiographs, and inspection of ground tooth sections of extracted teeth with a stereomicroscope. Prevalence and distribution of molars with CEPs and/or IBRs were also analyzed. Probing depths (PD), clinical attachment loss (CAL), gingival index (GI), and plaque index (PLI) were measured for the buccal and lingual surfaces of molar furcal areas. Moreover, the relationships between the molar FI with and without CEPs and IBRs and periodontal status were analyzed using Student's paired t-test. Based on those results, we can conclude the following: 1) among 87 molars with FIs examined, 63.2% (55/87) had cervical enamel projections and bifurcational ridges, and the prevalence was greatest in mandibular first (67.9%, 38/56) and second (54.8%, 17/31) molars; and 2) the differences in mean PD, CAL, PLI, and GI between the molars with and without CEPs and IBRs were highly significant (P < 0.001) in the mandibular first and second molars.

Periodontal and prosthetic therapy in severely advanced periodontitis by the use of the crown sleeve coping telescope denture. A longitudinal case report.

The crown and sleeve-coping (CSC) telescope denture is a removable prosthesis that is supported by both selectively retained teeth and the residual ridge or mucosa. Limited information regarding longitudinal studies of the CSC telescope denture has been reported as to the response of the abutments and their surrounding periodontal tissues to this type of design. The authors have documented a longitudinal ten-year follow-up of a case which was considered 'hopeless' for oral rehabilitation because of advanced periodontitis. The CSC telescope denture used in this case resulted in a significant improvement to the remaining dentition. The beneficial results of this form of treatment can be considered for a wide variety of clinical applications for the severely advanced periodontitis case.

Clinical significance of tooth morphology correlated with periodontal disease-I.

Anatomical abnormalities of tooth and root morphology may not only adversely influence the course and management of periodontal disease due to inaccessibility of periodontal instrumentation and oral hygiene efforts, but are also more likely to adversely become high risk areas for retention of dental plaque and calculus. This article reviewed the results of data on the root morphology and comparative literature associated with prevalence, anatomical considerations and clinical significance in the predisposing factors to the periodontal disease. The purpose was to emphasize the importance of understanding the knowledge concerning the variations of tooth and/or root anatomy as a high risk factor for periodontal disease and as a necessary tool for the prognosis, diagnosis and treatment of existing or potential periodontal disease.

Relationship between molar root fusion and localized periodontitis.

We investigated the relationship between molar root fusion and localized periodontitis in this study. A total of 143 individuals (1,109 molars) aged 23 to 68 years were examined for the presence of molar root fusion at diseased and healthy sites. Molar root fusions were diagnosed by periapical radiographs and clinical probing. Periodontal parameters measured included probing depth (PD), clinical attachment loss (CAL), gingival index (GI), and plaque index (PLI) around fused molars. Results indicated that the prevalence of molar root fusions in males and females was 15.2% (93/612) and 32.2% (160/497), respectively. The distribution of molars with root fusions occurs in the following order: maxillary second molars (51.8%), mandibular second molars (32.3%), maxillary first molars (5.7%), and mandibular first molars (0%). Statistically significant differences were observed between molar root fusions at healthy and diseased sites with respect to PLI, GI, PD, and CAL. The highest prevalence of molar root fusion was observed in females.

Analysis of oral manifestations of leukemia: a retrospective study.

OBJECTIVE: To evaluate in detail the oral complications of leukemia at initial presentation. Associations between oral manifestations and laboratory data were also investigated. STUDY DESIGN: A retrospective study of 230 cases was conducted to investigate the nature and incidence of oral manifestations at initial presentation. The following data were determined for each patient: age, sex, haemogram at diagnosis (which included haemoglobin, red blood cell counts, differential white blood cell counts, platelet counts), classification of the type of leukemia's systemic symptoms and oral manifestations at the initial physical examination including the dental consultation. RESULTS: It was revealed that the type of leukemia diagnosed, except with CML, is related to the age prediliction of patients. The incidence of leukemia is higher in males than in females. The most common manifestations of leukemia are lymphadenopathy (71.4% in ALL; 45% in AML), laryngeal pain (52.7% in ALL; 37.3% in AML), gingival bleeding (43.2% in AML; 28.6% in ALL), oral ulceration, and gingival enlargement. Fever (92.2%) was the most common symptom in patients with all types of leukemia. Platelet counts from 25,000 mm-3 to 60,000 mm-3 are at sufficiently low levels to result in spontaneous bleeding. Most of the patients had WBC counts of greater than 10,000 mm-3. Only 12.6% of patients had normal WBC counts. CONCLUSIONS: It was concluded that the age prediliction and prevalence of oral manifestations are closely related to the type of leukemia.

