Young adult patient with two palatally maxillary impacted canines and forced traction on rigid arches of stabilization. Case report.

OBJECTIVE: Young adult patient treated for impaction of two maxillary canines. METHODS: C.S., 15 years, female. Diagnostic evaluation by clinical and radiographic examinations shows permanent dentition with persistence of 5.3 and 6.3, impaction of 1.3 and 2.3, dento-skeletal Cl I malocclusion, normodivergence of bone bases. Analysis of TC dentalscan confirms the palatal impaction of 1.3 and 2.3. The treatment plan provided an orthodontic-surgical approach for adequate space management in dental arch, evaluation of eruption movements, choice of anchorage device, surgical exposure and application of the brackets. RESULTS: Deciduous canines have been extracted and an edgewise appliance with rigid rectangular full thickness archwires has been used to align the arches and to obtain maximum anchorage during the forced traction. The surgical phase, for exposure of 1.3 and 2.3 respectively, performed an open technique by excisional uncovering and a close technique by a repositioned flap. The case has been finalized for the achievement of the right occlusal keys. CONCLUSION: The possibility to choose the surgical technique depending on the intraosseous position of impacted teeth in association to the edgewise therapy with full thickness arches allows to realize an effectiveness surgical-orthodontic approach for the forced traction of impacted teeth in a favourable position.

Friction in a hybrid system. An in vitro study.

AIM: The aim of this study was to compare the frictional force generated by self-ligating and conventional brackets coupled with stainless steel wires when conventional elastomeric or stainless steel ligatures were applied. METHOD: FOUR TYPES OF BRACKETS WERE SELECTED FOR THE STUDY: one passive self-ligating bracket, two active self-ligating brackets, and one conventional bracket. For each type of bracket one molar tube and two upper premolars were used in combination with three different wires (0.016x0.022, 0.017x0.025 and 0.019x0.025 inch). Testing was performed with an Instron machine. Each bracket/wire combination was tested with conventional elastomeric and stainless steel ligatures. Tests performed with self-ligating brackets were carried out also without conventional ligatures. ANOVA with Tukey's post hoc tests were used to compare the results for the different bracket/wire/ligature assemblies. RESULTS: Active self-ligating bracket/0.017x0.025 inch or 0.019x0.025 inch/stainless steel ligature assemblies showed significantly higher values of frictional forces than conventional bracket for the same combinations. Passive self-ligating brackets showed significantly lower values of friction than conventional brackets for each wire/ligature assembly. CONCLUSIONS: The use of stainless steel ligatures applied on active self-ligating brackets produced significantly higher level of frictional force than in combination with conventional brackets for 0.017x0.025 inch and 0.019x0.025 inch wires.

[Renal involvement in systemic sclerosis]. / Sclerosi sistemica e coinvolgimento renale.

Systemic sclerosis is an autoimmune disease characterized by fibrosis of the skin and internal organs. Raynaud's phenomenon generally precedes other disease manifestations. The distribution of skin lesions and the internal organ involvement are the basis for the classification into limited and diffuse forms of the disease. Clinically evident renal disease is observed in 10-40% of patients. The most common renal presentation is renal crisis, characterized by acute onset of renal failure and severe hypertension; some patients remain normotensive, showing microangiopathic hemolytic anemia. Renal complications due to penicillamine may occur in some patients. Finally, ANCA-associated glomerulonephritis is a rare complication of the disorder. In spite of treatment with ACE inhibitors, 20-50% of patients with renal crisis progress to end-stage renal disease. In the absence of a specific therapy, there is accumulating evidence supporting the effectiveness of prostacyclin derivatives, antifibrotic and immunosuppressive drugs. The evidence is strong that the ACE inhibitors that are used in renal crisis are disease modifying. In our series including 193 patients with systemic sclerosis, renal involvement was observed in 19 patients; 11 presented renal crisis (hypertensive in 8; normotensive in 3); 5 had chronic nephropathy; 2 developed penicillamine-induced nephrotic syndrome, and 1 ANCA-associated glomerulonephritis. Renal disease occurs in a minority of patients with systemic sclerosis, and may have a variable clinicopathological picture. As renal involvement is associated with a worse prognosis, careful monitoring of blood pressure, urine chemistry and renal function is required, particularly in patients with diffuse skin disease.

A revolutionary approach to health care cost control: leveraging the power of Web-enabled employee "consumerism".

The confluence of two trends--health care "consumerism" and employee self-service benefits programs--offers employers a promising opportunity for health care cost control. To take advantage of this opportunity, employers must take a fresh look at the health care cost dilemma and find ways to simultaneously offer employees a new kind of benefit and implement more effective cost-control measures.

A study of consumer attitudes about health care: the control, cost, and financing of health services.

The delivery of health care had emerged as one of the most important political issues of the 1970's, yet public attitudes about health issues remains a relatively unexplored subject. Little is known about the public's opinion of who should control the delivery of health care, about how the costs of health care are perceived, or about how the delivery of care should be financed. This paper relates respondent attitudes on these subjects to attitudes about criteria that determine the respondent's choice of ambulatory care facility and to socioeconomic, political, and other demographic characteristics. The data are derived from a survey (N=521) of households representative of the area of Rochester, New York.