Staged autogenous calvarial bone grafting and dental implants placement in the management of oligodontia: a retrospective study of 20 patients over a 12-year period.

Oligodontia demands multidisciplinary management due to its repercussions on dentofacial growth. To place implants to realize implant-borne fixed denture, preimplant surgery may be necessary if bone volumes are insufficient. Our aim was to assess bone increase following autogenic bone grafting and to discuss prosthetic options. Twenty patients followed for oligodontia, who underwent bone grafting, were treated from 2008 to 2019. Transversal and vertical bone levels were measured pre- and postoperatively to assess alveolar ridge augmentation. Mean horizontal grafting increase was 4.60 mm [standard deviation (SD) 0.79 mm], mean sinus lift increase was 9.95 mm (SD 2.35 mm). Mean implants placed per patient was 9, mean implants placed on grafted site was 5 per patient. Overall implant survival rate was 100%. All patients benefited from prosthetic procedures when it was planned to perform implant-borne fixed dentures. Within the framework of a complete treatment plan (involving paediatric dentistry, dentofacial orthopaedics, oral and maxillofacial surgery, and prosthodontics), autologous bone grafting combined or not with orthognathic surgery is fully adapted to patients with oligodontia. It allows reconstruction of favourable bone volumes for placement of implants to realize implant-borne fixed dentures, with high implant survival rates and great improvements to quality of life.

Implant-borne rehabilitation for alveolar dental cleft: Retrospective analysis of thirty-nine cases.

INTRODUCTION: Dental rehabilitation of patients with alveolar-dental cleft sequelae is a crucial issue in the final stages of functional and aesthetic management of these patients. The objectives of this study are to establish the success of implant-supported rehabilitations for patients with alveolar dental cleft sequelae followed in the Department of Maxillofacial Surgery and Stomatology of Lille University Hospital and the reasons for not using this type of rehabilitation for others. MATERIALS AND METHOD: Patients treated between January 2009 and December 2018 with implant-supported prostheses at an alveolar dental cleft site were included. Dental implants were placed after a complementary alveolar bone graft. Clinical and radiological criteria regarding periodontal, occlusal and prosthetic status were studied. RESULTS: A total of 12 implants in 8 patients were placed. One of these implants was lost, resulting in an implant survival rate of 91.7%. All patients were able to benefit from functional rehabilitation. DISCUSSION: The present results demonstrate the interest and reliability of implant rehabilitation in these patients. They furthermore highlight financial factors as a barrier to using this solution among the majority of patients in care.

To what extent is climate change adaptation a novel challenge for agricultural modellers?

Modelling is key to adapting agriculture to climate change (CC), facilitating evaluation of the impacts and efficacy of adaptation measures, and the design of optimal strategies. Although there are many challenges to modelling agricultural CC adaptation, it is unclear whether these are novel or, whether adaptation merely adds new motivations to old challenges. Here, qualitative analysis of modellers' views revealed three categories of challenge: Content, Use, and Capacity. Triangulation of findings with reviews of agricultural modelling and Climate Change Risk Assessment was then used to highlight challenges specific to modelling adaptation. These were refined through literature review, focussing attention on how the progressive nature of CC affects the role and impact of modelling. Specific challenges identified were: Scope of adaptations modelled, Information on future adaptation, Collaboration to tackle novel challenges, Optimisation under progressive change with thresholds, and Responsibility given the sensitivity of future outcomes to initial choices under progressive change.

Trained-user opinion about Welfare Quality measures and integrated scoring of dairy cattle welfare.

The Welfare Quality (WQ) protocol for on-farm dairy cattle welfare assessment describes 27 measures and a stepwise method for integrating values for these measures into 11 criteria scores, grouped further into 4 principle scores and finally into an overall welfare categorization with 4 levels. We conducted an online survey to examine whether trained users' opinions of the WQ protocol for dairy cattle correspond with the integrated scores (criteria, principles, and overall categorization) calculated according to the WQ protocol. First, the trained users' scores (n = 8-15) for reliability and validity and their ranking of the importance of all measures for herd welfare were compared with the degree of actual effect of these measures on the WQ integrated scores. Logistic regression was applied to identify the measures that affected the WQ overall welfare categorization into the "not classified" or "enhanced" categories for a database of 491 European herds. The smallest multivariate model maintaining the highest percentage of both sensitivity and specificity for the "enhanced" category contained 6 measures, whereas the model for "not classified" contained 4 measures. Some of the measures that were ranked as least important by trained users (e.g., measures relating to drinkers) had the highest influence on the WQ overall welfare categorization. Conversely, measures rated as most important by the trained users (e.g., lameness and mortality) had a lower effect on the WQ overall category. In addition, trained users were asked to allocate criterion and overall welfare scores to 7 focal herds selected from the database (n = 491 herds). Data on all WQ measures for these focal herds relative to all other herds in the database were provided. The degree to which expert scores corresponded to each other, the systematic difference, and the correspondence between median trained-user opinion and the WQ criterion scores were then tested. The level of correspondence between expert scoring and WQ scoring for 6 of the 12 criteria and for the overall welfare score was low. The WQ scores of the protocol for dairy cattle thus lacked correspondence with trained users on the importance of several welfare measures.