Ultrasonic scaling therapy in advanced periodontitis. IV. A long-term study over six years.

The objective of the present study was to evaluate the long-term effectiveness of clinical trials of ultrasonic scaling performed solely by a periodontist. A total of 51 individuals (27 males and 24 females) ranging in age from 21 to 61 years with moderate to advanced periodontitis were investigated following baseline assessments included gingival index (GI), plaque index (PlI), probing pocket depths (PPDs), and probing attachment levels (PALs). The individuals were subjected to active supra- and subgingival ultrasonic scaling by a periodontist alone following meticulous oral hygiene instruction. The results revealed a significant (p < 0.001) reduction of mean GI and PlI scores. In addition, a significant and sustained reduction of mean PPDs (p < 0.001) as well as significant sustained gain of mean PALs (p < 0.001) with initial PPDs of 4-6 mm and > or = 7 were greater than those sites with initial PPDs of 1-3 mm at each time interval. Basically, there exists a greater reduction of mean PPDs and greater gain of mean PALs on the buccal and lingual sites than those on the mesial and distal sites at each time interval.

Types and dimensions of root trunk correlating with diagnosis of molar furcation involvements.

The objective of the present study was to investigate the possible correlation of dimension, location, prevalence, and types of root trunk with molar furcation involvement (FI). The samples used in the study include 166 maxillary molars (70 1st and 96 2nd molars) and 200 mandibular molars (103 1st and 97 2nd molars). The dimensions of the root trunks and root lengths were measured with an electric caliper and their means and standard deviations calculated. The types of root trunks were identified by the ratio of root trunk dimension to root length and classified as types A, B, and C. The results may be summarized as follows. (1) Short-root trunks were more commonly found buccally, whereas long-root trunks were more commonly found mesially, in both maxillary molars. (2) Short-root trunks were most commonly found buccally, whereas long-root trunks were more commonly found lingually in both mandibular molars. (3) Long-root trunks were more commonly found on the 2nd molars than on the 1st molars. (4) Long-root trunks were associated with short root length. (5) There is a strong correlation between vertical length and type of root trunk and FI. The findings of the study indicated that an awareness of root trunk type together with horizontal and vertical attachment levels in molar FI may be helpful in the prognosis, diagnosis, and treatment of molar FI.

[Analysis of divergent angle and length of CEJ to furcation entrance in extracted molars].

The purposes of this study were to investigate the furcation entrance angle (FEA) and the distance between cemento-enamel junction (CEJ) and furcation entrance (FE) of the extracted maxillary and mandibular molars. Assay teeth comprised 89 maxillary molars and 93 mandibular molars. All the FEAs and CEJ-FEs of the molars were measured by a stereomicroscope at 2.5 x equipped with a Bioscan OPTIMAS Image Analyzer (BOIA). The results were summarized as follows: (1) The mean FEAs in the buccal, mesial and distal furcations were 96.3 +/- 10.0, 103.8 +/- 9.7, and 107.2 +/- 12.2 degrees in the maxillary molars, and 91.6 +/- 11.7, 101.7 +/- 11.5, and 97.1 +/- 10.7 degrees in the maxillary second molars, respectively. At the buccal and lingual furcations of mandibular first and second molars, they measured 100.5 +/- 9.7/102.7 +/- 8.5, and 93.3 +/- 11.5/91.7 +/- 10.8 degrees, respectively. (2) The mean distance of CEJ-FEs at the buccal, mesial and distal furcations of maxillary molars were 3.42 +/- 1.5mm, 3.55 +/- 0.97 mm, and 3.69 +/- 0.98mm for the first molars, and 3.01 +/- 1.04mm, 4.04 +/- 1.58mm and 3.00 +/- 1.14mm for the second molars. At the buccal and lingual furcations of the mandibular first and second molars, they were recorded as 1.90 +/- 0.08mm and 2.90 +/- 0.07mm, and 2.82 +/- 1.34mm and 3.46 +/- 1.03mm, respectively. It was concluded that buccal FEA of maxillary 2nd molar was the smallest (91.56 +/- 9.68 degrees) as compared to the mesial and distal FEAs; whereas the mean distance of CEJ-FEs at the buccal surface was the smallest (1.90mm +/- 0.08mm) when compared to the others.

