Cinacalcet HCI (Sensipar/Mimpara) is an effective chronic therapy for hemodialysis patients with secondary hyperparathyroidism.

AIMS: This 1-year double-blind, placebo-controlled, multicenter study evaluated the long-term safety and efficacy of cinacalcet for the treatment of secondary hyperparathyroidism in patients receiving hemodialysis. METHOD: Patients were randomly assigned in a 1:1 ratio to cinacalcet or control treatment groups. The initial dose of cinacalcet (or matching placebo) was 30 mg. Doses were titrated every 3 or 4 weeks based on the intact parathyroid hormone (iPTH) response and safety profile. Sequential doses included 30, 60, 90, 120 and 180 mg/d. Phosphate binders and vitamin D sterols were adjusted per protocol as needed to control levels of calcium and phosphorus. Efficacy and safety were compared between treatment groups among patients who completed the study (52 total weeks of treatment). Reasons for withdrawal are presented for patients who did not complete the study. RESULTS: A total of 210 patients completed 52 weeks of double-blinded treatment with cinacalcet (n = 99) or placebo (n = 111). Over the last 6 months of the study, a greater proportion of patients in the cinacalcet group than the control group achieved an iPTH level < or = 250 pg/ml (61.6 vs. 9.9%, p < 0.001) or a > or = 30% decrease in iPTH from baseline (81.8 vs. 21.6%, p < 0.001). Mean iPTH levels decreased by -47.8% in the cinacalcet group and increased by +12.9% in the control group. Mean percentage changes in other laboratory values in the cinacalcet and control groups included the following: serum calcium -6.5 vs. +0.9% (p < 0.001), serum phosphorus -3.6 vs. -1.1% (p = 0.465), and Ca x P -9.9 vs. -0.3% (p = 0.006). The most commonly reported adverse events related to study drug by the investigators included nausea (13% cinacalcet, 5% control), investigator-reported hypocalcemia (11% cinacalcet, 1% control), vomiting (9% cinacalcet, 2% control), dyspepsia (5% cinacalcet, 4% control), and diarrhea (5% cinacalcet, 2% control). CONCLUSIONS: Treatment with cinacalcet is a safe and effective therapy for long-term control of secondary hyperparathyroidism. 1-year therapy with cinacalcet was associated with sustained, clinically significant reductions in calcium, Ca x P and iPTH which allowed a greater percentage of patients to achieve NKF-KDOQI target goals for PTH and Ca x P.

Polycystic ovary syndrome: it's not just infertility.

Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. A careful history and physical examination should guide diagnostic testing. Slowly progressive hyperandrogenic symptoms with anovulation of peripubertal onset often represent polycystic ovary syndrome. Treatment goals include symptom management and the identification and prevention of potential cardiovascular risks. Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.

Diabetes guidelines: a summary and comparison of the recommendations of the American Diabetes Association, Veterans Health Administration, and American Association of Clinical Endocrinologists.

OBJECTIVE: This paper summarizes and compares 3 major organizations' guidelines for the management of diabetes mellitus. BACKGROUND: Diabetes mellitus is a chronic disease that affects >16 million Americans. A decrease in adverse events has been demonstrated when hyperglycemia and comorbid conditions such as hypertension and dyslipidemia are controlled in patients with diabetes. Although each patient with diabetes is unique and medical care should be tailored to his or her individual needs, clinical evidence and expert opinion have established a baseline level of care for all patients with diabetes. Guidelines have been created to guide practitioners in selecting appropriate care, but their length and complexity may serve as barriers to their use. METHODS: The diabetes management guidelines of the American Diabetes Association (ADA), Veterans Health Administration (VA), and American Association of Clinical Endocrinologists (AACE) are summarized and compared in both text and tabular form. CONCLUSION: Although the guidelines published by the ADA, VA, and AACE vary slightly, all of them can be used to ensure that patients with diabetes receive appropriate care.

Width/length ratios of normal clinical crowns of the maxillary anterior dentition in man.