Farmers' preferences for automatic lameness-detection systems in dairy cattle.

As lameness is a major health problem in dairy herds, a lot of attention goes to the development of automated lameness-detection systems. Few systems have made it to the market, as most are currently still in development. To get these systems ready for practice, developers need to define which system characteristics are important for the farmers as end users. In this study, farmers' preferences for the different characteristics of proposed lameness-detection systems were investigated. In addition, the influence of sociodemographic and farm characteristics on farmers' preferences was assessed. The third aim was to find out if preferences change after the farmer receives extra information on lameness and its consequences. Therefore, a discrete choice experiment was designed with 3 alternative lameness-detection systems: a system attached to the cow, a walkover system, and a camera system. Each system was defined by 4 characteristics: the percentage missed lame cows, the percentage false alarms, the system cost, and the ability to indicate which leg is lame. The choice experiment was embedded in an online survey. After answering general questions and choosing their preferred option in 4 choice sets, extra information on lameness was provided. Consecutively, farmers were shown a second block of 4 choice sets. Results from 135 responses showed that farmers' preferences were influenced by the 4 system characteristics. The importance a farmer attaches to lameness, the interval between calving and first insemination, and the presence of an estrus-detection system contributed significantly to the value a farmer attaches to lameness-detection systems. Farmers who already use an estrus detection system were more willing to use automatic detection systems instead of visual lameness detection. Similarly, farmers who achieve shorter intervals between calving and first insemination and farmers who find lameness highly important had a higher tendency to choose for automatic lameness detection. A sensor attached to the cow was preferred, followed by a walkover system and a camera system. In general, visual lameness detection was preferred over automatic detection systems, but this preference changed after informing farmers about the consequences of lameness. To conclude, the system cost and performance were important features, but dairy farmers should be sensitized on the consequences of lameness and its effect on farm profitability.

Economic modelling of grazing management against gastrointestinal nematodes in dairy cattle.

Grazing management (GM) interventions, such as reducing the grazing time or mowing pasture before grazing, have been proposed to limit the exposure to gastrointestinal (GI) nematode infections in grazed livestock. However, the farm-level economic effects of these interventions have not yet been assessed. In this paper, the economic effects of three GM interventions in adult dairy cattle were modelled for a set of Flemish farms: later turnout on pasture (GM1), earlier housing near the end of the grazing season (GM2), and reducing the daily grazing time (GM3). Farm accountancy data were linked to Ostertagia ostertagi bulk tank milk ELISA results and GM data for 137 farms. The economic effects of the GM interventions were investigated through a combination of efficiency analysis and a whole-farm simulation model. Modelling of GM1, GM2 and GM3 resulted in a marginal economic effect of € 8.36, € -9.05 and € -53.37 per cow per year, respectively. The results suggest that the dairy farms can improve their economic performance by postponing the turnout date, but that advancing the housing date or reducing daily grazing time mostly leads to a lower net economic farm performance. Overall, the GM interventions resulted in a higher technical efficiency and milk production but these benefits were offset by increased feed costs as a result of higher maintenance and cultivation costs. Because the results differed highly between farms, GM interventions need to be evaluated at the individual level for appropriate decision support.

Le Fort 1 osteotomy and calvarial bone grafting for severely resorbed maxillae.