[Furcation entrance dimension, divergent angle and length of CEJ to furcation entrance relate to periodontal therapy].

In previous studies we have investigated the furcation entrance dimension (FED), furcation entrance angle (FEA) and the distance between cementoenamel junction and furcation entrance (CEJ-FE) of the first and second molars and compared the Chinese with the Caucasians. The aim of the present study was to relate the FED, FEA, and distance of CEJ-FE to the clinical significance of periodontal therapy of molar furcations. All the FEDs, FEAs, and distance of CEJ-FEs of the molars were measured by a stereomicroscope equipped with a Bioscan OPTIMAS Image Analyzer and statistically analyzed by Student's paired t-test, multiple regression of ANOVA and correlation analysis. The results are summarized below. (1) There is a significant relationship between FEA and location of buccal, mesial, and distal furcations of maxillary first and second molars (16& 26, p < 0.001; 17&27, p < 0.01). (2) There exists a significant relationship between FEA and FED in the mandibular first and second molars. (3) There exists a significant relationship between FED and FEA in the mandibular second molar (r = 0.370, p < 0.05). (4) The prevalence of mean FED and FEA (type D, FED < or = 0.75 mm and FEA < or = 90 degree) of the maxillary first molar (45%) is twice as high as the maxillary first molar (24%). (5) The prevalence of type D of the buccal (32%) and lingual (37%) furcations on the mandibular second molar is markedly higher than the first molar (buccal = 12%; lingual = 4%, respectively). These results reveal that those topographics of the FED, FEA, and distance of CEJ-FE in second molars have poor prognosis in periodontal therapy when compared with first molars.

[A cross-sectional radiographic study of proximal alveolar bone loss in molars with adult periodontitis].

The purpose of the present study was to document the mean proximal alveolar bone loss of molars. The samples consisted of 219 subjects receiving of full mouth radiographs by standardized paralleling technique from Jan, 1992 to Jun, 1994. All the radiographs of 219 individuals suffered from adult periodontitis at age between 20 and 65 years old were measured, and were assessed mean proximal alveolar bone loss of molars and associated contributing factors. The main results indicated that (1) the mean proximal alveolar bone loss of the maxillary first and second molars accounted for 38. 4% and 33.5%, respectively, whereas the mandibular first and second molars were 34.8% and 31.6%, respectively; (2) within the same dental arch, mean proximal alveolar bone loss of the first molars was significant greater than that of the second molars, while the bone loss in the maxillary first molars was significant greater than that of the mandibular first molars. There was no difference between mean proximal bone loss of the maxillary and mandibular second molars; (3) mean alveolar bone loss of the first molars was significant greater than second molars in the same side of the dental arch. There was no significant difference in the mean proximal alveolar bone loss between right and left side molars. (4) average bone loss was the greatest (39.4%) at the mesial surfaces of maxillary first molars, whereas the least mean alveolar bone loss appeared at the distal surfaces of mandibular second molars. A significant difference of mean proximal alveolar bone loss was found between mesial and distal surfaces in mandibular first molars.

[The study of molar furcation involvements in adult periodontitis. II. Age, sex, location and prevalence].

The purposes of the study were as follows: (1) to evaluate the molar furcation involvement and number of molar correlated with age and sex; and (2) to study the relationship between the means of alveolar bone loss and associated factors of molar furcation involvements (FIs). 1102 molars (703 males and 399 females) were measured in 219 individuals (136 males and 83 females) for the alveolar bone loss and associated factors of molar furcation involvements. Based on the results, we conclude the following: (1) the higher prevalence of FI was in the mandibular first molar (94.6%), whereas the lowest prevalence of FI was in maxillary second molar; (2) except for the mandibular first molar, the prevalence of molar FI markedly increased with an increased age group (16 & 26, r = 0.335, p < 0.01; 17 & 27, r = 0.345, p < 0.01; 37 & 47, r = 0.239, p < 0.01); (3) the prevalence of molar FI was significantly higher in males than in females (p < 0.05); (4) the mean number of molar FI was significant greater in males (mean = 3.45) than in females (mean = 2.69); (5) factors such as age (r = 0.222, p < 0.01), sex, (r = 0.145, p < 0.05), number of remaining teeth (r = -0.330, p < 0.01) and molar FI (r = 0.471, p < 0.01) are strongly associated with the mean alveolar bone loss of molars.

