bluuebunny/crossref_metadata_2025 huggingface dataset:
Complicated eyelid reconstruction after an unusual glabellar flap repair
Authors: Bajaj M. S. , Sethi Anita
Published: March 2003

ABSTRACT. Remote flaps may be used for lid reconstruction when tissue loss is extensive and there is insufficient tissue in the adjoining areas. Median forehead flaps are usually used for upper lid, medial canthal or nasal repairs. We describe a complicated reconstruction of the lid and correction of a deformity which resulted from the injudicious use of a glabellar flap for lower lid repair.

Improper use of a median forehead flap may interfere with the functioning of the lid, leading to corneal exposure and poor cosmesis. Lower lid defects are better repaired by advancement flaps or techniques like Tenzel's semicircular flap, reverse Cutler Beard, Hughes procedure or Mustarde's repair.
Conjunctival papilloma
Authors: Sjö Nicolai , Heegaard Steffen , Prause Jan Ulrik
Published: March 2003

Purpose: To determine morphological and clinical characteristics of conjunctival papilloma.

Methods: Specimens of conjunctival papilloma registered during the period 1983–1997 were collected. For each case the patient's sex and age, number of papillomas/patient, seasonal debut, duration, number of recurrences, localisation and presence of dysplasia and/or inflammation in the papilloma were registered.

Results: A total of 245 papillomas in 219 patients were found. 132 (60.3%) of the patients were males. The age distribution showed skewness to the left with a peak in the age groups 20–29 years and 30–39 years. No variation of seasonal debut was found. 14 patients (6%) had more than one papilloma concurrently. 24 (11%) of the patients had recurrence. Most of the papillomas were located medially and inferiorly. 98 (40%) of the papillomas were inflamed. 14 (6%) of the papillomas were dysplastic.

Conclusion: The conjunctival papilloma is a common tumour. More males than females develop conjunctival papillomas and the incidence is highest among patients aged 20–39 years. The conjunctival papilloma is primarily located medially and inferiorly.
Epithelial changes in early primary herpes simplex virus keratitis. Photomicrographic observations in a case of human infection
Authors: Tabery Helena M.
Published: March 2003

Purpose: To report the morphology of early corneal epithelial changes in primary herpes simplex virus type 1 (HSV 1), and to compare it to that of recurrent HSV 1 and adenovirus keratitis.

Methods: A 23‐year‐old man examined with the slit lamp and photographed by non‐contact in vivo photomicrography.

Results: 3 days after onset the cornea showed myriads of clear epithelial vesicles, two rounded limbal epithelial foci, and scattered, faintly discernible incipient ones. On day 5 several partly confluent foci, and on day 6 typical HSV dendrites were present. HSV 1 was isolated. Serological tests confirmed primary disease.

Conclusion: The early stage of primary HSV epithelial keratitis differed from recurrent disease by the presence of large numbers of clear vesicles. The photographs, however, captured similar early changes as in recurrent disease, and the subsequent development followed the same pattern. The main sign differentiating primary HSV from adenovirus infections was the early presence of epithelial foci with ulcerative features.
Diode laser photocoagulation of choroidal neovascularization associated with retinal pigment epithelial detachment
Authors: Gomez‐Ulla Francisco , Gonzalez Francisco , Abelenda Dolores , Rodríguez‐Cid María José
Published: March 2003

Aims/Background:

Association of choroidal neovascularization with pigment epithelial detachment is not an uncommon feature. Since this condition usually has a poor visual outcome, new treatments should be developed.

Methods: We studied the anatomical and visual results of 11 eyes with this association as a manifestation of an Exudative Age Related Macular Degeneration which were treated with diode laser photocoagulation guided by indocyanine green angiography. The average follow up time was 25.5 months (from 12 to 48 months).

Results: Complete closure with complete resolution of the exudates and flattening of the detachment was observed in five eyes (45%). Visual acuity in the final examination improved or remained stable in 6 cases (55%).

Conclusion: These results indicate that diode laser photocoagulation guided by indocyanine green angiography is at least as effective as conventional lasers with shorter wavelengths for treatment of vascularized pigment epithelial detachments in Age Related Macular Degeneration.
Cortical lens opacification in Iceland
Authors: Katoh Nobuyo , Jonasson Fridbert , Sasaki Hiroshi , Kojima Masami , Ono Masaji , Takahashi Nobuo , Sasaki Kazuyuki ,   Reykjavik Eye Study Group
Published: March 2003

ABSTRACT. Purpose: Cortical lens opacification has been associated with outdoor exposure and UV radiation more than other types of lens opacification. We studied risk factors for cortical lens opacification only, the most common as well as the earliest age related change we observe in the lens.

Methods: 1,045 persons, 583 females and 462 males, 50 years and older, underwent a detailed eye examination and answered a questionnaire. Participants with cortical lens opacification grade I, totalling 374 persons, were assigned to case‐control study I, and to case‐control study II those with cortical lens opacification grades II and III, totalling 82 subjects. 378 age and sex matched persons served as controls.

Results: Those who spent more than 4 hours/day outside on weekdays, in their 20’s–30’s and 40’s–50’s respectively, were found to have increased risk of moderate to severe cortical lens opacification. Thus the relative risk for grades II & III, was 2.80 (95% CI 1.01–7.80) and 2.91 (95% CI 1.13–9.62) respectively. Ageing and systemic cortical steroids use were also found to be risk factors.

