bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Intensity and Outcome of Patients Aged 80 and Older in Intensive Care Units: A Multicenter Matched‐Cohort Study
Authors: Boumendil Ariane , Aegerter Philippe , Guidet Bertrand ,   the CUB‐Rea Network
Published: December 2004

Objectives: To determine whether patients aged 80 and older have similar treatment intensity to that of younger patients in the intensive care unit (ICU).

Design: Multicenter, matched‐cohort study.

Setting: Data were extracted from a multicenter database with 36 ICUs in the Paris area (France) during a 4‐year period (1997–2000).

Participants: Three thousand one hundred seventy‐five patients aged 80 and older (oldest‐old) were retrospectively matched to 3,175 patients aged 65 to 79 (young‐old).

Measurements: The matching criteria were severity status on admission (±2) (assessed using a corrected Simplified Acute Physiology Score II leaving out age points), Charlson Comorbidity Index, type of admission (surgical vs medical), sex, admission to same ICU, and year of ICU admission. The underlying condition was classified using the McCabe classification. The functional status was assessed using the Knaus classification. The ICU workload was assessed using the OMEGA scoring system.

Results: Total and daily workload were lower in the oldest‐old than in matched young‐old patients. Estimated mean direct medical cost per stay was approximately $1,280 lower for oldest‐old patients. Older patients received less mechanical ventilation (adjusted odds ratio (AOR)=0.69, 95% confidence interval (CI)=0.61–0.78), less tracheostomy (AOR=0.37, 95% CI=0.28–0.50), and less renal support (AOR=0.52, 95% CI=0.41–0.66) than matched young‐old patients. Oldest‐old patients had a shorter length of ICU stay than matched young‐old patients and the same length of post‐ICU stay.

Conclusion: Oldest‐old patients receive less treatment in the ICU than young‐old patients even after adjustment for severity of illness.
Prestorage leukoreduction and low‐temperature filtration reduce hemolysis of stored red cell concentrates
Authors: Gyongyossy‐Issa M.I.C. , Weiss S.L. , Sowemimo‐Coker S.O. , Garcez R.B. , Devine D.V.
Published: December 2004

BACKGROUND:  Universal prestorage leukoreduction in Canada created the perception that stored red cells (RBCs) are more hemolyzed than their unfiltered predecessors. A pool‐split design tested the effects of leukoreduction on hemolysis of stored RBCs.

STUDY DESIGN AND METHODS:  Two ABO‐matched units were pooled, divided, and then processed into leukoreduced (LR) and nonleukoreduced (NLR) units with the Pall LT‐WB or RC‐PL systems and sampled during standard processing and storage for testing of sterility, counts, hemolysis, and osmotic fragility.

RESULTS:  Room temperature (RT) filtration of 10 pairs of LT‐WB‐LR and ‐NLR units showed significantly different percentage of hemolysis (0.39%) and osmotic fragility (0.643%) at 42 days. Cold‐stored and ‐filtered units (2 days at 4°C before processing) were less hemolyzed, but showed a similar proportional decrease of hemolysis in LR units (0.13% vs. 0.25% at 42 days). RBCs from RC‐PL systems showed the lowest hemolysis although there was a filtration effect (0.05% vs. 0.12%, 42 days). Osmotic fragility paralleled hemolysis. Segment samples gave inaccurate results. Two‐day prefiltration cold storage reduced hemolysis from 0.36 to 0.07 percent (42 days, p < 0.001). RT‐LR hemolysis became significantly higher by Day 10 and 4°C LR by Day 12. NLR units showed hemolysis by Day 7. LR units filtered cold were less hemolyzed (p < 0.05) than RT‐LR but osmotic fragility was unchanged.

CONCLUSIONS:  LR‐RBCs prepared by any of three methods (LT‐WB, RT or cold; RC‐PL), filtered at 4°C, were less hemolyzed during storage than nonfiltered concentrates: 4°C leukoreduction is beneficial for RBCs and does not cause hemolysis or enhance fragility.
Recombinant factor VIIa for intractable blood loss after cardiac surgery: a propensity score–matched case‐control analysis
Authors: Karkouti Keyvan , Beattie W. Scott , Wijeysundera D.N. , Yau Terrence M. , McCluskey Stuart A. , Ghannam Mohammed , Sutton David , Van Rensburg Adriaan , Karski Jacek
Published: December 2004

BACKGROUND:  Cardiac surgery is occasionally complicated by massive blood loss that is refractory to standard hemostatic interventions. Recombinant factor VIIa (rF‐VIIa) is being increasingly used as rescue therapy in such cases, but little information is available on its safety and efficacy for this indication.

STUDY DESIGN AND METHODS:  The outcomes of the first 51 cardiac surgery patients who received rF‐VIIa for intractable blood loss (from November 2002 to February 2004) at a single institution according to a standardized clinical guideline were compared to 51 matched control patients, with the control patients identified from a large database and matched based on the propensity for massive blood loss.

RESULTS:  Blood loss and blood product usage were significantly decreased after 2.4 to 4.8 mg of rF‐VIIa. In those treated after sternal closure (n = 32), there was a significant reduction in blood loss from the hour before to the hour after treatment: 100 (70, 285) mL (median [25th, 75th percentiles]; p < 0.0001). Except for a slower postoperative recovery and higher incidence of acute renal dysfunction, the adverse event rates were similar between the rF‐VIIa‐treated patients and their matched controls.

