bluuebunny/crossref_metadata_2025_split huggingface dataset:
Professional Negligence: When Practice Goes Wrong
Authors: Harris Curtis E , Richards Warren , Fincham Jack E 
Published: June 2006

Objective: TO review the practice and legal principles of negligence law. Case Summary: An illustrative, fictional case is presented, based in part on facts gleaned from actual case law. A respected pharmacist, faced with the financial loss of his business, decided to engage in 2 creative but unethical schemes to increase his profit margin. In doing so, he violated federal Medicare law and placed a number of the patients who used his services at significant risk for medical complications. Discussion: Negligence law has evolved over the past 30 years in a manner that significantly increases the liability of the practicing pharmacist for both ordinary negligence actions and criminal negligence actions. In addition, the past decade has seen the expansion of Medicare Fraud and Abuse law such that it now represents an increasingly high risk area for every medical service provider, including the pharmacist. Conclusions: Professional practice in the US is highly regulated, governed by both case law and statutory law. Every practicing pharmacist should be aware of the law that governs his or her behavior to avoid both civil and criminal liability.
Effect of EDTA Root Conditioning on the Healing of Intrabony Defects Treated With an Enamel Matrix Protein Derivative
Authors: Sculean Anton , Berakdar Mohammad , Willershausen Britta , Arweiler Nicole B. , Becker Jürgen , Schwarz Frank 
Published: June 2006

Background: Regenerative periodontal therapy with an enamel matrix protein derivative (EMD) has been shown to promote regeneration in intrabony periodontal defects. However, in most clinical studies, root surface conditioning with EDTA was performed in conjunction with the application of EMD, and, therefore, it cannot be excluded that the results may also be attributable to the effect of the root conditioning procedure. The purpose of this study was to determine the effect of root conditioning on the healing of intrabony defects treated with EMD.Methods: Twenty‐four patients, each of whom exhibited one deep intrabony defect, were randomly treated with either open flap debridement (OFD) followed by root surface conditioning with EDTA and application of EMD (OFD + EDTA + EMD) or with OFD and application of EMD only (OFD + EMD). The following parameters were recorded at baseline and at 1 year: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL).Results: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the OFD + EDTA + EMD group showed a reduction in mean PD from 9.3 ± 1.3 mm to 4.0 ± 0.9 mm (P <0.001), and mean CAL changed from 10.8 ± 2.2 mm to 7.1 ± 2.8 mm (P <0.001). In the OFD + EMD group, mean PD was reduced from 9.3 ± 1.2 mm to 4.2 ± 0.9 mm (P <0.001), and a change in mean CAL from 11.0 ± 1.7 mm to 7.3 ± 1.6 mm (P <0.001). There were no significant differences in any of the investigated parameters between the two groups.Conclusion: In intrabony defects, regenerative surgery including OFD + EDTA + EMD failed to show statistically significant differences in terms of PD reduction and CAL gain compared to treatment with OFD + EMD.
Osteoprotegerin and Receptor Activator of Nuclear Factor‐Kappa B Ligand Modulation by Enamel Matrix Derivative in Human Alveolar Osteoblasts
Authors: Galli Carlo , Macaluso Guido M. , Guizzardi Stefano , Vescovini Rosanna , Passeri Mario , Passeri Giovanni 
Published: June 2006

Background: Bone regeneration techniques increasingly rely on the use of exogenous molecules able to enhance tissue formation in pathologic and traumatic defects. An enamel matrix derivative (EMD) has been largely used to promote tooth ligament regeneration within periodontal pockets. Recent evidence suggests that EMD may contribute to inducing osteoblast growth and differentiation. We investigated the effects of EMD on growth and osteogenic marker modulation in human mandibular osteoblasts.Methods: We focused our attention on cell growth by 3‐(4,5‐dimethyl[thiazol‐2‐yl]‐3,5‐diphery)tetradium bromide (MTT) assay, cell differentiation, mineralized nodule formation, and, in particular, the expression of receptor activator of nuclear factor‐kappa B ligand (RANKL), the main osteoclast differentiation factor, and its decoy receptor, osteoprotegerin (OPG), by enzyme‐linked immunosorbent assay.Results: Cell growth was significantly increased by EMD. Similarly, a significantly higher quantity of OPG and a lower amount of RANKL were detectable in groups treated with 50 and 100 μg/ml at weeks 1, 2, and 3, and alkaline phosphatase activity and osteocalcin production were enhanced in cultures treated with 50 and 100 μg/ml at weeks 2 and 3. Mineralized nodules appeared bigger and more numerous in cultures treated with 50 and 100 μg/ml EMD.Conclusions: EMD was able to enhance osteoblast cell growth and the expression of markers of osteoblastic phenotype and differentiation. EMD also seemed able to create a favorable osteogenic microenvironment by reducing RANKL release and enhancing osteoblastic OPG production.
Bacterial Profile and Burden of Periodontal Infection in Subjects With a Diagnosis of Acute Coronary Syndrome
Authors: Renvert Stefan , Pettersson Thomas , Ohlsson Ola , Persson G. Rutger 
Published: June 2006