The purpose of this investigation was to analyze the clinical crown of the 3 tooth groups of the maxillary anterior sextant of the permanent dentition of normal subjects with respect to (i) width, length and the width/length ratios and (ii) determine if there is a correlation between tooth dimensions or tooth group ratios and subject height. Subjects (> or = 20 y.o.) were recruited for this study if (i) the free gingival margin on the facial surface of teeth in the maxillary sextant was positioned apical to the cervical bulge, (ii) there was no evidence of attachment loss; as determined by lack of a detectable CEJ and (iii) the marginal tissue was knife edged in form, firm in consistency and coral pink in color. Teeth were excluded if (i) there was evidence of gingival alteration, i.e., gingival overgrowth/hyperplasia, inflammation, altered passive eruption, attachment loss, gingival recession or history of periodontal surgery, or (ii) there was evidence or history of incisal edge/proximal tooth alteration as in, i.e., restorative intervention, traumatic injury or occlusal wear into dentin. At least 1 suitable tooth from each tooth group of the maxillary anterior dentition had to be present. A maxillary impression was taken and poured in yellow die stone. The widest mesial-distal portion and the longest apical-coronal portion of the test teeth were measured. Gender, ethnicity and subject height (SH) were recorded for each participant. Due to a limited ethnic diversity only data from the Caucasian group were analyzed. The mean coronal tooth width (mm) of males versus females was CI: 8.59 versus 8.06, LI: 6.59 versus 6.13 and CA: 7.64 versus 07.15. The mean coronal tooth length (mm) of males versus females was CI: 10.19 versus 9.39, LI: 8.70 versus 7.79 and CA: 10.06 versus 8.89. All width and length measures were significantly greater for males than for females. The mean coronal tooth width/length ratios for males versus females was CI: 0.85 versus 0.86, LI: 0.76 versus 0.79 and CA: 0.77 versus 0.81. A comparison between genders of the width/length ratios of the CI and LI were found not to differ, however the CA ratio for females was significantly greater than for males. A statistically significant difference was found to exist between the mean (cm) SH for males versus females: 181.2 versus 164.0. A positive correlation (p < or = 0.0001 to 0.0691) was found to exist between tooth group width/height ratios within genders. No significant correlation was found between any of the tooth dimensions or tooth group ratios and SH. The results of this study indicate that within male and female Caucasians, the mean width/length ratio of the maxillary 3 anterior tooth groups is 0.81. As well, within both genders there is a positive correlation between tooth group width/length ratios. The significance of these findings with respect to periodontal mucogingival plastic surgical procedures is discussed.

Diabetes patient education.

Not all medical practices are equipped to provide diabetes self-management training. Physicians can incorporate a team approach in their practice by establishing collaborative relationships with recognized diabetes education programs. The ADA's education recognition program has identified diabetes education programs that meet the National Standards for Diabetes Self-Management Education Programs. This list is available on the ADA's web site at http://www.diabetes.org/recognition and is printed twice a year in Diabetes Forecast. The National Certification Board for Diabetes Educators (NDEA) can provide a list of CDEs in your area. The South Carolina Model Diabetes Patient Education Program of DSC and SCDCP/DHEC is an excellent critical step towards obtaining ADA recognition.

A relationship between proteinase activity and clinical parameters in the treatment of periodontal disease.

The objective of this research was to determine the effectiveness of a biochemical assay which measures proteolytic enzyme activity in gingival crevicular fluid (GCF) and to relate this enzyme activity to clinical parameters traditionally utilized for periodontitis detection. A clinical trial was conducted on 8 periodontitis subjects with > or =4 sites exhibiting a loss of attachment of > or =5 mm and probing depths of > or =5 mm with bleeding on probing. On each subject, a plaque index was performed, followed by GCF sampling at those sites which exhibited a loss of attachment and probing depths. GCF was analyzed for activity against benzoyl-L-arginine-p-nitroanilide in the presence (BAPNA w/gly-gly) and the absence (BAPNA w/o gly-gly) of glycyl-glycine and against MeOSuc-Ala-Ala-Pro-Val-pNA and Suc-Ala-Ala-Pro-Phe-pNA for neutrophil serine proteinases activity (elastase and cathepsin G, respectively). Subsequently, a gingival index was performed, attachment levels and probing depths were recorded using a constant force probe with bleeding on probing being noted. A split-mouth design was employed and half mouths were randomly assigned to the following treatment groups: group A, half of the mouth received scaling/root planing and polishing: group B, half of the mouth received no treatment (control). Subjects were treated, then instructed on toothbrushing and interdental cleaning. After 4 weeks, subjects returned to receive a plaque index; GCF sampling, gingival index, attachment levels, probing depths and bleeding on probing as described above. Using a paired Student t-test, the findings suggest that BAPNA w/gly-gly was significantly less in treatment sites than in non-treated control sites (p=0.05). No such correlation was found for other activities, including neutrophil serine proteinases which were shown to occur in GCF in free, proteolytically active forms. In addition, significant treatment effects were detected for probing depths (p= 0.03) which reduced by 1.3 mm and attachment levels (p=0.02) which gained 0.7 mm. The reduction of P. gingivalis from treated periodontitis sites as detected by a significant decrease in BAPNA w/ gly-gly may prove to be a valuable marker for periodontal disease activity.