CONCLUSIONS:  These results suggest that rF‐VIIa may be an effective rescue therapy for patients with intractable hemorrhage after cardiac surgery. A clinically important risk of stroke or other major thrombotic complications could not be ruled out by our study. Controlled clinical trials with adequate power to detect the impact of rF‐VIIa therapy on morbidity and mortality therefore are necessary before one can recommend its routine use in patients undergoing cardiac surgery who have excessive bleeding.
Molecular genetic methods in the diagnosis of lower respiratory tract infections
Authors: MURDOCH DAVID R.
Published: December 2004

Molecular diagnostic techniques, such as PCR, have become useful tools for the rapid etiological diagnosis of lower respiratory tract infections. Nucleic acid amplification tests (NAATs) have been evaluated for detecting most respiratory pathogens, and commercial assays are available for some pathogens. However, standardized protocols are needed before these assays are introduced into routine diagnostic use. For pneumonia, NAATs offer advantages over conventional tests for the detection of Mycoplasma pneumoniae, Legionella spp. and Chlamydia pneumoniae. For pneumococcal pneumonia in adults, PCR adds little to existing diagnostic tests, and is unable to distinguish pneumococcal colonization from infection when testing respiratory samples. Although less sensitive than culture‐based methods, several commercial molecular diagnostic assays have been developed for tuberculosis and are useful rapid tests for selected patients. PCR can now be considered the rapid diagnostic test of choice for pertussis and some respiratory virus infections. Further work is required to better characterize the role of molecular diagnostic tests for diagnosing lower respiratory tract infections, and to develop standard assays that can be readily adopted by routine diagnostic laboratories.
Molecular genetic methods in diagnosis and direct characterization of acute bacterial central nervous system infections
Authors: TAHA MUHAMED‐KHEIR , OLCÉN PER
Published: December 2004

Acute bacterial infection of the central nervous system requires rapid and adequate management. Etiological diagnosis is hence crucial. Moreover, the epidemic threat of certain bacteria necessitates a reliable characterization of the involved bacterial strains to follow the spread of epidemic strains. Conventional identification and characterization of etiological agents are basically based on culture and identification of bacterial markers most frequently by serological assays. Molecular identification and characterization of bacteria have been employed. They provide more reliable analysis of bacterial isolates. Molecular methods for non‐culture diagnosis of bacterial infections have recently been developed. In many cases, the molecular assays have decreased the identification time of positive cultures and rescued detection of pathogens in culture‐negative clinical samples.
Molecular genetic methods for diagnosis and characterisation of Chlamydia trachomatis and Neisseria gonorrhoeae: impact on epidemiological surveillance and interventions
Authors: FREDLUND HANS , FALK LARS , JURSTRAND MARGARETHA , UNEMO MAGNUS
Published: December 2004

One of the mainstays in the prevention of Chlamydia trachomatis and Neisseria gonorrhoeae infections is the availability of laboratory diagnostics with high sensitivity and specificity. Assays for diagnosis of C. trachomatis include cell culture and nucleic acid amplification tests (NAATs). The major target sequences for C. trachomatis diagnosis by NAATs are located at the cryptic plasmid and the major target used for characterisation is the omp1 gene. The gold standard for diagnosis of N. gonorrhoeae is culture. However, numerous NAATs for identification of N. gonorrhoeae and a number of molecular genetic methods for characterisation of N. gonorrhoeae have been developed. Probably no routine laboratory can attain as high sensitivity by culturing C. trachomatis or N. gonorrhoeae as by using NAATs. For that reason NAATs can be recommended for diagnosing C. trachomatis, but not as the only diagnostic assay for N. gonorrhoeae, due to lack of antibiotic susceptibility testing and specificity problems, most pronounced for pharyngeal and rectal samples. Genotyping of C. trachomatis or N. gonorrhoeae provides additional information for contact tracing. It is recommended for N. gonorrhoeae, at least in low prevalence geographic areas, but cannot today be recommended for C. trachomatis. This is due to the low genetic variability and hence the limited benefits for partner notification. However, genotyping of C. trachomatis may play an important role under special circumstances.
Application of molecular genetic methods in macrolide, lincosamide and streptogramin resistance diagnostics and in detection of drug‐resistant Mycobacterium tuberculosis
Authors: JALAVA JARI , MARTTILA HARRI
Published: December 2004

Antimicrobial susceptibility testing has traditionally been based on measurements of minimal inhibitory concentrations of antimicrobials. Molecular genetic studies on antimicrobial resistance have produced a great deal of genetic information which can be used for diagnosis of antimicrobial resistance determinants. Bacteria can acquire resistance to macrolides, lincosamides and streptogramin antibiotics by modification of the target site of the drugs, by active efflux of the drugs, and by inactivation of the drugs. The genetic backgrounds of these resistance mechanisms are well known and several molecular methods for detection of resistance determinants have been developed. Outbreaks of multidrug‐resistant tuberculosis have focused international attention on the emergence of Mycobacterium tuberculosis strains that are resistant to antimycobacterial agents. Knowledge of the antimycobacterial resistance genetics and progress in molecular methods has made it possible to develop rapid molecular methods for susceptibility testing. This review presents the genetic background of drug resistance and introduces some methods for genotypic susceptibility testing.
Molecular biology methods for the characterization of Helicobacter pylori infections and their diagnosis
Authors: SIMALA‐GRANT JOANNE L. , TAYLOR DIANE E.
Published: December 2004

Simala‐Grant JL, Taylor DE. Molecular biology methods for the characterization of Helicobacter pylori infections and their diagnosis. APMIS 2004;112:886–97.
Implant design and interface force transfer
Authors: Cehreli Murat , Duyck Joke , Cooman Michel De , Puers Robert , Naert Ignace
Published: December 2004

Objectives: To compare stress and strain magnitudes of butt‐joint and internal‐cone oral implants in a bone simulant.

