Treatment planning for success: wise choices for maxillary single-tooth implants.

The purpose of this article is to demonstrate to general practitioners who have no experience with dental implant treatment the esthetic limitations of such treatment. The criteria for wise case selection will be described so that esthetic excellence can be predictably achieved in general practice. A checklist of criteria will be provided as a treatment-planning tool to determine if a patient is likely to have an esthetically successful outcome.

Evaluation of dental erosion in patients with gastroesophageal reflux disease.

STATEMENT OF PROBLEM: The cause of dental erosion may be difficult to establish because of its many presentations. Determination of the cause is an important aspect of diagnosis before extensive prosthodontic rehabilitation. PURPOSE: This cross-sectional study evaluated the association between loss of tooth structure as a result of dental erosion and gastroesophageal reflux disease. MATERIAL AND METHODS: Twenty consecutive adult dentate subjects referred to the Division of Gastroenterology for investigation of gastroesophageal tract disease were also evaluated for signs of dental erosion. All subjects underwent a dental evaluation that included a patient history to determine potential etiologic factors responsible for dental erosion. Subjects were examined clinically to quantify loss of tooth structure using a Tooth Wear Index (TWI). Endoscopic examination and 24-hour pH manometry were carried out to determine which subjects met the criteria for gastroesophageal reflux disease (GERD). Scores for maxillary versus mandibular dentition and anterior versus posterior dentition were also compared. Data were analyzed with the Kruskal-Wallis test (P =.004). RESULTS: Ten subjects were diagnosed with GERD and 10 subjects had manometry scores below the level indicating GERD. Overall, subjects diagnosed with GERD had significantly higher TWI scores compared with control subjects (mean difference = 0.6554; P =.004). GERD subjects had higher TWI scores in all quadrants, except in the mandibular anterior region where there was no difference. CONCLUSION: The results indicated that a relationship exists between loss of tooth structure, as measured by the TWI index, and the occurrence of GERD in this group of subjects.

Spiral computed tomography of the liver: contrast agent pharmacokinetics and the potential for improved hepatic enhancement.

RATIONALE AND OBJECTIVES: We conducted a prospective study of 131 patients to evaluate the contrast agent dose-response relationship for liver spiral computed tomography (CT) and to test the hypothesis that spiral CT scanning provides greater enhancement than does dynamic CT scanning. METHODS: Patients were assigned to one of two control groups (dynamic CT) or to one of five experimental groups (spiral CT). Dynamic CT patients received 150 ml and spiral CT patients received either 75, 100, or 150 ml of diatrizoate meglumine. All groups had a monophasic injection rate of 2.5 ml/sec. Hepatic enhancement was compared among experimental and control groups. RESULTS: In the experimental groups, there was a linear dose-response relationship (p < .0001) among the enhancements achieved for the three dosages. The enhancement of the last slice of liver for the spiral CT versus dynamic CT groups receiving 150 ml was significantly greater (p = .002). Peak, first liver slice, and average liver enhancement values were higher with spiral CT scanning, but the difference was not statistically significant (power > .55). CONCLUSION: Using uniphasic injection rates and identical doses of contrast agent, spiral CT scanning has the advantage of improved enhancement of the last part of the liver to be imaged.