Conclusion: Outdoor exposure appears to be associated with increased risk of moderate to severe cortical lens opacification. Ageing is, however, the main risk factor.
Interferon‐alfa treatment of facial infantile haemangiomas
Authors: Fledelius H. C. , Illum N. , Jensen H. , Prause J. U.
Published: March 2003

ABSTRACT. Purpose: To report on the efficacy of systemic Interferon‐alfa therapy in controlling the endothelial proliferation in expanding facial haemangiomas of infancy threatening the eye.

Methods: The series comprised 9 subjects with facial haemangiomas of rapid growth within the first few months of life. All haemangiomas had relation to an eyelid and affected the visual access to the eye. At least three tumours were also intraorbital, and in one case the glottis was affected. Interferon‐alfa was given subcutaneously in daily doses of 3 mio units/m2. Ophthalmic follow‐up including ultrasound evaluation was done, initially with intervals of 4–8 weeks.

Results: Interferon‐alfa was given over 9–41 weeks (median duration 22 weeks) in cumulated doses of 63–287 million units. Progression was arrrested in all and with a subsequent tumour regression considered accelerated as judged from earlier clinical giant haemangioma experience. A control series was not possible. One patient had systemic prednisone added over some weeks. Two infants reacted with a flu‐like malaise. A premature infant developed a slight spastic diplegia.

Conclusions: In the 9 infants with growing ophthalmic haemangiomas we recorded a good response to systemic Interferon‐alfa administered as daily doses by subcutaneous injection. In general the treatment appeared well tolerated. During clinical follow‐up diagnostic ultrasound evaluation (the depth dimension) proved helpful; in particular there was a sparing effect on CT and MRI scans which require general anaesthesia.
Visual evoked potentials in relation to visual acuity in macular disease
Authors: Negishi Chisako , Takasoh Michihiko , Fujimoto Naoya , Tsuyama Yoshihiko , Adachi‐Usami Emiko
Published: March 2003

ABSTRACT. Purpose: To investigate how central retinal function contributes to pattern visual evoked cortical potentials (PVECPs), we recorded transient and steady‐state PVECPs in patients with macular disease and compared the results with those of patients with optic neuritis. The results were also evaluated for correlation with visual acuity and kinetic perimetric measurements.

Methods: PVECPs to 3 rev/s stimulation (transient) and 12 rev/s stimulation (steady‐state) for check sizes 15′ and 30′ were obtained from all patients and age‐matched healthy controls. The peak latency and amplitude of the P100 component of the transient VECP and the amplitudes of the steady‐state VECP were measured and evaluated.

Results: Patients with macular disease produced significant delay of P100 latency and amplitude attenuation of the steady‐state VECP, as compared with healthy subjects. P100 latency delay was less in patients with macular disease than in those with optic neuritis, while the attenuation rate of the steady‐state VECP amplitude was similar between groups. Visual acuity was correlated with P100 latency and steady‐state VECP amplitude reduction.

Conclusions: Although the delay of latency was less in patients with macular disease than in those with optic neuritis, the electrophysiologic alterations that occur in macular disease demonstrate a potential for diagnostic value at the level of the retina.
Bilateral Coats' disease: long‐term follow up
Authors: Alexandridou Anastassia , Stavrou Panagiota
Published: March 2003

Purpose: To report on the long‐term follow‐up of a female patient with bilateral Coats' disease, who showed marked asymmetry between the two eyes.

Methods:
A five year old girl presented in 1978 with leukocoria in a blind right eye. A total exudative retinal detachment and extensive retinal telangiectasiae were noted. In the other eye, there was a localized area of retinal exudation and vascular abnormality in the supero‐temporal periphery. Ultrasonography showed no evidence of intraocular tumour in the right eye and a clinical diagnosis of bilateral Coats' disease was made.

Results: In 1995, the area or retinal exudation in the left eye increased and laser photocoagulation was applied successfully. To date, no disease recurrences have occurred.

Conclusion: Although Coats' disease is usually unilateral, bilateral, asymmetrical involvement may occur on rare occasions. Long‐term follow‐up of the least affected eye is necessary so that late complications can be identified early and treated adequately to prevent visual loss.
Screening for amblyopia and strabismus with the Lang II stereo card
Authors: Ohlsson Josefin , Villarreal Gerardo , Sjöström Anders , Abrahamsson Maths , Sjöstrand Johan
Published: March 2003

Purpose:  To evaluate the effectiveness of the Lang II stereo card as a screening test for amblyopia and/or strabismus.

Methods:  A total of 1046 children aged 12–13 years were examined in a field study in the Göteborg area, Sweden. In addition to the Lang II stereo card, the examination included visual acuity, cover testing, cycloplegic refraction, and inspection of the optical media and posterior pole.

Results:  If every incorrect subject response was considered a reason for referral, the Lang II test would have correctly identified 82% (23 subjects) of the 28 children with manifest strabismus and 38% (11 subjects) of the 29 children with amblyopia. The test failed to refer 45% (21 subjects). Of all subjects referred, 44 (63%) were found to be ophthalmologically normal.

Conclusions:  The Lang II stereo card is neither a reliable nor an efficient method of screening for amblyopia and/or strabismus.
High dose intravenous methylprednisolone pulse therapy versus oral prednisone for thyroid‐associated ophthalmopathy
Authors: Kauppinen‐Mäkelin Ritva , Karma Anni , Leinonen Eeva , Löyttyniemi Eliisa , Salonen Oili , Sane Timo , Setälä Kirsi , Viikari Jorma , Heufelder Armin , Välimäki Matti
Published: March 2003

Purpose:  To compare the effectiveness of intravenous (i.v.) methylprednisolone pulse therapy and oral prednisone when used as the initial treatment of patients with mild or moderate thyroid‐associated ophthalmopathy.