Background: Periodontitis has been identified as a potential risk factor in cardiovascular diseases. It is possible that the stimulation of host responses to oral infections may result in vascular damage and the inducement of blood clotting. The aim of this study was to assess the role of periodontal infection and bacterial burden as an explanatory variable to the activation of the inflammatory process leading to acute coronary syndrome (ACS).Methods: A total of 161 consecutive surviving cases admitted with a diagnosis of ACS and 161 control subjects, matched with cases according to their gender, socioeconomic level, and smoking status, were studied. Serum white blood cell (WBC) counts, high‐ and low‐density lipoprotein (HDL/LDL) levels, high‐sensitivity C‐reactive protein (hsC‐rp) levels, and clinical periodontal routine parameters were studied. The subgingival pathogens were assayed by the checkerboard DNA‐DNA hybridization method.Results: Total oral bacterial load was higher in the subjects with ACS (mean difference: 17.4 × 105; SD: 10.8; 95% confidence interval [CI]: 4.2 to 17.4; P <0.001), and significant for 26 of 40 species including Porphyromonas gingivalis, Tannerella forsythensis, and Treponema denticola. Serum WBC counts, hsC‐rp levels, Streptococcus intermedius, and Streptococcus sanguis, were explanatory factors to acute coronary syndrome status (Nagelkerke r2 = 0.49).Conclusion: The oral bacterial load of S. intermedius, S. sanguis, Streptococcus anginosus, T. forsythensis, T. denticola, and P. gingivalis may be concomitant risk factors in the development of ACS.
The Effect of rhBMP‐2 Around Endosseous Implants With and Without Membranes in the Canine Model
Authors: Jones Archie A. , Buser Daniel , Schenk Robert , Wozney John , Cochran David L. 
Published: June 2006

Background: Bone morphogenetic protein (BMP) is a potent differentiating agent for cells of the osteoblastic lineage. It has been used in the oral cavity under a variety of indications and with different carriers. However, the optimal carrier for each indication is not known. This study examined a synthetic bioabsorbable carrier for BMP used in osseous defects around dental implants in the canine mandible.Methods: Twelve canines had their mandibular four premolars and first molar teeth extracted bilaterally. After 5 months, four implants were placed with standardized circumferential defects around the coronal 4 mm of each implant. One‐half of the defects received a polylactide/glycolide (PLGA) polymer carrier with or without recombinant human BMP‐2 (rhBMP‐2), and the other half received a collagen carrier with or without rhBMP‐2. Additionally, one‐half of the implants were covered with a non‐resorbable (expanded polytetrafluoroethylene [ePTFE]) membrane to exclude soft tissues. Animals were sacrificed either 4 or 12 weeks later. Histomorphometric analysis included the percentage of new bone contact with the implant, the area of new bone, and the percentage of defect fill. This article describes results with the PLGA carrier.Results: All implants demonstrated clinical and radiographic success with the amount of new bone formed dependent on the time and presence/absence of rhBMP‐2 and presence/absence of a membrane. The percentage of bone‐to‐implant contact was greater with rhBMP‐2, and after 12 weeks of healing, there was approximately one‐third of the implant contacting bone in the defect site. After 4 weeks, the presence of a membrane appeared to slow new bone area formation. The percentage of fill in membrane‐treated sites with rhBMP‐2 rose from 24% fill to 42% after 4 and 12 weeks, respectively. Without rhBMP‐2, the percentage of fill was 14% rising to 36% fill, respectively.Conclusions: After 4 weeks, the rhBMP‐2–treated sites had a significantly higher percentage of contact, more new bone area, and higher percentage of defect fill than the sites without rhBMP‐2. After 12 weeks, there was no significant difference in sites with or without rhBMP‐2 regarding percentage of contact, new bone area, or percentage of defect fill. In regard to these three outcomes, comparing the results with this carrier to the results reported earlier with a collagen carrier in this study, only the area of new bone was significantly different with the collagen carrier resulting in greater bone than the PLGA carrier. Thus, the PLGA carrier for rhBMP‐2 significantly stimulated bone formation around dental implants in this model after 1 month but not after 3 months of healing. The use of this growth factor and carrier combination appears to stimulate early bone healing events around the implants but not quite to the same degree as a collagen carrier.
Comparative Analysis of the Effects of a Novel Vacuolar Adenosine 5′‐Triphosphatase Inhibitor, FR202126, and Doxycycline on Bone Loss Caused by Experimental Periodontitis in Rats
Authors: Niikura K. 
Published: June 2006