Material and methods: Photoelastic and strain‐gauged models of solitary Brånemark®, ITI® and Astra Tech® implants were obtained. Vertical and 20° oblique forces of 100 and 150 N were applied on the abutments in separate load cases. Isochromatic fringe patterns around implants were observed and photographed in the field of a polariscope. Strain‐gauge measurements were performed and principal strains induced around implants were calculated.

Results: Isochromatic fringe orders of all designs were similar under both loading conditions (P>0.05). Strains around Brånemark® implants were lower than around Astra Tech® and ITI® implants, particularly under vertical loads. The latter implants had similar strain magnitudes (P>0.05), although strains around the conical Astra Tech® implant were lower under vertical load.

Conclusions: Butt‐joint and internal‐cone oral implants have similar force distribution characteristics. The implant–abutment mating design is not a decisive factor affecting stress and strain magnitudes in a bone simulant.
Histomorphometrical and clinical comparison of submerged and nonsubmerged implants subjected to experimental peri‐implantitis in dogs
Authors: Zechner Werner , Kneissel Michaela , Kim Syngcuk , Ulm Christian , Watzek Georg , Plenk Hanns
Published: December 2004

Objectives: Soft and hard tissue healing around submerged and nonsubmerged versions of one dental implant design was evaluated in an experimental canine peri‐implantitis model.

Material and methods: Forty‐eight c.p. Ti‐implants with integrated (one‐piece=OPI) or screw‐on (two‐piece=TPI) abutments were inserted in edentulous mandibles of eight beagle dogs, one OPI and one TPI with connected abutments for nonsubmerged and one TPI without abutment (SMI) for submerged healing. After 3 months, all implants were functionally loaded, and at 4 months peri‐implantitis was ligature‐induced in one jaw side. Intravital polyfluorochrome labeling, monthly conventional radiography and gingival probing of all 48 implants were performed until sacrifice 8 months postimplantation. Undecalcified ground sections in the bucco‐lingual and mesio‐distal planes of four dogs (23 implants, one implant lost) were evaluated by light and fluorescence microscopy. The immunohistochemical and SEM‐vascular corrosion cast results of the four other dogs (24 implants) will be reported elsewhere. Levels of alveolar bone‐to‐implant contact (ABICL), alveolar crest (ACL) and junctional epithelium‐to‐implant contact were determined by computer‐assisted histometry. Peri‐implant alveolar bone loss (=saucerization) was assessed on the radiographs and calculated as ACL minus ABICL from histometric data.

Results: Around SMIs and OPIs without ligature less plaque adhesion and lower gingival indices were found when compared to TPIs. Radiologically, all ligatured, but also some nonligatured implants showed alveolar bone loss. Histometry demonstrated reduced ABICL around all these implants. Saucerization was more pronounced on the lingual and mesio‐distal sides. Particularly around TPIs, bone resorption was still active or bone formation was impaired on fluorochrome labeling. Only around SMIs and one OPI without ligature continuing alveolar bone formation reflected by gains in ABICL were found.

Conclusion: The clinical and histometric results of this study demonstrate that healing of submerged SMIs was not impaired by the two‐stage procedure, resulting in equally good healing as around nonsubmerged OPIs. However, peri‐implantitis plaque‐induced by ligature and/or dilated abutment connection microgaps in TPIs affected alveolar bone‐to‐implant contacts more than transmucosal or submerged healing mechanisms.
Bioactive glass granules as a bone adjunctive material in maxillary sinus floor augmentation
Authors: Turunen Tia , Peltola Juha , Yli‐Urpo Antti , Happonen Risto‐Pekka
Published: December 2004

Objectives: Bilateral sinus floor augmentation procedure was performed in 17 patients to study the effect of bioactive glass (BG) granules mixed with autologous bone (AB) chips on bone regeneration. The posterior part of 17 maxillary sinus was augmented with a 1 : 1 mixture of BG granules (∅ 800–1000 μm) and AB chips harvested from the iliac crest (BG–AB group). The anterior parts of the same sinus and the contralateral sinus, serving as a control (AB group), were filled with AB chips alone. Trephine biopsies for histological, scanning electron microscopy (SEM), and energy dispersive X‐ray (EDX) analyses were taken from the posterior part of the sinus after 21–34 weeks at the time of insertion of dental implants. Additionally, six biopsies were taken from the BG–AB group and four biopsies were taken from the AB group in connection with abutment operation at 49–62 weeks.

Results: Histological evaluation revealed lamellar bone growth in all the specimens. Although most of the BG granules were without bone contact in the majority of the patients in the BG–AB group, the bone lamellae were thicker than observed in the AB group. In the contact areas, bone was growing along the glass surface connecting the particles together. Histomorphometrical analysis carried out from the SEM images at 21–34 weeks revealed 26% and 25% bone in the BG–AB and the AB group, respectively. Corresponding figures for 49–62 weeks were 29% for the BG–AB group and 25% for the AB group. Bone–BG complex, i.e. the granules with intimate contact with bone, occupied 34% of the area measured at 21–34 weeks and 31% at 49–62 weeks. EDX analysis showed a tight contact and chemical bonding between the glass and bone. As a sign of dissolution, a few small Si‐depleted areas were present in some BG granules at 21–34 weeks, while more and larger Si‐free areas were observed in the granules at 49–62 weeks.