Methods:  Thirty‐three consecutive patients with thyroid‐associated ophthalmopathy in Helsinki and Turku University Hospitals were randomly assigned either i.v. methylprednisolone pulse therapy (group A, n = 18) or oral prednisone (group B, n = 15). Treatment outcomes were measured by subjective changes in the grade of diplopia and quantitatively in several ophthalmic variables at 3 and 12 months. Any decision to proceed with additional treatment at 3 months was made on clinical grounds. The study was open in respect of both the initial treatment and the need for additional therapy.

Results:  No significant differences in the grade of diplopia, proptosis or soft tissue activity scores were noted between groups A and B from 0 to 3 months. However, group A required additional forms of therapy at 3 months less frequently than did group B (p = 0.038).

Conclusions: Our data suggest that i.v. methylprednisolone pulse therapy and oral prednisone are equally effective as initial treatments for thyroid‐associated ophthalmopathy where diplopia, proptosis and signs of soft tissue inflammation are concerned. When additional treatment is required, i.v. methylprednisolone pulse therapy may be more effective than oral prednisone. However, the study's limitations meant that any decision to give additional treatment after the initial therapy was made on clinical grounds.
Effects of sympathetic denervation on the hyaluronan content of the anterior segment in the normal and traumatized rabbit eye
Authors: Koralewska‐Makár Anna , Johnsson Cecilia , Bruun Anitha , Stenevi Ulf , Ehinger Berndt
Published: March 2003

Purpose:  To determine whether there is any involvement of sympathetic nerves in the regulation of ocular hyaluronan production in the normal and traumatized rabbit iris.

Methods:  Unilateral sympathetic denervation was performed by removing the right superior cervical ganglion. Hyaluronan concentrations in the iris and aqueous were measured with a radiometric assay at various time intervals after denervation. Peripheral iridectomy was also performed in both denervated and non‐denervated eyes.

Results:  Hyaluronan concentrations in the iris tissue after denervation were observed to have increased after 1 day, reaching a peak of 129.6 ± 5.7 µg/g wet weight at day 3. Two weeks later, hyaluronan concentrations had fallen back to normal levels. Ocular trauma with peripheral iridectomy in denervated eyes caused an increase of hyaluronan content of up to 253.5 ± 30.5 µg/g wet weight, which was not significantly different from hyaluronan concentrations observed after the same trauma in non‐denervated eyes.

Conclusion:  Cervical sympathetic denervation results in a moderate increase of the hyaluronan content in the rabbit iris and does not appear to influence the hyaluronan response of the iris to trauma.
No evidence of association between GT/CA‐repeat polymorphism in the GLC1A gene promoter and primary open‐angle or exfoliation glaucoma
Authors: Sjöstrand Anna , Tomic Lidia , Larsson Lill‐Inger , Wadelius Claes
Published: March 2003

Purpose:  To investigate whether variants of the polymorphic GT/CA‐repeat in the regulatory sequences of the gene for GLC1A are associated with glaucoma. Mutations in the protein coding region of this gene are known to cause juvenile autosomal dominant glaucoma and are also found in a subset of cases with primary open‐angle glaucoma (POAG).

Methods:  Samples were collected from 197 patients with exfoliation glaucoma and 157 patients with POAG as well as from 92 healthy blood donors. The variable repeat located 342 base pairs upstream of the translational initiation site, was analysed by polymerase chain reaction (PCR) and detected on an ABI 377 DNA sequencer.

Results:  Five alleles were detected, ranging in size from 13 to 17 repeat units, the most common of which was 14 repeat units. This was present in 63.7%, 66.6% and 61.4% of the two cohorts of cases and the control group, respectively. There was no significant difference in the distribution of the alleles between the control group and the two patient groups, respectively.

Conclusion:  The present investigation provides no evidence that the variable repeat located in the regulatory sequences of the glaucoma gene GLC1A is associated with the risk of developing POAG or exfoliation glaucoma.
Primary palpebral and orbital ossification in pseudo‐pseudohypoparathyroidism
Authors: Klauber Stefan , Heegaard Steffen , Prause Jan Ulrik
Published: March 2003

Purpose:  To present a case of ossification of the eyelid, episclera and orbit in a patient with pseudo‐pseudohypoparathyroidism (pPHP).

Methods:  A 20‐year‐old woman diagnosed with pseudo‐pseudohypoparathyroidism underwent clinical and histopathological examination of calcified plaques of the right eyelid and orbit. The patient presented with a round face, tousled short hair and retarded speech. She had been diagnosed with pPHP at 3 years of age. During her first decade, calcified plaques developed in the right eyelid and orbit. Gradually, she developed horizontal diplopia, pseudo‐ptosis and periorbital pain. Vertical eye movements were reduced to 10 mm, although levator function remained intact. Computer tomography scans of the orbit showed three separate dense structures. Radiographic findings also showed bilateral shortening of the fourth metacarpus and a calcified subcutaneous plaque in the left thigh. The patient's blood status revealed an elevated level of thyroid stimulating hormone, but was otherwise normal. The patient was treated with eltroxin and shortly afterwards regained normal hair and normal speech function.

