Recurrence and progression of T1G3 transitional cell carcinoma of the bladder treated with intravesical bacillus Calmette-Guérin.

OBJECTIVE: To examine the incidence of recurrence and progression in patients with stage T1, grade-3 carcinoma of the bladder treated with endovesical bacillus Calmette-Guérin (BCG) after complete transurethral resection. MATERIAL AND METHODS: From May 1995 to June 2002, 937 patients with superficial bladder cancer underwent transurethral resection. 46 patients (4.9%) had T1G3 tumors. All patients received endovesical BCG therapy 2-3 weeks after transurethral resection, given in 6 sessions as weekly instillations of 120 ml Pasteur strain BCG in 50 ml saline. Success was defined by normal cytology and cystoscopy, and normal bladder biopsies. Recurrent tumors were resected and a second or third cycle of therapy was given according to pathological status. Progressive tumors were managed by radical cystectomy, radiotherapy and/or chemotherapy depending on the nature of the tumor or clinical status of the patient. RESULTS: During follow-up 60.7% of the patients (28 of 46) remained tumor free after only 1 BCG cycle and 73.9% (34 of 46) after the third BCG cycle, and the bladder was preserved in all. Muscle-invasive progression was noted in 10 (21.7%) patients at the end of the BCG cycles. Radical cystectomy was done in 10 patients. The tumor-free survival rate of all patients including those who underwent cystectomy is 84.8% (39 of 46) with a median follow-up of 61 (range 39-118) months. CONCLUSION: Adjuvant immunotherapy with BCG after complete transurethral resection of the bladder tumor represents a highly effective treatment for bladder preservation in stage pT1, grade-3 carcinoma of the bladder. pT1G3 tumors with early high-grade recurrence after failed immunotherapy should be regarded as candidates for early radical cystectomy.

Reactions of peri-implant tissues to continuous loading of osseointegrated implants.

Functional and morphologic reactions of peri-implant bone surrounding screw implants (Bonefit) were studied in three dogs by loading the implants with continuous forces of 2 (about 204 gm) and 5 N (about 510 gm). Eight implants were inserted to an endosseous length of 12 mm and placed about 10 mm apart in the region of the lower premolars. The fixtures healed in a closed environment for 12 weeks, after which they were uncovered and loaded with abutments and orthodontic devices to produce horizontal distraction with a force of 2 N (about 204 gm) for 12 weeks. Subsequently they were loaded with 5 N (about 510 gm) for another 24 weeks. The distance between and the mobility of the implants were determined before and after each phase of experimental loading. Fixtures of the same type that were osseointegrated and not exposed, or osseointegrated and loaded by mastication, were used as a control. Animals were euthanized and specimens sectioned. The result was that continuously loaded implants showed no significant displacement for any force level. The mobility of the fixtures increased slightly by about 1 Periotest-value (PTV) at the end of the experiment. No significant peri-implant pocket could be seen in implants loaded by continuous or masticatory forces. Histologic and morphometric evaluation indicated compaction of bone as a result of loading. Osseointegrated implants have potential as a firm osseous anchorage for orthodontic treatment and can resist continuous horizontal forces of at least 5 N (about 510 gm) during a period of several months.

Interdisciplinary concepts in treating adult patients.

Pre-prosthetics, as a part of orthodontic treatment in adults has gained increasing importance during recent years. Through coordinated orthodontic, prosthetic and periodontal treatment plans, patients with partial dentition can be offered further treatment possibilities. Such planning would allow for fixed prosthetic treatment possibilities and the survival of critical teeth. They would provide for better aesthetics and avoid functional disturbances. The aim of the present study was to present reports of patients treated by coordinated work at the Dental School of Hamburg University. In patients with partial dentition, premolars were uprighted and distally moved and molars were extruded to be used as abutments for fixed prosthetic reconstructions. Following trauma, the position of the remaining anterior teeth was improved to provide for optimal aesthetics after prosthetic treatment. Extraction of a subalveolarly fractured tooth is avoided through root extrusion and post-core reconstruction. The results demonstrate the advantages of pre-prosthetic treatment as regards stability, aesthetics and function. With the help of pre-prosthetic orthodontic treatment, complicated treatment situations could be handled more successfully than would have been the case without such treatment.

Shear bond strength of a new polycarbonate bracket--an in vitro study with 14 adhesives.

Shear bond strength and failure location were used to evaluate the effectiveness of plastic bracket primers for bonding diacrylate adhesives on a new fibre-reinforced polycarbonate bracket. Maxillary incisor polycarbonate and mesh-based brackets as control were bonded to human incisors with 14 different adhesives (four filled diacrylate two-paste, six diacrylate one-step and four power-liquid acrylic adhesives), and after thermo-cycling for 2000 cycles between 5 degrees and 55 degrees C, tested in shear. A non-parametric test (Mann-Whitney U test) was used to compare the shear bond strength of the polycarbonate brackets with the mesh based brackets and a One-way test (according to Scheffe) to compare the shear bond strength of different adhesives. The following conclusions can be made: 1. Seven of the 14 adhesives used in this study with both types of brackets demonstrated adequate shear bond strength values for the clinical application. The exceptions were: Achieve Mix, No-Mix:30 Silkon, Lee Insta-Bond, Ortho-Loc and Bond-Eze, all with too low a shear bond strength for one or both types of brackets, and finally Quasar, which used with the plastic brackets sometimes caused enamel fractures, due to high bond strength. 2. The adhesives with their own plastic primer demonstrated higher blood strength values than those without plastic primer, and two-paste adhesives used with plastic primer displayed a higher bond strength than the other adhesives. 3. Generally, the shear bond strength values of the one-step adhesives were lower compared with the two-paste adhesives. 4. The liquid-powder adhesives demonstrated very different values for bond strength.

[The shearing strength of titanium brackets depending on the coating procedure]. / Scherfestigkeit von Titanbrackets in Abhängigkeit vom Beschichtungsverfahren.

It has long been recognized that corrosion of the metal alloys used in the different fields of dentistry can cause intra-oral problems such as allergic reactions. Titanium, a metal all but impervious to corrosion, presents an alternative to the metal alloys used in the fabrication of orthodontic brackets. The purpose of this study was to test the bonding strength between titanium brackets treated with 5 different opaque and non-opaque coatings and a 2-phase adhesive. Five coating methods were tested: N1 (Dentaurum), N2 (Dentaurum), Rocatec (Espe), Sebond (Schütze), Silicoater Standard (Kulzer). After bonding the brackets with a mix adhesive, they were thermocycled and then the shear bonding strength established. Silicoated titanium bracket bases showed clinically acceptable bonding values with the exception of those coated with Sebond without opaquer layer. While the silicoating methods N1, N2, and Rocatec demonstrated minimum bonding strength using the opaquer Visio-Gem, the bonding strength of the bracket bases coated with Sebond MKV, Silicoater Standard and the opaquer appropriate to each was significant increased. Among all the coated surfaces, methods N1, N2, and Rocatec appear to establish the optimum bonding strength values. In addition, the thin opaquer layer (Visio-Gem) used together with these methods offers a good surface adaptation of the bracket to the tooth surface.