Conclusion: The results indicate that BG granules (S53P4) can be used together with AB chips for sinus floor augmentation procedure, thus decreasing the amount of bone needed. Further studies concerning especially the biomechanical properties of the BG–AB complex with dental implants are needed.
Deformation at the implant interface to prosthetic superstructure: an interferometric approach
Authors: Wahl Gerhard , Lang Hermann
Published: December 2004

Dental implants are deformed by masticatory forces. These deformations may affect the implant, the prosthetic superstructure or, in particular, the interfaces between the implant and the superstructure. The resulting changes in the geometrical relationships may lead to gap formation in this region. The objective of the present pilot study was to present an interferometric method for the direct recording and quantitative three‐dimensional analysis of load‐induced dynamic implant deformation. Three implant screws of 4.1 mm diameter were loaded using a piezoelectric device. The results showed that the screws itself exhibited a homogeneous deformation pattern, whereas implants with screw‐retained superstructures demonstrated dislocations of the crown and resulting gap formations (0.27±0.37 μm – mean±SD; max: 0.82 μm). The results supported the hypothesis that the high precision of prefabricated abutments is adversely affected by dynamic deformations under functional loading.
Use of a mineralized collagen membrane to enhance repair of calvarial defects in rats
Authors: Schliephake Henning , Tavassol Frank , Gelinsky Michael , Dard Michael , Sewing Andreas , Pompe W.
Published: December 2004

Abstract: The aim of the present study was to evaluate mineralized collagen membranes for enhancement of bone regeneration in calvarial defects. Forty adult female Sprague–Dawley rats received calvarial full thickness defects with a diameter of 8 mm. In 20 animals, the defects were covered with a mineralized collagen membrane, and 20 animals served as controls. After 6, 13, 26 and 52 weeks, bone regeneration was evaluated using undecalcified thick‐section histometry. There was no clear enhancement of bone regeneration during the first 26 weeks after the operation. Bone regeneration underneath the membrane produced consistently thicker bone, albeit without statistical significance. Accumulation of membrane material occurred in the center of the defects surrounded by multinuclear giant cells during early stages of healing. After complete resorption of the membrane, significantly increased bone formation was seen after 52 weeks in the defects that had received membrane coverage. It was concluded that mineralization in the present form did not increase mechnical strength of the membrane to prevent interference of the membrane with bone regeneration in the defect. The reason for the increase in bone formation after resorption of the membrane after 26 weeks remains to be clarified.
Influence of implant microstructure on the dynamics of bone healing around immediate implants placed into periodontally infected sites
Authors: Papalexiou Vula , Novaes Arthur B. , Grisi Márcio F. M. , Souza Sérgio S. L. S. , Taba Mário , Kajiwara João K.
Published: December 2004

Abstract: This study evaluated by fluorescence analysis the influence of implant microstructure on the placement of immediate implants in periodontally infected sockets. Periodontal disease was induced during 12 weeks bilaterally from P1 to P4 in six dogs. The teeth were extracted and immediate implants were placed. Each dog received six implants: three with Friadent experimental surface (grit blasted/acid etched – FES group) and three covered with titanium plasma spray (TPS group), for a total of 36 Frialit‐2 stepped cylinder implants. During the healing period, fluorescent bone markers were injected to study the bone remodeling around the implants. The dyes were injected in the following sequence: oxytetracyclin hydrochloride 3 days and 8 weeks, calcein green 4 weeks after the implantation and alizarin red S 3 days before killing. The animals were anesthetized and killed 12 weeks after implant placement. The mandibles were removed, dissected and processed for analyses of the percentage of newly formed bone surrounding the implant using a confocal laser scanning microscope. There were no significant statistical differences in bone formation (Mann–Whitney) between groups (FES group: 5.28% formation at 3 days, 10.3% at 4 weeks, 21.14% at 8 weeks and 6.98% at 12 weeks; TPS group: 3.36% at 3 days, 9.58% at 4 weeks, 14.57% at 8 weeks and 7.08% at 12 weeks). However, covariance analysis showed that the percent of marked bone was statistically greater for the FES group when compared to the TPS group, between the 3‐day and 8‐week periods of evaluation.
Stimulating effect of implant loading on surrounding bone
Authors: Mellal A. , Wiskott H. W. A. , Botsis J. , Scherrer S. S. , Belser U. C.
Published: December 2004

Abstract:  A number of algorithms have been proposed to model the adaptive behavior of bone under load. However, the predictions of several models have neither been compared nor have they been systematically related to in vivo data. To this end, the stress states of loaded implant–bone interfaces were analyzed before and after osseointegration using finite element (FE) techniques.

In a preliminary step, an FE mesh of a cylindrical implant encased in a cancellous core surrounded by a cortical layer was constructed, and the stresses and strains that developed at the interface were determined. The implant was loaded with 100 N vertical and 30 N lateral loads. Using this structure, the peak compressive and tensile stresses were determined. Then bone remodeling predictions were assessed using three different models: von Mises equivalent strain, strain energy density and effective stress. Finally, a systematic search of the literature was conducted to relate the numerical predictions to existing in vivo data.