Results: The calcified structures were removed surgically and almost normal eye movements were re‐established. Histological examination of the excised tissue demonstrated bone formation.

Conclusion:  This is the first reported case of ossification of the eyelid and orbit in a patient with pseudo‐pseudohypoparathyroidism.
The short‐term IOP‐lowering effect of brimonidine 0.2% and dorzolomide 2% combination in primary open‐angle glaucoma
Authors: Ermis Sitki Samet , Ozturk Faruk , Inan Umit Ubeyt
Published: March 2003

Purpose:  To evaluate the ocular hypotensive effect of dorzolamide 2% in primary open‐angle glaucoma (POAG) patients with intraocular pressure (IOP) of at least 22 mmHg despite ongoing twice daily treatment with brimonidine 0.2%.

Patients and Methods:  Nineteen eyes of 19 patients with POAG and IOP ≥ 22 mmHg, on twice daily brimonidine therapy, were included in the study. Intraocular pressure and adverse effects were recorded on days 2, 7, 14 and 30 after adding dorzolamide three times daily to the treatment.

Results:  Mean pretreatment IOP was 27.6 ± 2.2 mmHg. This decreased to 24.2 ± 2.2 mmHg after a mean duration of 23.8 ± 12.1 days. After dorzolamide was added to the treatment, mean IOP was 20.8 ± 2.3 mmHg on day 2, 19.3 ± 2.2 mmHg on day 7, 18.0 ± 2.5 mmHg on day 14 and 17.2 ± 2.3 mmHg on day 30. The differences between pre‐ and post‐treatment IOP values were statistically significant (p < 0.0001, anova test).

Conclusion:  Dorzolamide administered three times daily has significant additive ocular hypotensive effect in POAG patients whose IOP is elevated despite ongoing treatment with brimonidine.
Transmission of prion disease
Authors: Blättler Thomas
Published: March 2003

The transmission of bovine spongiform encephalopathy to humans as variant Creutzfeldt‐Jakob disease (vCJD) has focused public attention on how prion diseases are transmitted and how prions reach the brain after exposure. Prion diseases are characterised by transmissibility and neuropathological features of gliosis, neuronal loss and microscopic vacuoles, termed spongiosis. The principal component of prions is the glycoprotein PrPSc, which is a conformational modified isoform of the normal membrane protein PrPC. How are prions transmitted and how do prions find their way once they have been ingested? Prion models in mouse and hamster point to lymphoreticular cells which support an early replication phase of prions before reaching the central nervous system via peripheral nerves. Whilst some key players seem to have been identified so far, the mechanisms of prion propagation to the brain are still not fully understood. Seemingly contradictory results have led to some confusion and have provoked discussion.
Blood infectivity in transmissible spongiform encephalopathies
Authors: Dickmeiss Ebbe , Gerstoft Jan
Published: March 2003

Blood infectivity in transmissible spongiform encephalopathies (TSE) is reviewed with special emphasis on transmission by blood transfusion in human beings. It is concluded that transmission by transfusion seems biologically plausible as regards variant Creutzfeld‐Jakob Disease (vCJD), albeit present knowledge suggests that it is extremely uncommon. Precautionary measures against the putative risk of vCJD transmission by blood transfusion are discussed.
Solitary fibrous tumor of the abdominal wall:
Authors: Huang Hsuan‐Ying , Sung Ming‐Tse , Eng Hock‐Liew , Lee Timothy Yc , Ko Sheung‐Fat , Wang Chih‐Chi , Chen Wei‐Jen
Published: March 2003

Solitary fibrous tumors have been described at many extrapleural sites in recent years. However, solitary fibrous tumors arising from somatic soft tissue occur only rarely and can pose problems in the differential diagnosis from other benign or malignant soft tissue tumors. The majority of solitary fibrous tumors occurring in the somatic soft tissue have been found in the extremities and limb girdles, and the head and neck regions. There have been only eight published cases located in the abdominal wall. We herein report two female patients who developed solitary fibrous tumors of the abdominal wall that were not in association with the underlying peritoneum. Histologically, both tumors were characterized by a variety of architectural patterns, alternating hypercellular and hypocellular areas, proliferation of plump spindle cells, thick keloid‐like and/or amianthoid collagen bundles, and ectatic staghorn‐like vessels. Both tumors showed a diffuse strong reaction for CD34 and vimentin as well as focal positivity for bcl‐2 and smooth muscle actin. A striking predominance in females was found in a literature review of solitary fibrous tumors of the abdominal wall, contrasting with other somatic soft tissue sites which show an equal gender distribution. Interestingly, expression of estrogen but not progesterone receptor was observed in both tumors. Ultrastructurally, the tumor cells displayed features of fibroblasts with dilated branching rough endoplasmic reticulum (RER) and Golgi apparatus. Both tumors assayed by flow cytometry demonstrated a diploid DNA content with an S‐phase fraction of 7.9% and 11.4%, respectively. At follow up, both patients were well without evidence of recurrence or metastasis after surgical excision.
Superficial collagenous fibroma:
Authors: Huang Hsuan‐Ying , Sung Ming‐Tse , Eng Hock‐Liew , Huang Chao‐Cheng , Huang Wan‐Ting , Chen Wei‐Jen
Published: March 2003