Tetracycline demineralization of dentin: the effects of concentration and application time.

The current investigation was initiated to study the effect concentration and application time has on the rate of tetracycline demineralization of dentin. Buccal and lingual surfaces of extracted bovine molars were ground to a smooth flat dentin surface using wetted silicon carbide discs. Standardized depressions were made in the dentin surface with a #909-055 diamond round wheel. Fresh tetracycline HCl (TTC-HCl) (Flavine Int. Inc.) solutions, i.e., 0, 25, 50, 75, 100, 125 and 150 mg/ml were prepared. A 30% citric acid solution was used as a positive control. The pH of each solution was recorded. 7 microl of each solution were pipetted into a depression and remained undisturbed for 1, 3, or 5 min. At the end of each application time period a fresh #3 cotton pellet was placed in the depression, once every 20 s for 1 min, to soak up the solution. The 3 pellets were placed in a 2.00 ml of 18 M omega H2O sample. As a measure of the rate of demineralization, the parts per million calcium (ppm Ca++) found in each sample were determined using atomic absorption spectrophotometry. Two-way analysis of variance was used to determine effects of TTC-HCI concentration and time on the rate of demineralization. No significant differences were found in the mean ppm Ca++ released at 1-, 3- and 5-min application times for 0, 25, or 50 mg/ml TTC. No significant differences were found in the mean ppm Ca++ released (i) between 3- and 5-min application times for 75, 100, 125 and 150 mg/ml TTC-HCl solutions and (ii) between 75, 100, 125 and 150 mg/ml TTC-HCl solutions within either the 3- or 5-min application times. The mean ppm Ca++ released at 3- and 5-min application times for 75, 100, 125 and 150 mg/ml TTC-HCI solutions were all significantly greater than the respective readings at the 1-min application time. The mean ppm Ca++ recorded for the 30% citric acid solution for all 3 application times were 3 to 5.5 x greater than the highest mean ppm Ca++ recording for TTC-HCl. The results of this study show that a 3-min application time of 75 mg/ml TTC-HCl solution is equally as effective at demineralizing dentin as is higher concentrations and/or longer application times, but was far less effective than a 30% citric acid solution.

Citric acid demineralization of cementum and dentin: the effect of the storage medium.

The purpose of this study was to see if the root surface topography of teeth, stored in saline and subsequently treated with citric acid, differred from the root surface topography of teeth that were treated immediately upon extraction, 12 freshly extracted adult human permanent teeth, with proximal surfaces free of caries and periodontal disease, were treated in succession. The crowns were removed at the level of periodontal attachment, the teeth sectioned buccal-lingually and a treatment area deligniated on each proximal section. The treatment area of 6 teeth was root planed to expose dentin (D) and scaled to remove adherent tissue and leave a cementum surfaces (C) on the other 6 teeth. A coronal-apical groove down the middle of the treatment area divided it into approximately equal parts or experimental regions. One proximal section of each tooth was placed in physiologic saline (S) and treated after 6 weeks of storage while the other proximal section was freshly treated (F). Treatment consisted of applying a 30% citric acid (CA) solution (pH = 1.60) for 5 min. Cotton pellets soaked in the citric acid solution were placed (P) on one half of the experimental area and heavily burnished (B) on the other half. Treatment areas were subsequently prepared for scanning electron microscopy analysis. Assessment was made of (i) the % of surface area tufted, (ii) fibril tufting depth (0.3) and (iii) fibril tufting density (1.3). Similarities were found in the data for both storage methods (F and S) across each application technique (P or B) and each tooth surface (D or C) with respect to the (i) % area tufted and (ii) frequency distribution of tufting depth scores. As for the application techniques, the data for burnishing was greater than placed across each storage method (F or S) and each tooth surface (D or C) for the same two parameters. The results of the study indicated that 6-week physiologic saline storage does not affect root surface demineralization by citric acid, as assessed by SEM.

Tooth thickness at the furcation entrance of lower molars.