The FE simulations led to the following conclusions: (1) calculated compressive stresses were lower than the ultimate compressive stresses of cortical and cancellous bone. (2) Calculated tensile stresses were generally superior to experimental data on the tensile strength of the bone–implant interface. (3) With one exception, the predictions of all models were homogeneously grouped on the stimulus scales. (4) The predictions of the models as to bone gain or loss were not consistent and at times contradictory. It is hypothesized that this effect is linked to a lazy zone that is too narrow. With respect to the application of the numerical models to in vivo data, peak strains and strain energy densities were consistent with in vivo data. No in vivo data were found that supported effective stress as a stimulus.
Swallowing thresholds of mandibular implant‐retained overdentures with variable portion sizes
Authors: Fontijn‐Tekamp Francina A. , Slagter Ad P. , Van der Bilt Andries , Van't Hof Martin A. , Kalk Warner , Jansen John A.
Published: December 2004

Abstract: We analysed the effect of three portion sizes Optocal Plus (small, medium and large) on swallowing thresholds in subjects with either conventional complete dentures or mandibular implant‐retained overdentures (transmandibular and permucosal cylindric implants). Tests were carried out in 52 women and 15 men (mean age 59 years) 4 years after treatment in a randomised controlled clinical trial. The results indicated that the degree of mucosal support for the mandibular denture did not affect the number of chewing strokes, time till swallowing or swallowed particle size. Only the chewing rate differed: subjects wearing mandibular implant‐retained overdentures chewed the food at a higher rate than complete‐denture wearers. With larger portion sizes, subjects needed significantly more chewing strokes and time until swallowing and they would have swallowed larger particles. Men chewed their food more efficiently than women, as they used the same number of chewing strokes and time, but achieved a greater particle size reduction at the swallowing moment.
Implant‐supported fixed prostheses in the edentulous maxilla
Authors: Bergkvist Göran , Sahlholm Sten , Nilner Krister , Lindh Christina
Published: December 2004

Abstract
Objectives: To evaluate the survival rate of non‐submerged solid‐screw ITI dental implants with a rough (titanium plasma sprayed, TPS) surface in the edentulous maxilla after 1 and 2 years of loading.

Material and method:  Twenty‐five patients (mean age 64 years) with edentulous upper jaws received five–seven implants and, after a mean healing time of 6.9 months, screw‐retained implant‐supported fixed prostheses. A total of 146 ITI solid screw TPS implants were inserted. The diameter of 56% of the implants was smaller (3.3 mm) than the standard (4.1 mm) and the diameter of the rest (44%) was standard. The bone quantity of the majority of the patients was low and the bone quality poor. Clinical parameters were registered at baseline and at two annual follow‐ups. Radiological examinations and assessments were also made at these times.

Results: Mean marginal bone level at baseline was measured at a point 4.52 mm (range 1.45–7.70, SD 1.2) apical of the reference point. Mean bone loss from baseline to 1 year of loading was 0.24 mm (SD 0.9, P=0.002) and from 1 year to 2 years of loading 0.15 mm (SD 0.4, P<0.001). Five implants failed, four of which were early failures prior to loading. One implant failed shortly after bridge installation. The cumulative survival rate was 96.6% after 1 and 2 years.

Conclusion: ITI TPS solid‐screw implants in combination with fixed prostheses had successful survival rates and were found to be a viable treatment alternative in the edentulous maxilla.
Vertical distraction osteogenesis of the mandible applied to an iliac crest graft: report of a case
Authors: Nocini Pier Francesco , Massimo Albanese , Editta Buttura da Prato , Antonio D'Agostino
Published: December 2004

Objectives:

This clinical case represents a particular application of vertical distraction osteogenesis of the mandible. The surgical technique was applied to an iliac crest bone graft previously positioned on an anterior mandibular defect with the aim to restore the vertical height after a partial resorption in a trauma patient.

Case report: Distraction osteogenesis was applied because it was necessary to restore the mandibular height in a young male patient who presented with a post‐trauma anterior mandibular bony deficiency. Because of the irregularity of the mandibular surface and the depth of the defect, the patient first underwent an iliac crest bone grafting that, after 3 months, showed partial resorption. Vertical distraction osteogenesis was performed on the grafted mandible in order to obtain a satisfactory bony height of the mandibular ridge. Then the patient was successfully rehabilitated by means of an implant‐supported prosthesis.

Conclusion: Vertical distraction osteogenesis appears to be a versatile surgical procedure, which can be applied as a secondary treatment in patients presenting with mandibular trauma sequelae.
Single‐tooth replacement by immediate implant and connective tissue graft: a 1–9‐year clinical evaluation
Authors: Bianchi Andrea E. , Sanfilippo Francesco
Published: December 2004

Objectives: The aim of the present study was to evaluate the long‐lasting efficacy of a combined surgical protocol, using immediate implant and subepithelial connective tissue graft for single‐tooth replacement. The advantages of this single‐center, longitudinal, randomized, blind examiner research were the following: preservation of both keratinized mucosa amount and bone tissue, optimal peri‐implant marginal sealing, satisfactory aesthetic results, reduction in treatment time.

Materials and methods: In the time period from 1990 to 1998, 116 patients were consecutively admitted for treatment with a total of 116 solid screw ITI‐implants supporting single crowns. Ninety‐six patients underwent the proposed combined treatment (test group), while 20 received only single immediate implants (control group). The observation time extended from 1 up to 9 years.