Collagenous fibroma (desmoplastic fibroblastoma) is an extremely rare benign soft tissue tumor of fibroblastic origin. The majority of reported cases have been located in the deep subcutis, fascia, aponeurosis, or skeletal muscle of the extremities, limb girdles, or head and neck regions. There has been no mention of underlying diseases in patients who developed this tumor. We here report an additional three cases of superficial collagenous fibroma, one of which was a dermal lesion occurring in the abdomen of a 26‐year‐old male patient with a 5‐year history of pemphigus vulgaris prior to development of the tumor. To the best of our knowledge, an association between collagenous fibroma and pemphigus vulgaris has not previously been reported. The remaining two tumors were located in the superficial subcutaneous tissue of the infrascapular area and right foot, respectively. There was no tumor recurrence or metastasis during follow up of 18, 25, and 47 months, respectively. All three tumors were well‐circumscribed and unencapsulated without infiltrating borders. Histologically, the common denominator of all three cases was paucicellular proliferation of spindle or stellate fibroblasts enmeshed within an extensively collagenous background. Immunohistochemically, there was diffuse strong staining for vimentin and intense focal reaction for smooth muscle actin in two tumors tested. Electron microscopy revealed features consistent with a fibroblastic or myofibroblastic lineage. Flow cytometry in two cases demonstrated a diploid DNA content with low S‐phase fractions, which correlated with minimal MIB‐1 nuclear labeling (less than 1%) and benign behavior of this entity.
Bone regeneration in 2 stages for retention of dental implant. A case report.
Authors: Lundgren D. , Nyman S.
Published: March 2003

This case report describes the successful rebuilding of jaw bone for the anchorage of an endosseous implant by applying the principle of “guided tissue regeneration”. The extremely reduced bone volume required reconstructive surgery in 2 stages, the 1st surgical procedure being carried out before the installation of the implant and the 2nd simultaneously with the placement of the implant. The biological prerequisites as well as technical demands for this treatment modality are discussed.
Speech before and after treatment with bridges on osseointegrated implants in the edentulous upper Jaw
Authors: Lundqvist Sture , Lohmander‐agerskov Anette , Haraldson Torgny
Published: March 2003

Speech may be affected by the transition from complete dentures to fixed prosthesis on osseointegrated implants (OIB). If so, is there any correlation between interdental spaces (open or closed) in the prosthodontic construction and deteriorated speech? 21 individuals advocated for maxillary OIB were randomised so that one half of the group got constructions with wide interdental spaces and the other half with minimised inter‐dental spaces. All patients were examined audiologically and their speech was individually tape‐recorded before and after treatment. Perceptual, acoustic, model and audiological analyses were made. Approximately 60% of the patients were judged to have indistinct speech after the treatment. The s‐sound was perceptually and acoustically distorted. 67% of the patients suffered from hearing defects. No correlation between interdental spaces (open or closed) and deteriorated speech could be found. It is supposed, that hearing plays a part in the effort to adjust speech to a new maxillary OIB, and thus reduced hearing can enhance speech difficulties.
Localized ridge augmentation using guided tissue regeneration in humans. A report of nine cases.
Authors: Cortellini P. , Bartolucci E. , Clauser C. , Pini Prato G. P.
Published: March 2003

Nine localized buccal ridge deformities were treated combining the use of barrier membranes and resorbable space‐making material. After elevating flaps, the bone defects were completely filled with calcium carbonate and a fibrin‐fibronectin sealing system (FFSS). Membranes (Gore‐Tex aug‐mentation material) were then shaped and positioned to cover the calcium carbonate overlapping the surrounding bone. The flaps were sutured, taking care to avoid any compression on the treated area. The membranes were removed 4 to 5 months postoperatively: in all cases the membranes were tightly adapted to the regenerated tissues and force was required to separate them from the underlying tissues. The defects were filled with hard, bone‐like tissue. The histology from one case, taken 1 year post‐operatively, confirmed the regeneration of bone and revealed the presence of a few residual particles of calcium carbonate in the sample. The clinical appearance of the treated areas was satisfactory for colour. texture and form. The horizontal deficiencies were almost completely resolved in all cases, while the vertical component showed incomplete filling in some cases.
Immediate transmucosal implants using the principle of guided tissue regeneration. I. Rationale, clinical procedures and 30‐month results.
Authors: Lang N. P. , Brägger U. , Hämmerle C. H. F. , Sutter F.
Published: March 2003

The installation of implants directly into extraction sockets offers considerable advantages over other treatment modalities for both practitioners and patients. Usually, immediate implants are placed and subsequently covered by mucosa allowing a submerged healing mode. This report presents the rationale, clinical procedures and results for immediate transmucosal implants. Following an intracrevicular incision and flap elevation, the tooth to be extracted is carefully luxated by means of small elevators to preserve the entire bony housing of the tooth. A titanium plasma‐sprayed implant (ITI Bonefit®) is then installed at the bottom or in the wall of the extraction socket. An expanded polytetrafluoroethylene barrier membrane (Gore‐Tex GTAM®) is tightly adapted around the implant post and over the bony margins of the alveolus. The flaps are then replaced, adapted around the neck of the implant and sutured. During nonsubmerged, transmucosal healing of the site, meticulous plaque control is performed by mechanical and chemical means. Membranes are removed after 5–7 months. Since infection was prevented, the implants obtained stability, healthy peri‐implant mucosal tissues were observed and missing bone in the alveoli regenerated. Of 21 transmucosal implants placed into fresh extraction sockets, 20 yielded complete bone fill and coverage of the entire plasma‐coated implants surface at the time of membrane removal. This documentation suggests that the immediate nonsubmerged installation of an implant into an extraction socket is a predictable treatment modality with good long‐term prognosis.
Overdentures sumorted bv two IMZ implants in the lower jaw. A retrospective study of peri‐implant tissues.
Authors: Batenburg R. H. K. , Van Oort R. P. , Reintsema H. , Brouwer T. J. , Raghoebar G. M. , Boering G.
Published: March 2003

