Ridge augmentation with guided bone regeneration and GTAM case illustrations.

The principle of Guided Bone Regeneration (GBR) can be used for Ridge Augmentation. These case illustrations describe the technique using Autogenous Cortico-Cancellous Bone Grafts and stabilization with Miniscrews and placement of a GTAM Barrier Membrane. Nyman et al (1990) published the first report of enlargement of a reduced alveolar ridge. Becker & Becker, Jovanovic, Buser et al have documented successful regeneration of such ridges. A study by Lang et al established that: 1. An undisturbed healing period of at least six months is required for optimal bone regeneration. 2. Smaller defects (less than 70 mm.3) regenerate almost completely. 3. Larger defects (greater than 90 mm.3) regenerate 90-93 percent and bone grafts may enhance success in larger defects. 4. Premature membrane removal will result in incomplete regeneration. Buser et al have described the technique of GBR in detail. They found the creation and maintenance of a secluded space is essential for successful outcome with GBR procedures. This space allows for the in growth of osteogenic cells so that bone regeneration is undisturbed by competing non-osteogenic soft tissue cells. Space-making defects such as extraction sockets are simple to treat, but localized ridge augmentation may be difficult because the membrane is not supported by bony walls. E-PTFE membranes have been reinforced with titanium struts and mini screws have been developed as a way of dealing with membrane collapse. Buser et al began to utilize autogenous bone grafts to support the membrane and to act as an osseoinductive scaffold for bone regeneration. They utilized a cortico-cancellous block graft in the centre of the augmentative area with smaller chips to fill in the periphery. The cortical portion of the graft re-establishes the buccal cortex and the cancellous portion is placed against the host bone. The host bone is perforated to open the marrow spaces. Placement of membrane protects the bone graft (up to 50 percent of grafted bone is lost through resorption in augmentation procedures where membrane is not used).

Recognition and management of occlusal disease from a hygienist's perspective.

Dental disease can be described as a permanent alteration of loss or function of those parts generally cared for by dentists. Specifically, these include the teeth, periodontal tissues and associated dental structures. Historically the breakdown and subsequent loss of tooth structure was caused by dental caries. It has also been observed that tooth loss can result from overuse-abuse referred to as bruxism or bruxamania.

Use of tetracycline fibre to treat localized unstable periodontitis.

Tetracycline fibre cords will be introduced in Canada in January 1996. Presently it is used in the United States and the placement of the fibres is included within the dental hygienists's scope of practice in many states. Dental Hygienists in each province may want to request that this procedure be added to the list of duties they may perform within their scope of practice. (Although tetracycline cords are not yet available in Canada, some offices have been permitted to use these products on a trial basis. Presuming they will soon be available in Canada, the author suggests they would be a valuable adjunct in periodontal therapy.

Acute periodontal abscess associated with an immediate implant site in the maintenance phase: a case report.

This article describes a complication that occurred with root-form implants: an acute periodontal abscess associated with an implant during the maintenance phase. The clinical treatment is outlined, as are the results achieved.

Preoperative insurance status influences postoperative complication rates for gastric bypass.

One hundred morbidly obese patients who had gastric bypass surgery were studied to determine how various demographic and medical variables affected complication rates, weight loss, and reduction in comorbidities associated with obesity. During the follow-up period (range: 12 to 59 months), 42 patients developed at least 1 complication. Twenty-three patients developed postoperative medical complications, 9 developed psychiatric complications, and 24 developed complications related to food ingestion. No significant relationships were observed between outcome and age, sex, age of obesity onset, or associated medical disorders. Striking differences in outcome were noted, however, when patients were contrasted according to their preoperative insurance status. Patients dependent on medical assistance, social security disability, or workman's compensation (publicly funded group) (n = 40) developed significantly more medical and psychiatric complications than did those (n = 60) who had private medical insurance (p less than 0.02). Despite the higher complication rate, both groups had the same average weight loss (44.9 +/- 15.3 kg for the publicly funded group versus 43.1 +/- 12.9 kg for those with private insurance) and similar reductions in percent excess weight (66.0 +/- 18.4% versus 75.7 +/- 23.0%) during the first postoperative year. All patients also had similar reductions in medication requirements for hypertension, diabetes, and degenerative joint disease. Additionally, 45% of the publicly funded insurance group who either received public welfare (n = 26) or disability benefits (n = 14) preoperatively were able to attain either full-time or part-time employment postoperatively which allowed them to decrease their level of support (58% and 21%, respectively). Forty-six percent of women in the private insurance group who were not working outside the home also began part-time or full-time employment postoperatively. All patients who were working preoperatively continued to work. These data suggest that although the risks associated with gastric bypass surgery are greater in patients dependent on public funding, these patients benefit significantly from the surgery.

Pharmacologic and psychotherapeutic issues in coexistent paranoid schizophrenia and narcolepsy: case report.

The case of a 32-year-old man with schizophrenia and narcolepsy, two seemingly unrelated disorders, is discussed from the perspective of the diagnostic and therapeutic challenges raised by their coexistence. In addition, the development of tardive dyskinesia and its subsequent amelioration with a depot form of a high-potency neuroleptic are discussed in relation to these disorders. Consistent and supportive psychotherapy for such patients is recommended for maintaining compliance, for pharmacotherapy, and an optimal level of personal, occupational, and interpersonal functioning.