Results: The 9‐year cumulative survival rate was 100% for both test and control groups. Comparative statistical analysis of soft and hard tissue peri‐implant parameters demonstrated better results in the test group than in the control during every single 3‐year analysis and especially in the last observation interval. The test group also showed very good results in terms of aesthetic parameters, which estimated the keratinized mucosa width, the alignment of crown emergence profile and the patient's satisfaction.

Conclusion: Single‐tooth replacement by immediate solid screw ITI implants in association with connective tissue autograft was demonstrated to be a predictable procedure. Moreover, this treatment can be considered as a sure system to reach an excellent functional and harmonious aesthetic restoration.
Novel development for intraoral distraction osteogenesis by individually fabricated traction prostheses
Authors: Zauza Konstantin , Čelar Aleš G. , Zechner Werner , Watzek Georg
Published: December 2004

Abstract: Modified fixed or removable partial dentures are used for intraoral distraction osteogenesis. These traction prostheses rest on teeth or endosseous implants and direct distraction forces to an endosseous implant in the osteotomy segment. This article explains the fabrication and function of custom‐made traction prostheses for 1‐, 2‐ and 3‐dimensional distraction osteogenesis.
CARD15 gene mutations in periodontitis
Authors: Laine M. L. , Murillo L. S. , Morré S. A. , Winkel E. G. , Peña A. S. , Van Winkelhoff A. J.
Published: December 2004

Objectives: The CARD15 gene encodes the Nod2 protein, which is involved in intracellular recognition of bacterial products like peptidoglycan, activates inflammation and regulates apoptosis through nuclear factor‐kappa B, a transcription factor that plays a central role in the innate immunity. Two functional mutations, an insertion mutation at nucleotide 3020 (3020insC) and a missense mutation C2104T in the CARD15 gene (originally NOD2 gene) have been reported to be associated with Crohn's disease. Our aim was to investigate the occurrence of CARD15 gene polymorphisms in adult patients with periodontitis taking into account smoking and presence of putative periodontal pathogens as additional variables.

Material and methods: A case–control study was performed in 104 Dutch Caucasian patients with severe adult periodontitis (54 non‐smokers and 50 smokers, mean age 46 years) and in 97 ethnically matched, periodontal healthy controls (73 non‐smokers and 24 smokers, mean age 40 years). DNA isolated from a mouthwash was typed with PCR technology. Presence of putative periodontal pathogens was established by culture technique.

Results: Frequencies of the CARD15 3020insC and 2104T mutations were similar in the periodontitis group and in the control group (5.1% and 13.3%; 5.2% and 10.3%, respectively). The highest carrier frequency of CARD15 mutations was found in non‐smoking patients without Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans (29.4% versus 17.4% in controls); however it did not reach statistical significance.

Conclusion: Our results suggest no role for CARD15 3020insC and C2104T mutations in adult periodontitis.
Clinical development and evolution in plaque removal performance of a battery powered toothbrush
Authors: Claydon N. , Moran J. , Newcombe R. G. , Smith S. R. , Addy M.
Published: December 2004

Background and aim: There is growing evidence that the new generation of electric toothbrushes are more effective than manual toothbrushes. The primary aim of these studies was to compare, as an indication of the stage of development, the plaque removal properties of a prototype battery powered toothbrush with an established product. A secondary aim was to utilise the data to appraise plaque accumulation together with the patterns of removal.

Method: The three studies presented used the same, single‐examiner, randomised, single‐blind cross‐over design involving up to 24 healthy volunteers. The prototype brushes, E6500 versions s1, s2 and s3 and E8000 with head speeds of 6500 and 8000 oscillations/min were compared with a similar design marketed product (MP) with a head speed of 8800 oscillations/min. All brushes had circular brush heads with oscillating rotating actions. Subjects accumulated plaque over a 4‐day period during which no oral hygiene measures were performed. On day 4, the plaque accumulation was scored by index. Subjects then used the allocated toothbrush for 2 min. This was followed by a re‐scoring of the remaining plaque.

Results: Studies 1 and 2 showed significantly less plaque removed by prototype E6500 (s1) and prototype E6500 (s2), respectively, than by MP. In study 3, prototype E8000 removed similar quantities of plaque to MP (approximately 65%). In contrast prototype E6500 (s3) only removed 60% of accrued plaque. Differences, however, did not reach statistical significance.

Conclusions: The study methodology was appropriate to distinguish between the study toothbrushes and was furthermore able to establish a level of comparability for one of the prototype modifications with a similar MP.
Efficacy of subgingivally applied minocycline in the treatment of chronic periodontitis
Authors: Lu Hsein‐Kun , Chei Chong‐Ji
Published: December 2004

Background:  The use of adjunctive minocycline with mechanical debridement in treating periodontitis has been widely studied using different methods. However, the results from these studies are equivocal.

Objective:  The purpose of this study was to clarify the efficacy of the adjunctive use of subgingival minocycline application plus scaling/root planing as compared with the results of one episode of scaling/root planing in the treatment of chronic periodontitis.

Methods:  Fifteen patients were enrolled in this split‐mouth clinical trial. Probing depth, clinical attachment loss, gingival index, and bleeding on probing were evaluated at the baseline before scaling/root planing and 6, 10, 14, and 18 weeks later according to a single‐blind protocol. The amount of interleukin‐1β (interleukin‐1β pg/site) at each lesion was also simultaneously measured in gingival crevicular fluid in a parallel comparison design. After full‐mouth baseline measurements and scaling/root planing, 78 lesions with a residual mean probing depth of 5 mm at anterior teeth were selected and equally distributed in either right or left sites based on a split‐mouth symmetrical design and randomly assigned to one of two treatment groups (with or without minocycline administration, n = 39 for each group).