Between 1987 and 1990, 57 edentulous patients were treated with overdentures supported by 2 endosseous IMZ implants connected by a bar in the lower jaw. The condition of the peri‐implant tissue was evaluated for a loading period ranging from 12 to 57 months (mean 30 months and median 24 months). The evaluation parameters included Plaque Index, Bleeding Index, Gingiva Index, pocket depth, dysesthesia of chin or lip, peri‐implant bone loss and loss of implants. During the healing phase prior to the construction of an overdenture, 3 implants were lost. After a healing period of 6 months, these implants were successfully replaced. During the follow‐up period, a Plaque Index ≤1 was observed in 45 patients and an abundance of plaque and calculus was observed in 1 patient. Heavy or profuse bleeding and severe gingival inflammation was observed in 3 patients. The mean pocket depth was 3.6±1.7 mm. None of the patients experienced lip or chin dysesthesia. Marginal bone loss was observed around 30 (26%) implants. From this study it is concluded that, once proper osseointegration is obtained, 2 IMZ implants connected with a bar in the lower jaw supply a proper base for the support of an overdenture; the condition of the peri‐implant tissues is steady and independent of the follow‐up time.
A comparison of the diagnostic advantages of panoramic radiography and computed tomography scanning for placement of root form dental implants
Authors: Reddy M. S. , Mayfield‐donahoo T. , Vanderven F. J. J. , Jeffcoat M. K.
Published: March 2003

This study evaluated the advantages of computed tomography (CT) in comparison to routine panoramic radiography for dental implant treatment planning. An in vitro validation study was performed to assess the accuracy of CT and panoramic radiography film images for measurement of anatomic structures and distances between anatomic structures. After correcting by a standard 25% magnification on the panoramic images, a significant difference in measurements was found between the CT and panoramic radiography images. Ten subjects requiring implants in compromised ridges were treatment planned with either CT and panoramic radiographs or panoramic radiographs alone. The ideal implant length was determined at surgery with direct digital radiography. The dentists were significantly more confident using CT and panoramic images than panoramic radiographs alone. Implant length treatment planned with panoramic radiography alone underestimated length significantly compared with the implant length determined to be ideal during surgery.whereas treatment planning with CT and panoramic radiography demonstrated no significant difference. The data indicate the CT may be of value in treatment planning for dental implants, especially when gaining maximum length is of critical importance.
Osseointegration of subperiosteal inmlant via guided tissue regeneration. A pilot study.
Authors: Hjörting‐hansen E. , Helbo M. , Aaboe M. , Gotfredsen K. , Pinholt E. M.
Published: March 2003

The principle of guided tissue regeneration was applied in an attempt to generate bone to cover a subperiosteal implant. Titanium frame works, casted on individual impressions of the anterior surface of the tibia of 4 Copenhagen White rabbits, were stabilized to the tibia by microscrews, and half of them were covered by an expanded polytetrafluoroethylene augmentation membrane. The observation period was 12 weeks. Guided bone regeneration partly covering the implants was seen at all experimental sides; on the control sides the implants were mainly embedded in fibrous tissue. Studies are in progress with the aim of reducing marked marrow space formation observed in all the regenerated areas.
Osseointegration enhanced by chemical etching of the titanium surface. A torque removal study in the rabbit.
Authors: Klokkevold Perry R. , Nishimura Russell D. , Adachi Moriyasu , Caputo Angelo
Published: March 2003

Roughened implant surfaces are thought to enhance osseointegration. Torque removal forces have been used as a biomechanical measure of anchorage or osseointegration in which the greater forces required to remove implants may be interpreted as an increase in the strength of osseointegration. The purpose of this study was to compare the torque resistance to removal of screw shaped titanium implants having an acid etched (HCl/H2SO4) surface (Osseotite®) with implants having a machined surface. Two custom screw shaped implants, 1 acid etched and the other machined, were placed into the distal femurs of 10 adult New Zealand White rabbits. These implants were 3.25 mm in diameter x 4.00 mm in length without holes, grooves or slots to resist rotation. Following a 2 month healing period, the implants were removed under reverse torque rotation with a digital torque measuring device. Two implants with the machined surface preparation failed to achieve osseointegration. All other implants were found to be anchored to bone. Resistance to torque removal was found to be 4 x greater for the implants with the acid etched surface as compared to the implants with the machined surface. The mean torque values were 20.50 ± 6.59 N cm and 4.95 ± 1.61 N cm for the acid etched and machined surfaces respectively. The results of this study suggest that chemical etching of the titanium implant surface significantly increases the strength of osseointegration as determined by resistance to reverse torque rotation.
Evaluation of postsurgical crestal bone levels adjacent to non‐submerged dental implants
Authors: Brägger Urs , Häfeli, Urs , Huber Beat , Hämmerle Christoph H. F. , Lang Niklaus P.
Published: March 2003

