The use of patient specific polyetheretherketone implants for reconstruction of maxillofacial deformities.

PURPOSE: The aim of this study was to evaluate polyetheretherketone (PEEK) as a patient-specific implant (PSI) material in maxillofacial reconstructive surgery. MATERIALS AND METHODS: The retrospective study included a cohort of 24 patients who underwent maxillofacial surgery using PEEK PSIs. Each patient underwent preoperative multislice computed tomography (CT) with 0° tilt of gantry. Based on the CT scan, the PEEK PSIs were planned and manufactured using three-dimensional (3D) modeling and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. All procedures were performed under general anesthesia. Implants were placed intraorally, extraorally or through subciliary, transconjuctival or coronal incisions. RESULTS: In 22 of 24 cases, the PEEK PSI fit well without adjustments. Although the fit to the surrounding bone was perfect in almost all of the cases, the outer contour of the PSI was modified in nine cases before fixation. However, intraoperative implant modification did not affect the infection rate. In two cases, postoperative wound dehiscence and infection needed additional treatment and healed without removal of the implants. CONCLUSION: The follow-up data in this study showed good outcomes with reliable results for PSI made of PEEK in the maxillofacial region.

Helicobacter pylori in alcohol induced acute pancreatitis.

BACKGROUND AND AIMS: The objective of this study was to measure the association of Helicobacter pylori infection with alcoholic acute pancreatitis. MATERIAL AND METHODS: This study comprised of 50 patients with their first alcoholic pancreatitis and 50 alcoholic controls with no history of pancreatitis but similar alcohol use recruited from an alcohol rehabilitation center. Helicobacter infection was measured using Enzygnost EIA IgG-test. Complications and length of hospital stay were also recorded in patients with alcoholic pancreatitis. RESULTS: The seroprevalence of Helicobacter pylori was 10/50 (20%) in the pancreatitis group and 15/50 (30%) in the control group (p = NS). The median length of hospital stay of pancreatitis patients was 7 days, 11 days for those tested positive (range 6-25) and 6 days for those tested negative (range 3-47) for Helicobacter pylori, p = 0.013. As determined with the Atlanta criteria, seropositive patients tended to have more often severe pancreatitis, 4/10 (40%) vs. 6/40 (15%), OR 3.78 (95% CI 0.815-17.52), p = 0.097. CONCLUSIONS: This study suggests that Helicobacter pylori infection is not associated clinically significantly with the development of alcoholic pancreatitis. However, Helicobacter pylori infection may be associated with longer hospital stay due to more severe disease, which needs to be studied in a larger series of patients.

Atrial fibrillation: relation between clinical risk factors and transoesophageal echocardiographic risk factors for thromboembolism.

OBJECTIVE: To correlate clinical risk factors for thromboembolism with transoesophageal echocardiography (TOE) markers of a thrombogenic milieu. DESIGN: Clinical risk factors for thromboembolism and TOE markers of a thrombogenic milieu were assessed in consecutive patients with non-rheumatic atrial fibrillation. The following TOE parameters were assessed: presence of spontaneous echo contrast, thrombi, and left atrial appendage blood flow velocities. A history of hypertension, diabetes mellitus, or thromboembolic events, patient age > 65 years, and chronic heart failure were considered to be clinical risk factors for thromboembolism. SETTING: Tertiary cardiac care centre. PATIENTS: 301 consecutive patients with non-rheumatic atrial fibrillation scheduled for TOE. RESULTS: 255 patients presented with clinical risk factors. 158 patients had reduced left atrial blood flow velocities, dense spontaneous echo contrast, or both. Logistic regression analysis showed that a reduced left ventricular ejection fraction and age > 65 years were the only independent predictors of a thrombogenic milieu (both p < 0.0001). The probability of having a thrombogenic milieu increased with the number of clinical risk factors present (p < 0.0001). 17.4% of the patients without clinical risk factors had a thrombogenic milieu whereas 41.2% of the patients presenting one or more clinical risk factors had none. CONCLUSION: There is a close relation between clinical risk factors and TOE markers of a thrombogenic milieu. In addition, TOE examination allows for the identification of patients with a thrombogenic milieu without clinical risk factors.

Indexes for orthodontic treatment need.

Orthodontic treatment need indexes are used extensively in Northern Europe, especially in selecting patients for treatment in public orthodontic health services and in determining the level of third party copayment. This article describes certain treatment need indexes and their uses in everyday practice. The reliability and validity of indexes are discussed.

Angio-oedema induced by enalapril.

We report the case of a patient who, 9 months after initiation of enalapril and hydrochlorothiazide combination treatment for hypertension, developed angio-oedema with near fatal outcome. Our patient was successfully intubated using a flexible bronchofiberoscope. This case demonstrates that patients given an angiotensin-converting enzyme (ACE) inhibitor may develop serious facial and laryngeal swelling even several months after the initiation of treatment. The occurrence of even mild swelling should lead to prompt cessation of the drug. Patients with incipient ACE inhibitor-related angio-oedema should, without any delay, be referred to hospital for emergency treatment.