Background: Doxycycline is reported to inhibit alveolar bone destruction by blocking matrix metalloproteinases (MMPs). Nevertheless, MMPs are not involved in osteoclastic bone resorption; osteoclasts directly resorb bone. An acidic microenvironment, which is formed by vacuolar adenosine 5′‐triphosphatase (V‐ATPase) expressed in the plasma membranes of osteoclasts, is indispensable for osteoclastic bone resorption. In the present study, we investigated the potential role of the acidic environment on periodontal bone destruction using a novel and specific V‐ATPase inhibitor, FR202126, which we compared to doxycycline.Methods: Inhibitory activity against in vitro bone resorption was examined by measuring the Ca2+ release from murine calvariae cultured for 6 days, which were treated with interleukin‐1 (IL‐1), IL‐6, or parathyroid hormone. Experimental periodontitis was induced by a ligature wire tied around the contact between the first and second maxillary molars of male Wistar rats. FR202126 and doxycycline were administered orally once daily for 6 days. Seven days after tying, the maxillae were dissected and mesiodistal longitudinal paraffin sections, including interdental alveolar bone, were processed for histopathologic analysis.Results: FR202126 inhibited bone resorption almost completely in calvaria cultures induced by three stimulators, whereas doxycycline was unable to prevent in vitro bone resorption. Oral administration of FR202126 significantly prevented alveolar bone loss in experimental periodontitis. However, doxycycline did not inhibit alveolar bone destruction.Conclusion: These results suggest that an acidic microenvironment plays a more important role than MMPs in periodontal alveolar bone destruction and that V‐ATPase inhibitors may offer a new approach to the treatment of periodontal disease.
Accuracy of Cone Beam Computed Tomography for Periodontal Defect Measurements
Authors: Misch Kelly A. , Yi Erica S. , Sarment David P. 
Published: June 2006

Background: Periodontal diagnosis relies heavily on traditional two‐dimensional radiographic assessment. Despite efforts in improving reliability, current methods of detecting bone level changes over time or determining three‐dimensional architecture of osseous defects are inadequate. To address these issues, computed tomography (CT) has been explored because of its ability to produce accurate three‐dimensional imaging, but limitations such as radiation, machine size, and cost have made this approach impractical. Recently, cone beam computed tomography (CBCT) has turned this concept into potential reality because these lower‐cost small machines produce high‐quality data. Yet there is little research to establish periodontal bone measurement using CBCT as a valid method. Therefore, the aim of this study was to compare CBCT measurements of periodontal defects to traditional methods.Methods: Artificial osseous defects were created on mandibles of dry skulls. CBCT scanning, periapical radiography (PA), and direct measurements using a periodontal probe were compared to an electronic caliper that was used as a standard reference.Results: Linear measurements for all defects revealed no statistical differences between bone sounding, radiography, and CBCT. There was a significant difference when comparing isolated interproximal measurements using a probe versus the caliper (P <0.001) but no significant difference for CBCT or radiography. All bony defects were identifiable and measurable directly or with CBCT. In comparison, buccal and lingual defects could not be measured with radiographs.Conclusions: Overall, all three modalities are useful for identifying interproximal periodontal defects. Compared to radiographs, the three‐dimensional capability of CBCT offers a significant advantage because all defects can be detected and quantified.
Host Response to Titanium Dental Implant Placement Evaluated in a Human Oral Model
Authors: Flatebø Rigmor S. , Johannessen Anne C. , Grønningsæter Arne G. , Bøe Olav E. , Gjerdet Nils R. , Grung Bjarte , Leknes Knut N. 
Published: June 2006