INTRODUCTION: Long standing maxillary edentulism leads to alveolar ridge resorption which prevent implant placement and causes prosthetic malocclusion. The aim of the study was to assess vertical and transversal bone increase following Le Fort 1 osteotomy associated with calvarial bone grafting. MATERIALS AND METHODS: 66 patients who presented severely atrophic maxillae were treated with Le Fort 1 osteotomy with bone grafting from 2003 to 2014. Vertical and transversal bone level was measured preoperatively and 6 months post-operatively to calculate the alveolar ridge augmentation. Follow up ranged from 10 months to 11 years. RESULTS: The mean increase of bone height was 9.3 mm and the mean increase of bone width was 6 mm 417 endosseous implants were placed in the grafted maxilla. Mean endosseous implant length was of 10.7 mm at the first molar site (range: 8-16 mm). A total of 25 implants failed, the overall implant survival rate is of 94%. The definitive prosthetis was fixed in 65% of the patients and removable in 35% of the patients. DISCUSSION: Le Fort 1 osteotomy associated with calvarial bone grafting is the main treatment option able to offer fixed bridge and perfect class 1 occlusion in cases of severe maxillary atrophy.

The relation between input-output transformation and gastrointestinal nematode infections on dairy farms.

Efficiency analysis is used for assessing links between technical efficiency (TE) of livestock farms and animal diseases. However, previous studies often do not make the link with the allocation of inputs and mainly present average effects that ignore the often huge differences among farms. In this paper, we studied the relationship between exposure to gastrointestinal (GI) nematode infections, the TE and the input allocation on dairy farms. Although the traditional cost allocative efficiency (CAE) indicator adequately measures how a given input allocation differs from the cost-minimising input allocation, they do not represent the unique input allocation of farms. Similar CAE scores may be obtained for farms with different input allocations. Therefore, we propose an adjusted allocative efficiency index (AAEI) to measure the unique input allocation of farms. Combining this AAEI with the TE score allows determining the unique input-output position of each farm. The method is illustrated by estimating efficiency scores using data envelopment analysis (DEA) on a sample of 152 dairy farms in Flanders for which both accountancy and parasitic monitoring data were available. Three groups of farms with a different input-output position can be distinguished based on cluster analysis: (1) technically inefficient farms, with a relatively low use of concentrates per 100 l milk and a high exposure to infection, (2) farms with an intermediate TE, relatively high use of concentrates per 100 l milk and a low exposure to infection, (3) farms with the highest TE, relatively low roughage use per 100 l milk and a relatively high exposure to infection. Correlation analysis indicates for each group how the level of exposure to GI nematodes is associated or not with improved economic performance. The results suggest that improving both the economic performance and exposure to infection seems only of interest for highly TE farms. The findings indicate that current farm recommendations regarding GI nematode infections could be improved by also accounting for the allocation of inputs on the farm.

PLAYING THE TRUMP OF DUALITY IN DISCUSS: UPGRADING POCER WITH QUESTIONNAIRE RESULTS.

DISCUSS, the Dual Indicator Set for Sustainable Crop protection Sustainability Surveys, was designed to help farmers achieve more sustainable crop protection. The indicator set pairs risk indicators--POCER--, with response indicators--a management questionnaire. Both parts of DISCUSS are indicators in their own right, but the dual risk-response setup has the additional trump that the questionnaire reveals farm level information, by which POCER calculations are refined. Simulations with personal protection and drift mitigation measures illustrate how DISCUSS can be used to support the farmers' crop protection decisions.

Le Fort I osteotomy and calvarial bone grafting for dental implants.

INTRODUCTION: We present a reconstruction technique for atrophied maxilla which combines a Le Fort I osteotomy and calvarial bone grafting. This retrospective study was carried out to evaluate bone volume increase and the possibility to insert dental implants. PATIENTS AND METHODS: Bone volume increase was assessed in 56 patients using preoperative and 6-month postoperative computed axial tomography (CAT). The implant rate success and the type of prosthesis were evaluated. RESULTS: The average increase at the first molar level was 10.2mm vertically and 8.2mm transversally. No infection was reported. The implant success rate was 97.9% and a prosthetic rehabilitation was performed in all patients (55% with removable bar-supported prostheses, and 45% with fixed prostheses). DISCUSSION: The technique is adapted to atrophied maxilla reconstruction for dental implant rehabilitation. The implant success rate was similar to that of other bone augmentation techniques.

[Hypodontia: therapeutic strategy elaborated from 30 cases]. / L'oligodontie: stratégie thérapeutique à partir de 30 cas.