The effect of ultrasonic scaling therapy in periodontitis III. A longitudinal study over three years.

The purpose of the present study was to examine and evaluate the effect of clinical trials of non-surgical periodontal therapy (NSPT) by ultrasonic scaling alone for three years. A total of 51 individuals (27 males; 24 females) ranging in age from 21 to 61 years with moderately to extremely advanced periodontitis were studied following baseline assessments which included gingival index, plaque index, probing pocket depths, and probing attachment levels (PALs). The patients were subjected to NSPT by using supra- and subgingival scaling with ultrasonic instrumentation alone. The results showed that this therapy resulted in a pronounced and significant reduction (p < 0.001) of gingival inflammation and dental plaque formation for the 3 years of study. In addition, a significant reduction of probing depth as well as an obvious gain of PALs were found greater in sites with initial depth of 4-6 mm and 7 mm or more (p < 0.001) than those in sites with initial probings of 1-3 mm (p > 0.05) at each survey time point.

Ectopic supernumerary teeth as a predisposing cause in localized periodontitis. Case report.

Supernumerary teeth are relatively common in the maxillary incisor and molar areas. However, bilateral ectopic, fully erupted supernumerary mesiodentes are relatively rare. The present case documents a patient with localized periodontitis of the maxillary first and second molars associated with bilaterally erupted supernumerary teeth located in proximity to the buccal embrasure space between the molars. Combined clinical data suggested that these ectopic mesiodentes predisposed or contributed to the development of localized periodontitis.

The topography of the furcation entrance in Chinese molars. Furcation entrance dimensions.

The purpose of the present study was to document the furcation entrance dimensions (FEDs) of the maxillary and mandibular 1st and 2nd molars and relate them to the choice of periodontal therapy. Study samples consisted of 89 maxillary molars (49 1st and 40 2nd molars) and 93 mandibular molars (50 1st and 43 2nd molars). All the FEDs of the molars were examined and measured under a stereomicroscope at 2.5 x equipped with a Bioscan OPTIMAS Image Analyzer (BOIA). The results may be summarized as follows. (1) The mean FEDs in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars were 0.74 mm, 0.99 mm and 1.04 mm in the 1st molars, and 0.63 mm, 0.67 mm, 0.90 mm in the 2nd molars, respectively. In the buccal and lingual furcations of mandibular 1st and 2nd molars, they measured 0.88 mm and 0.81 mm, and 0.73 mm and 0.71 mm, respectively. (2) The %s of FEDs of 0.56 mm or less (the tip width of a Cavitron tip being 0.56 mm) in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars, accounted for 32%, 8% and 6% of 1st molars, and 40%, 40% and 18% of 2nd molars. In the buccal and lingual areas of mandibular 1st and 2nd molars, they accounted for 16% and 26%, and 35% and 33% of the furcations, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The morphology of root fusion in Chinese adults (I). Grades, types, location and distribution.

The purpose of the present study was to investigate the morphology, extent, and distribution of root fusions in 1st and 2nd permanent molars in a Chinese population. The sample consisted of 158 maxillary and 151 mandibular extracted 1st and 2nd molars. Root fusion in molars was assessed by direct viewing and measuring the length of the root and root trunk with stereoscopic microscopy. Root fusion was graded by the extent of fusion and the number of affected surfaces. The main results were as follows: (1) the majority of root fusions affected upper and lower 2nd molars (39.7% and 28.1%, respectively); (2) the prevalence of maxillary roots with 1, 2 and 3 fusions was 55.2%, 31.3% and 13.4% respectively, and most of the root fusions affected the maxillary 2nd molars (65.7%); (3) the majority of mandibular root fusions affected the 2nd molars (89.2%), and were of grade III (48.7%); (4) in order of decreased prevalence, the grades of root fusion in 2nd molars were grades III, II and I; whereas in 1st molars they were grades I, II and III; (5) there were 44 (41.5%) and 19 (51.4%) complete root fusions (grade III) among 106 fused roots in maxillary molars and 37 fused roots in mandibular molars, respectively.