Better understanding of the furcation anatomy may serve to decrease the risk of pulpal injury during rotary odontoplasty, a procedure often used in conjunction with guided tissue regeneration. The purpose of this study was to determine (i) the tooth thickness about the furcation entrance of lower molars, and (ii) whether there is a relationship between tooth thickness and patient age. 40 mandibular 1st molars (M1) (mean age = 36.2; range 10-65 years) and 40 mandibular 2nd molars (M2) (mean age = 37.9; range 14-70 years) were collected. Age, gender and furcation involvement (if any) were noted for each tooth at the time of extraction. Teeth were sectioned in half, buccal-lingual, at the furcation entrance with a rotary diamond blade. A standardized linear reference scale was placed on each experimental section and an 8 x 10 in. photograph generated. The distance from the floor of the pulp chamber to 5 predetermined sites on the root surface was calculated. The data were expressed as (a) the mean of each site and (b) the mean of each tooth (the average of the 5 points of each tooth). Analysis of covariance failed to show a relationship between thickness measurements and gender or furcation involvement. Thus, the data was subjected to simple regression analysis to determine the relationship of age with tooth and cementum thickness. This study revealed that by site, the mean measurements ranged from 2.7-3.0 mm for both M1 and M2. The single least/greatest measurements of the 5 sites were for M1: 1.6/4.7 mm and for M2: 1.8/4.2 mm. By tooth, the average distance from the pulp to the root surface was 2.83 mm (+/- 0.49) for M1 and 2.88 mm (+/- 0.44) for M2. Regression analysis of tooth thickness with age was significant for M1 only. The maximum slope of the 5 sites was approximately 0.3 mm/10 years. No relationship was found between cementum thickness and age for either tooth group. The results of this study indicate that the majority of times the pulp is 1.6-4.2 mm from the root surface in the vicinity of the furcation entrance of lower 1st and 2nd molars. Although tooth thickness in this area may increase with age, the amount is not enough to forego judicious odontoplasty on older patients.

Porphyromonas gingivalis endotoxin affinity for dental ceramics.

This study evaluated the effects of chemical composition, surface treatment, and initial exposure dose on Porphyromonas gingivalis lipopolysaccharide adherence to and elution from dental ceramics. Lipopolysaccharide, commonly known as endotoxin, can initiate a variety of biologic responses. Opaque, body, and Dicor ceramic disks were individually exposed to 250, 1000, or 2500 EU/ml 3H-lipopolysaccharide and incubated for 24 hours at 37 degrees C. Disks were then transferred to fresh lipopolysaccharide-free water and incubated for up to 96 hours to evaluate elution. Mean initial lipopolysaccharide adherence ranged from 0.397 +/- 0.048 EU/mm2 to 5.056 +/- 0.117 EU/mm2. Greater initial exposure levels resulted in greater adherence, and at higher lipopolysaccharide exposure levels, lipopolysaccharide adherence differences were based on ceramic type. Mean lipopolysaccharide elution levels ranged from 0.063 +/- 0.02 EU/mm2 to 0.00 EU/mm2 at 96 hours for all groups. Greater initial adherence resulted in greater elution. Ceramic type did not affect elution. Surface finish affected elution at the 2500 EU exposure level. The affinity of lipopolysaccharide for dental ceramics could contribute to a periodontal inflammatory process.

Citric acid demineralization of cementum and dentin: the effect of application pressure.

Previous work has shown that a 25-30% citric acid solution was the most effective concentration with which to demineralize dentin. The purpose of this investigation was to study the topography, using a scanning electron microscope, of root surfaces treated with a 30% citric acid solution using various application pressures. 20 freshly extracted human teeth were collected and stored in physiologic saline at room temperature. 3 root specimens, approximately 3x5x5 mm in size, were prepared from the coronal periodontally healthy area of each tooth. 30 specimens were root planed to expose dentin (dentin group) while the remaining 30 specimens were lightly scaled to remove periodontal soft tissue (cementum group). A freshly made 30% citric acid (CA) solution, (pH = 1.60), was applied to each of the experimental areas. Cotton pellets soaked in the citric acid solution were either placed (CAP), lightly rubbed (CAR) or heavily burnished (CAB) on the prepared root surface for 3 min. Pellets were resoaked every 30 s. The root sections were rinsed, fixed in glutaraldehyde, dehydrated in graded ethanol, critically point dried in liquid CO2 and sputter coated in gold. The treated surfaces were assessed for fibril tufting using scanning electron microscopy. Assessment was made of: (i) the % of surface area tufted; (ii) tufting depth (0-3); (iii) tufting density (1-3). Results of the study showed significantly more tufted surface area and greater tufting depth on both dentin and cementum for CAR and CAB compared to CAP. CAP produced a flat/mat fibril surface with no evidence of tufting.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of home bleaching on the tissues of the oral cavity.