In most of the studies on long‐term radiographic evaluations of crestal bone levels adjacent to dental implants, no baseline radiographs taken immediately post‐surgically had been obtained.The aim of this study was to test the reproducibility of a simple radiographic method for linear measurements of changes in bone levels and to evaluate changes in crestal bone levels adjacent co non‐submerged ITI® implants 1 year following the surgical procedure. From 128 patients enrolled in a clinical and radiographic longitudinal study 40 patients also had radiographs taken immediately postsurgically. They were, however, not obtained as “identical” images. The radiographs were mounted onto slides and projected on a screen. Mesially and distally from 57 implants triplicate linear measurements of the distance implant shoulder to bone crest were taken, using known dimensions of the implants as internal reference distances. The median difference of 213 (out of 228 possible) duplicate measurements was 0.00 mm (ranging from −1.72 mm to +1.47 mm when comparing the second co the third reading). Some 81% of the double measurements were within ±0.5 mm and the precision was 0.30 mm. In the immediate postoperative radiographs the median mesial bone level was located at 2.07 mm (distally 2.19 mm) from the implant shoulder. A statistically significant amount of bone loss in the first year was observed mesially (median=−0.78 mm) and distally (0.85 mm)(Wilcoxon matched pairs signed rank test ±0.001). No statistically significant influence of the implant location, the implant length, type of the implant (screw; cylinder) was observed (Kruskal‐Wallis P>0.05).The age of the patients was not correlated significantly to the amount of bone loss observed. In conclusion, methodological limitations existed when evaluating linear bone changes in non‐identical radiographs using reference dimensions of the implants. The amount of postsurgical bone loss estimated in other studies was confirmed when using an immediate postoperative radiograph as a baseline.
Resolution of peri‐implantitis following treatment. An experimental study in the dog.
Authors: Persson Leif G. , Araújo Mauricio G. , Berglundh Tord , Gröndahl Kerstin , Lindhe Jan
Published: March 2003

The aim of the present experiment was i) to study the effect of anti‐microbial therapy of experimentally induced peri‐implantitis lesions and ii) to assess features of bone regrowth following treatment. Four beagle dogs were used. Three titanium fixtures (Brånemark System®) were installed in each quadrant of the mandible (premolars previously extracted). Abutment connection was performed 5 months later and ligature induced break‐down was initiated. The ligatures were removed when approximately 50% of the initial bone support was lost. A 3‐week antibiotic regimen (amoxi‐cillin and metronidazole) was initiated 1 month later. Two days after the start of the antibiotic administration, the experimental implant sites were exposed to local therapy. The abutments were removed and the exposed fixture surfaces were treated with an abrasive (pumice) administered via a rotating brush (left side) or cleaned with cotton pellets soaked in saline (right side). Cover screws were attached to the fixtures and the implants were submerged. Fluorochromes were injected intravenously 2 weeks, 4 weeks and 12 weeks after surgery. The animals were killed 7‐months after surgery and block biopsies of each implant site were dissected and prepared for histological analysis. The findings of the examinations disclosed that the inflammatory lesion was resolved and new bone formation had occurred in the previous defect following antimicrobial and local therapy. The amount of “re‐osseointegration” that had taken place, however, was small. Indeed, at all experimental implant sites, a thin connective tissue capsule was found to separate the implant surface from the newly formed bone.
Re‐use of implant coverscrews changes their surface properties but not clinical outcome
Authors: Schwartz Zvi , Lohmann Christoph H. , Blau Galia , Blanchard Cheryl R. , Soskolne Aubrey W. , Liu Yuhong , Cochran David L. , Dean David D. , Boyan Barbara D.
Published: March 2003

This study examined the effect of re‐using coverscrews for dental implants (Brånemark) and the influence of re‐use on clinical outcome. Nine patients, each receiving 3 implants in either the maxilla or the mandible, received 1 new coverscrew, 1 re‐used coverscrew, and a third coverscrew that had been used multiple times. In all cases, the re‐used coverscrews had been washed, mechanically cleaned, and steam‐sterilized prior to re‐implantation. Clinical outcome was assessed by X‐ray analysis of the mandible/maxilla and light microscopy of histologically prepared sections of the overlying tissue. The surfaces of the coverscrews were characterized by profilometry, scanning electron microscopy (SEM), Auger electron spectroscopy (AES), and atomic force microscopy (AFM). There was no difference in clinical outcome whether the coverscrews were new or re‐used multiple times. Histological evaluation showed no influence of re‐use on the overlying epithelial and connective tissues at the time the coverscrew was removed. Surface topography and roughness changed with increasing number of uses, but surface chemistry was virtually unchanged. SEM and AFM analyses revealed the presence of machining marks, as well as deep scratches, across the surface of the re‐used coverscrews. This study shows that coverscrews can be cleaned and re‐used without any apparent adverse affect on clinical outcome. However, the cleaning procedures, as well as the surgical procedure, change the surface characteristics. If this approach were applied to the implant itself, it might affect osseointegration.
In‐vitro assessment of a registration protocol for image guided implant dentistry
Authors: Birkfellner Wolfgang , Solar Peter , Gahleitner André , Huber Klaus , Kainberger Franz , Kettenbach Joachim , Homolka Peter , Diemling Markus , Watzek Georg , Bergmann Helmar
Published: March 2003