Results:  Probing depth significantly decreased from the baseline (week 0) to week 6 after scaling/root planing (p < 0.05) in both groups, but there was no statistically significant difference between the two groups (p > 0.05). However, at weeks 10, 14, and 18, the experimental group showed significantly greater improvement in pocket reduction than the control group (p < 0.05). Similarly, both groups also showed significant decreases in gingival index scores from weeks 0–6 (p < 0.05), but gingival index reductions at weeks 10, 14, and 18 were statistically significant in favor of the experimental group (p < 0.05). The experimental group had more attachment gain than the control group at weeks 14 and 18 (p < 0.05). Values of interleukin‐1β (pg/site) at the experimental sites were significantly reduced at weeks 10, 14, and 18, as compared to values at control sites (p < 0.01). Finally, the incidence of bleeding on probing showed no differences between the two groups for any time interval (p > 0.05).

Conclusions:  In this 18‐week clinical trial, the results suggested that scaling/root planing with adjunctive subgingival administration of minocycline ointment has a significantly better and prolonged effect compared to scaling/root planing alone on the reduction of probing depth, clinical attachment loss, gingival index, and interleukin‐1β content, but not on bleeding on probing.
Chronic glycine treatment inhibits ligature‐induced periodontal disease in Wistar rats
Authors: Breivik Torbjørn , Gundersen Yngvar , Fonnum Frode , Vaagenes Per , Opstad Per Kristian
Published: December 2004

Objective:  Dysregulation of immune and stress responses plays a significant role for the development and progression of inflammatory diseases, including periodontal disease. The non‐essential amino acid glycine modulates immune and central nervous system (CNS) responses, and has been shown to beneficially affect tissue destructive inflammatory conditions. The purpose of this study was to test the ability of orally administered glycine to influence periodontal disease progression, as well as immune and hypothalamic–pituitary–adrenal (HPA) responses following lipopolysaccharide stimulation.

Methods:  Glycine was supplied in the drinking water during the whole experiment to male Wistar rats, starting 3 days before the induction of experimental ligature‐induced periodontal disease. Control rats were given tap water only. The periodontal breakdown was assessed after the ligatures had been in place for 34 days. Following intraperitonal lipopolysaccharide stimulation, concentrations of the proximal cytokines tumour necrosis factor‐α (TNF‐α) and interleukin‐10, as well as the HPA axis‐derived hormone corticosterone, were measured in blood serum.

Results:  Orally administered glycine significantly reduced periodontal bone loss as measured by digital X‐rays (p = 0.007). Bone loss was negatively correlated with increased serum glycine, whereas no significant relationship was found with TNF‐α, interleukin‐10, or corticosterone.

Conclusion:  Chronic ingestion of glycine supplied in the drinking water significantly reduced periodontal bone loss. No effect of glycine on immune and HPA‐axis responses was revealed. Further studies are needed to clarify the mechanisms of action.
Biological foundation for periodontitis as a potential risk factor for atherosclerosis
Authors: Chun Yong‐Hee P. , Chun Kyoung‐Ryul J. , Olguin De'Avlin , Wang Hom‐Lay
Published: December 2004

Objectives:  Links between periodontal diseases and systemic diseases have been well documented by epidemiological studies. Recently, research has shifted to elucidating the biologic mechanism for a causal relationship. One focus of interest is atherosclerosis, the underlying event of cardiovascular diseases due to its serious health impact. However, it is still not clear whether periodontopathic pathogens are truly etiologic agents or ubiquitous bystanders. This article reviews the current understanding about the molecular biological interactions between periodontal disease and atherosclerosis and the biological plausibility of periodontitis as a potential risk factor for cardiovascular disease.

Materials and methods:  The current literature regarding periodontal diseases and atherosclerosis and coronary vascular disease was searched using the Medline and PubMed databases.

Results:  In vitro experiments and animal models are appropriate tools to investigate the biological interactions between periodontal disease and atherosclerosis at the cell molecular level. The concepts linking both pathologies refer to inflammatory response, immune responses, and hemostasis. In particular, Porphyromonas gingivalis appears to have unique, versatile pathogenic properties. Whether or not these findings from isolated cells or animal models are applicable in humans with genetic and environmental variations is yet to be determined. Likewise, the benefit from periodontal therapy on the development of atherosclerosis is unclear. Approaches targeting inflammatory and immune responses of periodontitis and atherosclerosis simultaneously are very intriguing.

Conclusion:  An emerging concept suggests that a pathogenic burden from different sources might overcome an individual threshold culminating in clinical sequela. P. gingivalis contributes directly and indirectly to atherosclerosis.
Effect of periodontal treatment on the C‐reactive protein and proinflammatory cytokine levels in Japanese periodontitis patients
Authors: Yamazaki Kazuhisa , Honda Tomoyuki , Oda Taro , Ueki‐Maruyama Kaoru , Nakajima Takako , Yoshie Hiromasa , Seymour Gregory J.
Published: December 2004

Background:  Recent epidemiological studies have shown that individuals with periodontitis have a significantly increased risk of developing coronary heart disease. In addition to conventional risk factors, chronic infection and subsequent production of systemic inflammatory markers may be associated with this increased risk.