Unerupted second primary molars: report of two cases.

Two cases with an unerupted primary left mandibular second molar are described. second premolar was congenitally missing, in the other the unerupted primary molar was positioned inferiorly and lingually to its permanent successor. Unerupted primary molars should be extracted, but the time of extraction should be defined carefully by taking into consideration the development of the succedaneous premolar and the space relations in the permanent dentition.

Evaluation of the correlation box (Segner) for characterization of the facial skeleton.

The convenience of the so-called harmonious combinations of five basic radiographic cephalometric measurements (Segner), derived from multiple regressions and presented in the form of a correlation box, as a means of diagnosing skeletal malocclusion has been evaluated statistically. The study involved 55 untreated orthodontic patients 7-14 years old with Angle's Class I malocclusion. The correlation box was built stepwise on the basis of four linear regressions computed between five angular measurements (SNA, SNB, NSL/ML, NSL/NL, and NSAr). The regression analyses indicated that the correlation box was not accurate enough. The coefficients of determination for the regressions varied between 0.26 (for NSL/NL) and 0.63 (for SNB). Most part of the variation in NSL/ML, NSL/NL, and NSAr angles remained unexplained. Individual norms indicated by the box for the ANB angle seemed doubtful in many cases. The correlation box seemed to show the statistically most probable associations between measurements used. The combinations may be harmonious but the existence of other harmonious combinations cannot be excluded.

[BRACS--a method for cephalometric diagnosis and orthodontic treatment planning. Biometric radiographic analysis of the craniofacial skeleton]. / Die BRACS--ein Weg zur kephalometrischen Diagnose und zum kieferorthopädischen Behandlungsplan.

The BRACS (the biometric radiographic analysis of the craniofacial skeleton) is a mathematically originated method for diagnosing malocclusion and planning orthodontic treatment. In the conventional cephalometrics, the measurements are to be made in an unstable reference frame without any definable direction or coordinate system. When using the BRACS, the natural reference structures can be replaced by an artificial stable reference system. The procedure is introduced in this paper.

[Evaluation of the applicability of a mathematical model in the x-ray cephalometric diagnosis of sagittal bite anomalies. A clinical test]. / Bewertung der Anwendbarkeit eines mathematischen Modells in der röntgenkephalometrischen Diagnostik der sagittalen Gebissanomalien. Ein klinischer Test.

The mathematical model (Järvinen) for measuring the sagittal difference between the maxillary and mandibular apical bases has been clinically tested. The material for this study consisted of 30 lateral skull radiographs of orthodontically untreated children (aged seven to 15 years) with different types of skeletal and/or dento-alveolar malocclusions. A comparison of the model with two conventional and two more developed methods to measure the sagittal apical base difference showed that the correlation between the new and the older methods increased as the errors of the older methods were eliminated. The results seemed to indicate that sagittal malocclusions could be accurately diagnosed by means of the model.

Relation of the Wits appraisal to the ANB angle: a statistical appraisal.

The hypothesis that the relationship between the ANB angle and the Wits appraisal can be expressed by measuring the individual variations in their reference systems and by constructing a model of regression between them and a few parameters describing the reference systems was tested with material consisting of 30 lateral cephalometric radiographs of untreated orthodontic patients with different types of skeletal and/or dentoalveolar malocclusions. The results indicated that approximately 93% of the variation of the Wits appraisal could be explained by the variation of the ANB, NSL/OL, and SNA angles. The study also showed that the results given by different measurements with different reference systems, such as the ANB angle and the Wits appraisal, cannot be directly compared. To obtain comparable interpretations, one should correct the results of both measurements in relation to the variations in their reference systems.

Variability in assessment of need for orthodontic treatment when using certain treatment-need indices.

The need for orthodontic treatment was assessed in a sample of 29 children by using four treatment-need indices (ISMHB by the Swedish Medical Health Board, HMAR by Salzmann, INOT by Ingervall & Rönnerman, and TPI by Grainger). Furthermore, the need for treatment was evaluated clinically according to the criteria of Järvinen. When scoring the cases, and when selecting the cases with the highest scores, the study showed a marked variation between the indices, and indicated that the different methods selected different groups of children for treatment. Indirectly, the conclusion could be drawn that there were differences in the validity of the indices, even though it was not possible to evaluate the degree of validity on the basis of the knowledge we have today about the disadvantages and consequences of malocclusions.

A study of the factors causing differences in the relative variability of linear radiographic cephalometric measurements.

