Pink esthetic and radiological scores around immediate implants placed in the esthetic zone - Socket-Shield Technique versus Immediate Conventional Technique: A Pilot Study.

OBJECTIVE: It is irrefutable that the extraction of teeth inextricably results in definitive changes in the surrounding hard and soft tissues. Recently, Socket-Shield Technique (SST) has been used to keep the buccal two-third of the root intact in the socket. This buccal shield further preserves the periodontium-bundle bone complex and hence preserves the buccal hard and soft tissue. The purpose of the study was to do a statistical comparative analysis of two different types of flapless and graftless techniques using the esthetic (Pink Esthetic Index) and radiological parameters. MATERIALS AND METHODS: A total of thirty nonrestorable tooth/root stumps (vital or nonvital) were selected and randomly allocated to two different groups: control group with immediate conventional implant placement (without SST) (Group C, n = 15) and test group with immediate implant placement using SST (Group S, n = 15). All of the sites received immediate chairside temporaries. All implants were restored either with screw- or cement-retained prostheses 4 months postoperative. Each control and test group was analyzed at two different durations: 15 days after placement of provisional and 15 days after placement of definitive prosthesis. Five parameters of Pink Esthetic Score (PES) were used for esthetic analysis, and digital periapical radiographs were used for radiographic analysis. RESULTS: Within the time frame of the study (15 days postplacement of definitive prosthesis), a statistically significant difference (p < 0.05) was observed between PES of the two techniques. Test group S (mean = 9.07) showed better scores than control group C (mean = 6.87). It was observed that buccal bone was maintained in all the cases of test group S while there was loss of buccal bone in almost all the cases of control group C. CONCLUSION: Within the limitations of this short-term pilot study, better soft-tissue parameters were observed with SST as compared to a conventional graftless technique whenever a restoration on immediate implant placement is considered.

Caveolae in CNS arterioles mediate neurovascular coupling.

Proper brain function depends on neurovascular coupling: neural activity rapidly increases local blood flow to meet moment-to-moment changes in regional brain energy demand1. Neurovascular coupling is the basis for functional brain imaging2, and impaired neurovascular coupling is implicated in neurodegeneration1. The underlying molecular and cellular mechanisms of neurovascular coupling remain poorly understood. The conventional view is that neurons or astrocytes release vasodilatory factors that act directly on smooth muscle cells (SMCs) to induce arterial dilation and increase local blood flow1. Here, using two-photon microscopy to image neural activity and vascular dynamics simultaneously in the barrel cortex of awake mice under whisker stimulation, we found that arteriolar endothelial cells (aECs) have an active role in mediating neurovascular coupling. We found that aECs, unlike other vascular segments of endothelial cells in the central nervous system, have abundant caveolae. Acute genetic perturbations that eliminated caveolae in aECs, but not in neighbouring SMCs, impaired neurovascular coupling. Notably, caveolae function in aECs is independent of the endothelial NO synthase (eNOS)-mediated NO pathway. Ablation of both caveolae and eNOS completely abolished neurovascular coupling, whereas the single mutants exhibited partial impairment, revealing that the caveolae-mediated pathway in aECs is a major contributor to neurovascular coupling. Our findings indicate that vasodilation is largely mediated by endothelial cells that actively relay signals from the central nervous system to SMCs via a caveolae-dependent pathway.

Rehabilitation of a partial glossectomy patient: Palatal augmentation prosthesis.

Tongue-palate contact is necessary for the production of normal speech, and the proper location of the tongue on the palate during certain sounds is important. Partial glossectomy leads to difficulty in tongue-palate articulation during speech, and it becomes difficult for a patient to reach the palate with the tongue to form certain sounds. In-depth knowledge of the production of different sounds can be used as a diagnostic aid in determining the thickness of the palatal augmentation prosthesis fabricated to rehabilitate such patients. A functional wax technique is used to make a functional impression of tongue-palate contact during the speech.

Shield the socket: Procedure, case report and classification.

The extraction of a tooth leads to a cascade of events which results in resorption of the alveolar bone around the socket. The buccal bone loss that occurs postextraction leads to vertical and horizontal bone loss. It requires complex hard and soft-tissue reconstruction to achieve esthetically pleasing results in such cases. In the socket-shield technique (SST) the root is bisected, and the buccal two-third of the root is preserved in the socket so that the periodontium along with the bundle bone and the buccal bone remains intact. A classification of SST technique is proposed depending on the position of the shield in the socket. This classification is required so as to help in understanding the preparation design and the role of shield and in maximizing the usage of the shield to achieve best possible esthetics in immediate implant placement sites.

Adherence to AAP practice guidelines for urinary tract infections at our teaching institution.

Urinary tract infection (UTI) in children is a common diagnosis in general pediatric practice. Because of the potential severity and proven morbidity of such infections, the American Academy of Pediatrics (AAP) developed guidelines to better direct clinicians in the workup. This retrospective study sought to evaluate the uniformity of adherence to these guidelines at our teaching institution. A total of 104 charts were reviewed, and data were collected based on the parameters outlined by the AAP. It is found that at the authors' teaching institution, there is at least 70% adherence to the recommendations for method of urine collection and 97% adherence to performance of urinalysis. However, imaging workup, which may be the most important follow-up of a first-time UTI, has only a 61% adherence rate.