Objectives:  The aim of the present study was to determine whether the presence of chronic periodontitis and subsequent periodontal treatment could influence the serum levels of C‐reactive protein (CRP), interleukin‐6 and tumor necrosis factor‐α (TNF‐α) in a Japanese population.

Methods:  Sera were obtained from 24 patients with moderate to advanced periodontitis at the baseline examination and at reassessment after completion of treatment. As a control, sera were also obtained from 21 subjects without periodontitis. High‐sensitivity CRP (hs‐CRP) was measured using nephelometry with a latex particle‐enhanced immunoassay and interleukin‐6 and TNF‐α were determined by sensitive enzyme‐linked immunosorbent assay.

Results:  The levels of hs‐CRP and interleukin‐6 in the sera of this Japanese population seemed to be much lower than those reported in other populations. TNF‐α on the other hand, demonstrated similar levels between this Japanese and other populations. Periodontal status demonstrated a significant improvement in all patients following treatment. There was a trend toward higher hs‐CRP levels in patients at baseline compared with control subjects. Hs‐CRP level tended to decrease with improvement of the periodontal condition following treatment and approached that of control subjects, although this decline was not statistically significant. interleukin‐6 and TNF‐α levels did not change following periodontal treatment. Furthermore, there was no difference in the serum levels of these inflammatory cytokines between patients either at baseline or at reassessment and control subjects.

Conclusions:  In this pilot study, we were unable to show that periodontal disease significantly affects the serum levels of systemic inflammatory markers. However, this does not necessarily mean that periodontitis does not contribute to the total burden of inflammation as there was a tendency for hs‐CRP to decrease following successful periodontal treatment. Large‐scale studies are clearly needed to determine the impact of periodontal disease on systemic inflammation.
Investigation of periodontal ligament reaction upon excessive occlusal load – osteopontin induction among periodontal ligament cells
Authors: Kaku Masaru , Uoshima Katsumi , Yamashita Yasuo , Miura Hiroyuki
Published: December 2004

Objective:  The purpose of the present study was to investigate the reaction of the periodontal ligament to excessive occlusal loading by observing the histological changes and osteopontin induction. The possibility of ligand for receptor activator of nuclear factor κB (RANKL) participation in osteopontin induction was also discussed.

Background:  The precise mechanism of periodontal ligament breakdown by excessive occlusal loading remains unclear. We established an experimental model for excessive occlusal loading in vivo. Osteopontin is known to be produced upon mechanical loading and is considered to induce the migration of osteoclasts to the resorption site. RANKL is one of the essential factors for osteoclast maturation and induces the constitutive induction of intracellular osteopontin in vitro.

Methods:  The occlusal surface of the upper left first molars of rats was raised by steel wire bonding in order to induce occlusal trauma. The destruction of the periodontal ligament was observed and the production of osteopontin and RANKL by periodontal ligament cells was detected via immunohistochemistry.

Results:  Our model produced wide‐ranging destruction of the periodontal ligament. From day 3 to day 7, prominent compression of the periodontal ligament and osteoclast migration were observed at the apical interradicular septum. Osteopontin was detected in some osteoclasts, surrounding fibroblasts, and osteoblasts adjacent to the compression area. RANKL was observed from day 1 to day 7 around the osteoblasts and osteoclasts.

Conclusions:  Our model was useful for the detailed investigation of periodontal ligament breakdown during excessive occlusal loading. Although intracellular osteopontin was produced in osteoclasts with intermittent occlusal loading, the role of this protein in the cells was not clear. No correlation between RANKL distribution and osteopontin production in osteoclasts could be found.
Melatonin attenuates lipopolysaccharide‐induced down‐regulation of pregnane X receptor and its target gene CYP3A in mouse liver
Authors: Xu De‐Xiang , Wei Wei , Sun Mei‐Fang , Wei Ling‐Zhen , Wang Jian‐Ping
Published: December 2004

Abstract:  Pregnane X receptor (PXR) is a member of the nuclear receptor superfamily that regulates target gene transcription in a ligand‐dependent manner. Our earlier study indicated that reactive oxygen species contribute to lipopolysaccharide (LPS)‐induced down‐regulation of PXR and its target gene CYP3A in mouse liver. Melatonin is a powerful endogenous antioxidants. In this study, we investigated the effects of melatonin on LPS‐induced down‐regulation of PXR and CYP3A in mouse liver. Mice were intraperitoneally administrated different doses of melatonin before and/or after LPS treatment. PXR and CYP3A11 mRNA levels were measured using RT‐PCR. Erythromycin N‐demethylase (ERND) was used as an indicator of CYP3A catalytic activity. Results indicated that melatonin significantly attenuated LPS‐induced down‐regulation of PXR and CYP3A11 mRNA levels in a dose‐dependent manner. Repeated doses of melatonin (10 mg/kg) treatments also significantly attenuated LPS‐induced down‐regulation of dexamethasone‐inducible CYP3A11 mRNA level and ERND activity in mouse liver. In addition, the present study also shows that melatonin significantly increased hepatic superoxide dismutase, Se‐dependent glutathione peroxidase, glutathione reductase and catalase activities and glutathione levels in LPS‐treated mice. These findings suggest that melatonin may exert its protective effects on LPS‐induced down‐regulation of PXR and CYP3A via counteracting LPS‐induced oxidative stress in mouse liver.