Abstract: In this study a computer aided navigation technique for accurate positioning of oral implants was assessed. An optical tracking system with specially designed tools for monitoring the position of surgical instruments relative to the patient was used to register 5 partially or completely edentulous jaw models. Besides the accuracy of the tracking system, the precision of localizing a specific position on 3‐dimensional preoperative imagery is governed by the registration algorithm which conveys the co‐ordinate system of the preoperative computed tomography (CT) scan to the actual patient position. Two different point‐to‐point registration algorithms were compared for their suitability for this application. The accuracy was determined separately for the localization error of the position measurement hardware (fiducial localization error – FLE) and the error as reported by the registration algorithm (fiducial registration error – FRE). The overall error of the navigation procedure was determined as the localization error of additional landmarks (steel spheres, 0.5 mm diameter) after registration (target registration error – TRE). Images of the jaw models were obtained using a high resolution CT scan (1.5 mm slice thickness, 1 mm table feed, incremental scanning, 120 kV, 150 mAs, 512 · 512 matrix, FOV 120 mm). The accuracy of the position measurement probes was 0.69±0.15 mm (FLE). Using 3 implanted fiducial markers, FRE was 0.71±0.12 mm on average and 1.00±0.13 mm maximum. TRE was found to be 1.23±0.28 mm average and 1.87±0.47 mm maximum. Increasing the number of fiducial markers to a total of 5 did not significantly improve precision. Furthermore it was found that a registration algorithm based on solving an eigenvalue problem is the superior approach for point‐to‐point matching in terms of mathematical stability. The experimental results indicate that positioning accuracy of oral implants may benefit from computer aided intraoperative navigation. The accuracy achieved compares well to the resolution of the CT scan used. Further development of point‐to‐point/point‐to‐surface registration methods and tracking hardware has the potential to improve the precision of the method even further. Our system has potential to reduce the intraoperative risk of causing damage to critical anatomic structures, to minimize the efforts in prosthetic modelling, and to simplify the task of transferring preoperative planning data precisely to the operating room in general.
Organ radiation dose assessment for conventional spiral tomography: a human cadaver study
Authors: Serhal Charbel Bou , Van Steenberghe Daniel , Bosmans Hilde , Sanderink Gerard C. H. , Quirynen Marc , Jacobs Reinhilde
Published: March 2003

Abstract: The head of a human cadaver was positioned in a Cranex TOME® multifunctional unit (Orion Corporation Soredex, Helsinki, Finland) to measure the organ radiation doses after tomographic examinations of the upper and lower edentulous jaw bone. Five consecutive examinations were carried out in the upper and lower anterior jaw regions to cover the entire frontal area, 2 in the upper and lower left premolar regions, and 3 and 4 in the upper and lower left molar regions, respectively. Each examination consisted of 4 slices with a 2 mm slice thickness. Thermoluminescent dosimeter chips were placed in the thyroid gland and bilaterally in the parotid and submandibular glands. Dosimetric measurements were repeated for the different tomographic examinations mentioned above. For spiral tomography in the maxilla, organ doses for both parotid glands were most elevated, while those for the thyroid glands were the lowest. Average doses per examination reached levels of 0.27 mGy for the right (OS) parotid gland with frontal tomography, and 3.89 mGy and 1.67 mGy for the parotid gland at tube‐side (TS) for premolar and molar tomography. For the thyroid gland, a minimal dose of ≤0.004 mGy was noticed for all examinations. For spiral tomography of the frontal area in the mandible, the OS parotid gland received the highest dose (0.77 mGy), while for an analysis of the premolar and molar areas, doses were more elevated for the TS parotid gland (1.22 mGy and 1.72 mGy, respectively). For the TS submandibular gland, organ doses were also raised, with values of 0.39 mGy for frontal, 1.31 mGy for premolar and 1.61 mGy for molar tomography. This study thus indicates that for conventional spiral tomographic examinations in the maxilla and the mandible, radiation doses for the TS submandibular and parotid glands were significantly more elevated than those to the thyroid gland. These values remain however below the organ doses previously reported for spiral CT involving both a full upper or lower jaw.
Reproducibility of peri‐implant probing using a force‐controlled probe
Authors: Eickholz Peter , Grotkamp Frank L. , Staehle Hans J. , Steveling Helmut , Mühling Joachim
Published: March 2003

Abstract: The aim of the present study was to evaluate the reproducibility of probing depth (PD) and vertical attachment level (PAL‐V) measurements at endosseous implants. Twenty partially edentulous patients who had received 44 Frialit‐2 and 30 Astra implants between 1994 and 1996 were examined. At all teeth and implants, clinical parameters (GI, PlI, PD, PAL‐V) were measured at 6 sites using the flexible plastic version of the universal explorer TPS probe. At the implants and at teeth that were in similar locations compared to the implants, PD and PAL‐V measurements were repeated. For each of the 20 probes that had been used for clinical examination of the 20 patients, the probing force was assessed using a precision balance. As a measure of intraexaminer reproducibility, the following standard deviations of single PD and PAL‐V measurements were calculated: Frialit‐2: 0.71/0.74 mm; Astra: 0.72/0.75 mm; tooth: 0.59/0.57 mm (PD/PAL‐V). Stepwise multiple regression analysis revealed implant/tooth position and GI to influence PD and PAL‐V measurement error (P<0.001). At anterior teeth, a lower variability was observed than at posterior teeth (P<0.001). PD and PAL‐V measurement error were higher at implants than at teeth and influenced by patients. The respective models explained 13% and 17% of the variability of the dependent variable (PD/PAL‐V), respectively. Intraexaminer variability of PD and PAL‐V measurements at implants tended to be higher than at teeth. Multivariate analysis of variance revealed probe and probe holder to statistically significantly (P<0.001) influence probing force. However, the differences in probing force between the various probe heads were very small. They reached a maximum of 0.054 N between probe 3 and 14 and may be looked upon as clinically irrelevant.