Accuracy, Reliability and Clinical Implications of Static Compared to Quantifiable Occlusal Indicators.

OBJECTIVE: This literature review summarizes the properties, advantages, limitations, and clinical implications of employing static occlusal indicators compared to quantifiable digital occlusal indicators during occlusal adjustments. METHOD: An electronic database search of dental literature was carried out in PubMed/MEDLINE using the key words Occlusal Indicators, Occlusal Assessment, Static, Reliability, Dynamic, Repeatability, Validity and Clinical Accuracy. A total of 231 papers were isolated, with 129 papers considered for review. RESULTS: The included papers were grouped by Static and Dynamic Occlusal indicators. The numbers of papers in the Static Group was extremely low (only 20 papers) compared to The Dynamic group (T-Scan: 89; Dental Prescale: 28; Intraoral Scanners:17). CONCLUSION: Little evidence supports the use of static occlusal indicators due to their high degree of subjectivity required during implementation. However, much scientific evidence supports the use of T-Scan, as it measures relative occlusal forces and timing objectively, accurately, and repeatedly. For the improvement of Occlusal Practice, Subjective Interpretation using Static occlusal indicators should be replaced with digital ones for objective measurements. CLINICAL RELEVANCE: The computerized occlusal analysis system is well studied and has the capacity to provide precise time and force sequencing information to objectively evaluate occlusal contacts for improved treatment outcome.

Treatment of superficial basal cell carcinoma by topical photodynamic therapy with fractionated 5-aminolaevulinic acid 20% vs. two-stage topical methyl aminolaevulinate: results of a randomized controlled trial.

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of skin cancer and incidence rates are increasing. Photodynamic therapy (PDT) is a frequently used treatment, especially for superficial BCC (sBCC). Two topical photosensitizing agents are currently used to treat sBCC, namely 5-aminolaevulinic acid (ALA) and its ester, methyl aminolaevulinate (MAL). Previous research showed a high efficacy for ALA-PDT using a twofold fractionated illumination scheme in which two light fractions of 20 J cm-2 and 80 J cm-2 were delivered 4 h and 6 h after ALA application. OBJECTIVES: To evaluate whether twofold ALA-PDT is superior to conventional MAL-PDT for sBCC. METHODS: We performed a single-blind, randomized, multicentre trial in the Netherlands. RESULTS: Overall, 162 patients were randomized either to conventional MAL-PDT or twofold ALA-PDT. After 12 months, a total of six treatment failures occurred following ALA-PDT and 13 treatment failures occurred following MAL-PDT. The 12-month cumulative probability of remaining free from treatment failure was 92·3% [95% confidence interval (CI) (83·7-96·5)] for ALA-PDT and 83·4% (95% CI 73·1-90·0) for MAL-PDT (P = 0·091). CONCLUSIONS: The twofold ALA-PDT scheme resulted in fewer recurrences, although the difference between both treatment groups was not statistically significant. However, ALA-PDT resulted in higher pain scores and more post-treatment side-effects compared with MAL-PDT.

Ambulatory quantitative assessment of body position, bradykinesia, and hypokinesia in Parkinson's disease.

We used ambulatory monitoring to quantify body position, bradykinesia, and hypokinesia simultaneously in 50 patients with Parkinson's disease (PD) and 43 healthy elderly during the diurnal period. Reliable automatic detection of three defined body positions proved possible. As compared with controls, PD patients spent less time upright and more time during the day lying down, which correlated well with the self-reported time spent lying down. PD patients had significantly lower mean values of extremity acceleration and higher mean values of immobility than controls. The objective measures of bradykinesia and hypokinesia showed only a modest or no relation to the semiquantitative subjective Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, which most likely was due to differences between the methods. In contrast to bradykinesia measures, hypokinesia measures showed clear sex differences in both patients and controls. Over time, trunk and arm movements occurred more frequently in women than in men. Our ambulatory monitoring assessment disclosed clinically relevant information about the mobility profile and offers a way to quantify cardinal movement features simultaneously in PD patients throughout the day.

Topical R-85355, a potent and selective 5-lipoxygenase inhibitor, fails to improve psoriasis.