INTRODUCTION: Hypodontia is defined as the absence of at least six permanent teeth due to the hypodevelopment of tooth germs. The prevalence is weak and varies according to the ethnic origin. This familial abnormality is due to various mutations or polymorphisms of genes. It may be associated with other dental abnormalities. In children, it is responsible for growth, mastication, and phonation disorders, hypo-alveolia and lingual interposition in the toothless sites. We report the management of 30 patients presenting with oligodontia. MATERIAL AND METHOD: The diagnosis was made on clinical and paraclinical data. The vertical and transversal facial dimensions, the three facial proportions, labial morphology, the number and localization of teeth, and occlusion were analyzed for future orthognathic and implant rehabilitation. The occlusion was studied transversally and vertically on dental casts. Rehabilitation with implant supported dental prostheses was chosen when conditions were met. The therapeutic protocol could include up to four chronological phases: the early prosthetic phase, the orthodontic phase, the surgical phase, and the implant and prosthetic phase. RESULTS: The 30 patients' age (13 male and 17 female patients) ranged from six to 20 years. An average of 15 dents were missing (6 to 28). Except for one case, all the third molars were missing. In 66% of the cases, the second molar was missing, in 33% for the first molar. In 66% of the cases, two lateral maxillary incisors were missing. There were no premolars in 50% of the patients. Agenesis of premolars and molars induced posterior bone insufficiency in the mandibula. Dysmorphosis was always present with vertical growth disorders. Six patients were not given orthodontic treatment because they did not have enough teeth. Orthognathic surgery was used in 14 cases (46.7%). Seventeen patients (56.7%) underwent apposition graft. In three patients, a high position of the alveolar nerve required nerve derivation. Implants were inserted in 14 patients (46.7%). The total number of implants was 155. DISCUSSION: Rehabilitation with implant supported dental prostheses is a good treatment for oligodontia. It requires an interdisciplinary approach (including a maxillo-facial surgeon, an orthodontist, a dentist, and a prosthesis specialist). The patient's motivation as well as that of his family is crucial.

Treatment of GI dysmotility in scleroderma with the new enterokinetic agent prucalopride.

Scleroderma is a multisystem disorder frequently resulting in disturbed GI motility. Although, especially early in the disease, symptomatic improvement is achieved with prokinetic agents, more severe GI manifestations of scleroderma may be difficult to treat, leading to parenteral feeding and hospitalization. Recently, a new serotonin (5-HT4) receptor agonist prucalopride was shown to have remarkable prokinetic properties, resulting in symptomatic improvement and increased frequency of defecation in patients with chronic functional constipation. Here we report two cases of scleroderma with GI manifestation in which previous prokinetic treatment failed, but where the patients were successfully treated with prucalopride. Our data suggest that prucalopride may be a promising and effective drug to treat GI motility disorders in scleroderma. However, further placebo-controlled double blind studies are needed for full documentation of the usefulness of prucalopride in patients with scleroderma.

Oral antimony intoxications in man.

Four cases of acute oral antimony intoxication are reported. Three patients survived without sequelae. One patient, a 93-yr-old male, died from multiple organ failure. Toxicological analysis of blood, urine, and tissues revealed a severe intoxication.

Incidence and etiology of rhinosinusitis in children.

The authors discuss the incidence of chronic rhinosinusitis in children. From the study of 196 CT-scans, there follows that as well the ethmoidal as the maxillary sinuses are involved in the young child. In older children, however, the incidence of maxillary sinusitis is more frequent. The etiology of chronic rhinosinusitis is discussed stressing the importance of general factors such as environmental factors, congenital and acquired abnormalities and the influence of drugs, as well as of local factors such as again environmental factors, malformations, and upper respiratory infections. Most of these factors are discussed following personal studies.

Prognostic value of gastric intramural pH in surgical intensive care patients.

Gastric intramural pH (pHi), which has been shown to reflect the adequacy of oxygenation in peripheral tissue beds, was measured in acutely ill surgical patients in order to evaluate its value as a prognostic factor and its relation to the sepsis score. Fifty-nine surgical patients were studied on ICU admission. The stomach wall pH was calculated from the PCO2 in gastric juice and arterial bicarbonate concentration using the Henderson-Hasselbalch equation. A fall in tissue pH less than 7.32 was taken as an indication of inadequate tissue oxygenation. Patients with sepsis scores greater than 10 were considered septic. Hospital and short-term (within 72 h of admission) mortality rates were determined. A significantly higher short-term mortality rate was observed in patients having a pHi less than 7.32 (37% vs. 0%, p less than .005). Most (90%) of the septic patients had a pHi less than 7.32. The short-term mortality rate was the highest (50%) in the septic group. In this group also, a linear correlation was found between pHi and the sepsis score (r = -.43, p less than .01). Gastric pHi, however, offered no prediction for the long-term outcome.