Eight subjects used a 10 per cent carbamide peroxide (Opalesence) home bleaching system in a mouthguard for 14 nights. Their periodontal health was assessed by measuring gingival crevicular fluid flow with a Periotron 6000, and subjects were given a questionnaire to assess the effects of the bleaching system. There was no significant change in the gingival crevicular fluid flow, recession, bleeding index or plaque index of any patient during the treatment phase. All treated teeth were lightened, and mild transient tooth sensitivity was common to all participants. One subject experienced internal tooth discoloration, possibly due to marginal leakage around an amalgam restoration.

Epithelial remnants in the crestal periodontium of the deciduous and permanent dentition of beagle dogs.

The purpose of this study was to document and characterize epithelial remnants (EPRs) of the crestal periodontium of the deciduous dentition of a diphyodont and compare them with EPR units found in the corresponding area of the permanent dentition. 7 beagle dogs were used. At the age of 10 weeks (deciduous dentition) and 15 months (permanent dentition), respectively, a 6-week plaque control period was initiated. At the end of each plaque control period, biopsies were obtained from the mandibular 02P, 03P (deciduous dentition) and P3, P4 (permanent dentition) premolar regions and prepared for histologic analysis. 2 regions, (1) the supracrestal region and (2) the periodontal ligament region, were identified. The supracrestal region was divided into 4 compartments of equal height. The histologic parameters studied included the (i) EPR frequency: number of EPRs/mm of root length, (ii) EPR size, (iii) EPR-root distance, (iv) EPR-bone distance and (v) cell area. No differences were observed between the 2 dentitions with respect to the number, size and relative location of EPR units in the supracrestal regions or the periodontal ligament regions. Epithelial remnants of the supracrestal region in both dentitions tended to be more frequent, larger and positioned further from the root surface than the EPRs of the periodontal ligament region. EPR units of the periodontal ligament region were located significantly further from the bone in the deciduous dentition than in the permanent dentition. The cell area of EPRs did not differ between the 2 dentitions.(ABSTRACT TRUNCATED AT 250 WORDS)

Dentin demineralization. The effects of citric acid concentration and application time.

Preliminary work has shown that the rate of dentin demineralization increases with increasing concentrations of citric acid. This rate subsequently diminishes at much higher concentrations. The purpose of this study was to more precisely identify the citric acid concentration which produces peak dentin demineralization and to determine if this demineralization process is time dependent. Flat dentin surfaces were prepared on the buccal and lingual sides of 15 bovine molars. 8 depressions were made in each dentin surface using a #8 round bur in a high-speed handpiece with air-water coolant. Various concentrations of citric acid solutions (weight per cent) were prepared, e.g., 0%, 10%, 20%, 25%, 30%, 35%, 40%, 65% and their respective pH's recorded. 3 microliters of each citric acid solution were placed in individual depressions on the dentin surfaces and left undisturbed for 1, 2 or 3 min. Cotton pellets were used to soak up the citric acid solution, along with any dissolved calcium, and were subsequently placed in 10 ml of 18 Me omega water. The parts per million calcium found in each water sample were determined using atomic absorption spectrophotometry. Peak dentin demineralization for 1-, 2- and 3-min application times occurred at 30% (pH = 1.55), 25% (pH = 1.62) and 25% (pH = 1.62) citric acid concentrations/(pH), respectively. Dentin demineralization was found to be time-dependent for all citric acid solution concentrations. The clinical significance of these findings is discussed.

Epithelial remnants in the crestal periodontium of the dog.

The purpose of this study was to access the effect of age on the epithelial remnants (EPRs) of the crestal periodontal tissues of beagle dogs. The material consisted of 10 beagle dogs; 5 were 1-year-old (young dogs) and 5 were 9-years-old (old dogs). All animals belonged to the same dog colony and had been raised under similar conditions. Since birth, the dogs had been subjected to professional prophylaxis 4x /per year. Biopsies were obtained from the mandibular 3rd and 4th premolar regions and were prepared for histologic analysis. 2 areas, (1) the supracrestal region and (2) the marginal periodontal ligament region, were identified. The supracrestal region was further divided into 4 compartments of equal height. The histologic parameters studied included: the (i) number of EPRs/mm root length; EPR frequency; (ii) size of EPR; (iii) distance between the root surface and the EPR; (iv) distance between the alveolar bone and the EPR; (v) epithelial cell area. The supracrestal region (total and various compartments) of old dogs harbored significantly fewer yet larger EPRs than epithelial remnants of young dogs. Similarly, the EPR's of the periodontal ligament region were significantly larger and closer to the root surface in old dogs compared to young dogs. No difference was noted in the cell area of EPRs between young and old dogs for either region. Epithelial remnants of the supracrestal region in both groups of dogs were somewhat more frequent, larger and positioned further from the root surface than the EPRs of the periodontal ligament region.(ABSTRACT TRUNCATED AT 250 WORDS)

Surface topography of demineralized dentin preceded by formalin fixation.