Certain factors causing variation of linear radiographic cephalometric measurements were evaluated using the regression analysis. The material of the study consisted of data from three earlier investigations and included 73 measurements of four separate samples of children and young adults. Approximately 75% of the variation of the variation coefficient (V) could be attributed to the variation in the length of the measurements (means) and thus mainly to the mathematic properties of V. Thus, differences in the relative variation did not always indicate differences in the absolute variation (SD). Two factors were extracted that had an increasing effect upon the variability--the location of the reference points on an osseous contour and the location of the reference points (one or both) in the mandible. The great variability of the reference points located on osseous contours was probably caused by local changes in bone configurations, and the great variability of the measurements involving the mandible probably indicated some specific growth changes in the size, form, and rotation movements of this bone. In clinical use such reference points that include relevant information only and that could be fixed by consistent features of the local morphology should be preferred.

Evaluation of the Bergen cephalometric norms: a radiological and statistical appraisal.

The normal values of the angular radiographic cephalometric measurements in the Bergen analysis, the so called orthognathic combinations, were compared with the associations between these measurements obtained from two population samples. The original sample of the study consisted of 55 untreated orthodontic patients aged 7-14 years and with Angle's Class I malocclusion. Additional data were obtained from Solow's study on young male adults. The comparison indicated differences between the Bergen acceptable combinations and the population estimates. The Bergen norms seemed to be constructed partly on the basis of solely topographical correlations. Therefore, it can be claimed that Bergen cephalometric norms are more artificial than biological, because of which the clinical use of the Bergen analysis requires special caution.

Floating norms for the ANB angle as guidance for clinical considerations.

If the ANB angle is used in cephalometric analyses, its individual nature should be recognized. A method to interpret the measured values of the ANB angle has been recently presented by Hussels and Nanda. This article introduces another method to evaluate the appropriateness of the measured values. A regression analysis was applied to explain the individual variation of the ANB angle in a sample of 55 untreated orthodontic patients, aged 7 to 14 years, with Class I (Angle) malocclusion. Approximately 63% of the variation of the ANB angle could be explained by the variation of the SNA and NSL/ML angles. The regression produced a list of floating norms of the ANB angle for different facial types. The floating norms can help to interpret the individual normal variation of the ANB angle.

Epidemiologic characteristics of dental caries: relation of DMFT and DMFS to proportion of children with DMF teeth.

The relation of the age-specific mean DMFT and mean DMFS to the age-specific proportion of children with DMF teeth has been studied using the original data of Knutson and data of a recent Finnish material. When studying the relationship between the mean DMFT (x) and the proportion of children with DMF teeth (y), three models of regression were compared. For low caries populations, a specific correction exponential curve y = 1-abx seemed to fit caries data somewhat better than the other models. The relationship between the mean DMFS (x) and the proportion of children with DMF teeth (y) could be expressed by a curvilinear model y = e[b(lnx) + a]; this applied to low caries populations (y approximately less than 0.7) as well, but the unexplained residual variation was about 6%.

An analysis of the variation of the ANB angle: a statistical appraisal.

The variation of the ANB angle was studied in a sample which consisted of 138 orthodontically untreated children 7 to 15 years of age with Class I, Class II, or Class III (Angle) malocclusion. A regression analysis was used in order to describe the proportion of the distorting variation caused by some usual changes in the cranial and facial skeleton. The results revealed that a part of the variation of the ANB angle could be attributed to factors other than the actual apical base difference, among these factors being the rotation of the S-N plane, the relative length of the S-N plane, and the rotation of the jaws. Because the ANB angle can vary without any marked abnormalities in the sagittal jaw relationship, the use of the so-called normal limits for the ANB angle is not justified. It would be better to replace the ANB angle with a more accurate indicator.

Saddle angle and maxillary prognathism: a radiological analysis of the association between the NSAr and SNA angles.

In cephalometric radiography, two angles have been commonly used, the saddle angle (NSAr) and the SNA angle. The former has been regarded as the cranial base angle, the latter as an indicator of the antero-posterior relation of the maxilla to the cranial base. In this study, a sample of 138 lateral skull radiographs of untreated orthodontics patients aged 7-15 years and analysed. The sample consisted of Angle's Class I, Class II, and Class III malocclusion cases. Means and standard deviations of the NSAr and SNA angles and the S-N and S-Ar lines for different malocclusion groups were estimated, and for each malocclusion group, the model of linear regression (y = bx + a) between the SNA and NSAr angles was computed. The mean of the NSAr angle was significantly larger in the Class II malocclusion group than in the Class III malocclusion group (p less than 0.05). The computed regressions indicated that about 14-40 per cent of the variation of the SNA angle in different malocclusion groups and about 24 per cent in the whole sample could be explained by the variation of the NSAr angle. Because at least a part of the correlation between the NSAr and SNA angles had a topographical causation, the main cause of this topographical correlation probably being the rotation of the S-N plane, the SNA angle was regarded as an unreliable indicator, the use of which can lead to considerable errors.