Inhibitors of 5-lipoxygenase have been studied with respect to antipsoriatic efficacy. Of these compounds, R-68151 is of particular interest as it proved to inhibit 5-lipoxygenase without inhibiting 12-lipoxygenase, cyclooxygenase and thromboxane-A2 synthetase. R-68151 has been shown to have a mild-to-moderate therapeutic effect in psoriasis. In the present study a new 5-lipoxygenase, R-85355, was investigated with respect to its efficacy in psoriasis. R-85355 is 3 times more potent compared to R-68151 with respect to inhibition of in vitro A-23187-stimulated leukotriene-B4 production by polymorphonuclear leukocytes. In a left-right double-blind comparative study, the compound was studied at saturation with respect to its antipsoriatic efficacy in 11 patients with chronic stable plaque psoriasis. In addition, various markers for epidermal proliferation, keratinization and inflammation were assessed. In no single patient was a left-right difference observed in favour of R-85355 compared to placebo with respect to clinical severity scores or the cell-biological markers. The present study indicates that a selective and highly potent 5-lipoxygenase inhibitor was not effective in the topical treatment of chronic plaque psoriasis.

The transmandibular implant: from progressive bone loss to controlled bone growth.

PURPOSE: In a prospective study, 146 consecutive transmandibular implant (TMI) patients were treated according to revised surgical and prosthetic protocols to induce and control bone growth. Revisions included 1) placement of transosseous posts and cortical screws between the mental foramina so that two threads extended beyond the alveolar crest of the mandible without protruding through the mucosa and 2) fabrication of an implant-borne prosthesis that rested on the retromolar pads with a gap of 2 mm between the denture base and the mucosal tissues in the saddle areas. PATIENTS AND METHODS: Measurements of the height of the mandible were made using a digital millimeter calliper and panoramic radiographs, with the enlargement calculated for each radiograph. The follow-up period ranged from 18 to 51 months. RESULTS: Bone growth was present in 131 of the 146 patients whereas the bone resorption was arrested in the remaining patients. Increase in bony apposition varied from 9 mm in patients with severe mandibular atrophy to 2 mm in patients with mild atrophy. CONCLUSION: The revised surgical and prosthetic protocols for TMI insertion and rehabilitation are advocated to prevent further alveolar resorption and to promote bone growth in patients with mandibular atrophy.

In vitro activity of commonly used oral antimicrobial agents against community isolates of respiratory pathogens.

The in vitro activity of ampicillin, amoxicillin/clavulanate, cefadroxil, cefaclor, cefuroxime (axetil), co-trimoxazole, doxycycline, ciprofloxacin, ofloxacin, erythromycin, and roxithromycin was tested against unselected isolates of S. pneumoniae (70), H. influenzae (93), and M. catarrhalis (46), cultured from clinically significant sputum samples of general practice patients. All isolates of S. pneumoniae were highly susceptible to ampicillin; cefadroxil and cefaclor were markedly less active on a weight basis; resistance was only observed with co-trimoxazole (4.3%), doxycycline (5.7%), and erythromycin (2.9%); however, ciprofloxacin and ofloxacin showed median MICs (MIC50), that were only one dilution below breakpoint. Beta-lactamase was detected in 14.0% of H. influenzae isolates; all isolates were susceptible to amoxicillin/clavulanate, cefaclor, and cefuroxime (axetil), although MICs were generally higher for cefaclor; the highest activity was exhibited by ciprofloxacin and ofloxacin; apart from cefadroxil, erythromycin, and roxithromycin, that showed only marginal activity, resistance was observed with co-trimoxazole (4.3%) and doxycycline (1.1%). All (including 71.7% of beta-lactamase producing) isolates of M. catarrhalis were susceptible to amoxicillin/clavulanate, cefaclor and cefuroxime (axetil), although MICs were markedly lower for amoxicillin/clavulanate; ciprofloxacin and ofloxacin showed the lowest MICs; resistance was only observed with cefadroxil (2.2%). In conclusion, the antimicrobial agents showing the most uniformly high in vitro activity against the 3 common community respiratory pathogens tested in the present study, were amoxicillin/clavulanate and, to a lesser extent, cefuroxime (axetil).