Formalin treatment of dentin, prior to burnishing demineralization, results in a "tufted" collagen surface that may optimize bonding of hydroxyethyl methacrylate dentinal bonding agents. The purpose of this study was to determine if there is a clinically acceptable formalin treatment time that will yield a deeply tufted collagen surface. The exposed dentin of periodontally healthy and periodontally diseased human teeth was treated with formalin for various treatment times before "burnishing" demineralization with citric acid. Photographs of the specimens revealed that there was a statistically significant difference in the number of tufted surfaces found in the healthy group, as a whole, and the number found in the diseased group. No statistically significant difference was found among fixation times within either tooth group. It was concluded that 2 minutes of fixation was sufficient to produce a tufted fibrillar surface.

Considerations on the contribution of ageing to loss of periodontal tissue support.

The present study is an attempt to assess if age-related changes, manifested as loss of probing attachment and alveolar bone, occur in humans. 511 subjects, in ages 20-24, 30-34, 40-44, 50-54 and 60-64 years, were included in the study. All subjects had undergone a comprehensive clinical examination, including recordings of probing pocket depth and probing attachment level. A subsample of subjects was selected, whose periodontal status indicated minimal experience of destructive periodontal disease. In these particular subjects, the height of the alveolar bone was also assessed. The results showed that in the subsample, (i) attachment loss increased with age, but (ii) a high proportion of tooth surfaces remained with no attachment or alveolar bone loss in ages between 20 and 64 years. There are reasons to suggest, therefore, that age-related alterations in the periodontium may not inevitably be manifested as loss of probing attachment or alveolar bone.

Clinical and structural characteristics of periodontal tissues in young and old dogs.

The aim of this study was to examine some clinical and structural features of healthy periodontal tissues in young and old beagle dogs. The material consisted of 10 beagle dogs; group I (1-year old) and group II (8-9 years of age). All animals belonged to the same beagle dog colony and had been carefully monitored from birth. A given day was termed day 0 on which the teeth of all 10 dogs were scaled and polished and a 6-week period of enhanced plaque control was initiated. On day 42, clinical examinations were performed and biopsies obtained from the right mandibular 4th (4P) and 3rd (3P) premolar regions. The biopsies were prepared for histometric and morphometric analyses. Clinically, the lower premolars of the old but not the young dogs showed signs of marked wear. In the old dogs, the free gingival unit had a more curved and bulky appearance than in the young animals and in the old dogs, the free gingiva was consistently separated from the attached gingiva by a gingival groove. The histometrical dimensions of the free marginal gingiva and the width of the coronal portion of the periodontal ligament did not differ between the 2 groups of dogs. The apical cells of the junctional epithelium (aJE) in the young dogs were consistently located at the cemento-enamel junction (CEJ), whereas in the old dogs, aJE was consistently located apical to the CEJ.(ABSTRACT TRUNCATED AT 250 WORDS)

Ridge contour related to esthetics and function.

Maxillary anterior fixed prostheses may be compromised when pontics are adapted to deficient residual alveolar ridges. This study determined the effect of ridge contour on esthetics and function. Thirteen men and 17 women, 23 to 75 years of age, who had received maxillary anterior fixed prostheses during the period 1976 to 1986 participated. A six-item structured interview was conducted for each subject to determine causes of satisfaction or dissatisfaction with esthetics and function. Pontic esthetics were also determined by examination using a 12-point esthetic index that was developed and pretested for this study. Residual ridge contour was classified according to Siebert as being deficient buccolingually (I), deficient apicocoronally (II), or deficient in both areas in combination (III). The results showed that patients with class I ridges had a higher subjective level of satisfaction with their prosthesis than did those with class II or III ridges. Esthetic index scores were significantly higher (p less than 0.05) for type I (10) than for type II (7.4) or III (7.3) using a post hoc Scheffé comparison. These results suggest that consideration be given to ridge augmentation prior to construction of maxillary anterior fixed prostheses, particularly when class II or III defects are present.