Background: Recent reports have questioned if metal sensitivity may arise from exposure to titanium. The objective of this study was to histologically evaluate non‐perforated mucosa covering submerged maxillary titanium implants with regard to induced tissue reactions.Methods: Thirteen patients, 21 to 69 years of age, without previous implants were included. After initial examination, the bone crest areas destined for dental implant placement were exposed, and threaded external hex dental implants were inserted. Prior to wound closure, a full mucosal tissue slice was biopsied from the edge of the mucoperiosteal flap (baseline). The patients were monitored monthly for 6 months. At the abutment connection, biopsies were taken by a 6‐mm punch, altogether yielding 26 specimens. Tissue reactions were analyzed by coded histometric analysis at four defined areas at increasing distance from the oral epithelium, including ratios of inflammatory cells (IC)/epithelial cells, IC/fibroblasts, and number of dense particles.Results: The stained sections portrayed gingival tissue with intact oral epithelium and connective tissue with variable accumulation of IC. Experimental biopsies demonstrated mineralized areas and dense particles of different sizes. Analysis of variance revealed a higher IC/fibroblast ratio for level 3 at baseline compared to level 3 at 6 months (P <0.01). Furthermore, a significant decrease in IC/fibroblast ratio was observed between levels 2 and 3 and 2 and 4 at 6 months (P <0.001). The connective tissue level facing the cover screw contained the highest number of dense particles (P <0.01).Conclusions: Tissue sensitivity reactions to titanium implants were not disclosed. All 6‐month biopsies contained dense particles that were most likely metals.
Gingival Squamous Cell Carcinoma: Diagnostic Delay or Rapid Invasion?
Authors: Seoane Juan , Varela‐Centelles Pablo I. , Walsh Trevor F. , Lopez‐Cedrun Jose L. , Vazquez Ines 
Published: June 2006

Background: The similarity between gingival squamous cell carcinoma (GSCC) and more common periodontal lesions may lead to a delay in diagnosis or misdiagnosis. Neoplastic lesions of gingival tissues are frequently diagnosed at an advanced stage.Methods: To assess the relative time from when patients first become aware of the problem to histopathologic diagnosis (total diagnostic time), 59 consecutive oral cancer cases were examined in this study. The following variables were considered: age, gender, smoking habits, tumor stage at diagnosis, and total diagnostic time. The median of the patients' total diagnostic time (1.5 months) was used as a cutoff point to distinguish between delayed and non‐delayed cases. Analysis of the variables was undertaken using the Student t test and χ2 test, with a 95% confidence interval (CI).Results: The total diagnostic time was <1.5 months for 75% of gingival carcinomas, 50% of tongue carcinomas, and 78% of floor‐of‐the‐mouth carcinomas. It was >1.5 months for 25% of gingival carcinomas, 50% of tongue carcinomas, and 21% of floor‐of‐the‐mouth carcinomas. No significant differences in time before diagnosis were found when gingival cancers were compared to other oral tumors (χ2 = 0.21; 95% CI = −0.40 to 0.26). However, by the time of diagnosis, gingival cancers had invaded adjacent structures more frequently than other oral cancers (χ2 = 13.51; 95% CI = 0.18 to 0.85).Conclusions: The gingival location of oral squamous cell carcinoma (OSCC) was associated with advanced stages at the time of diagnosis, due to early invasion of contiguous bone tissue (T4‐primary tumor). This would indicate that even earlier referral and diagnosis are necessary.
Effects of Er:YAG Laser and Ultrasonic Treatment on Fibroblast Attachment to Root Surfaces: An In Vitro Study
Authors: Crespi Roberto , Romanos George E. , Cassinelli Clara , Gherlone Enrico 
Published: June 2006

Background: The aim of this study was to analyze the effects of erbium‐doped:yttrium, aluminum, and garnet (Er:YAG) laser and ultrasonic treatment on fibroblast attachment to periodontally diseased root surfaces.Methods: Thirty single‐rooted human periodontally involved teeth were included in this study. A total of 60 specimens were obtained from all selected teeth and were randomly assigned to the following three groups: group A, untreated control group; group B, ultrasonic group; and group C, Er:YAG laser at 160 mJ/pulse at 10 Hz group. All of the specimens were incubated in petri dishes with fibroblast suspension and observed by scanning electron microscopy.Results: Laser‐treated specimens showed a significantly higher cell density number, with a mean ± SD of 3,720 ± 316 cells/mm2. The ultrasonically treated group showed a lower cell density number, with a mean ± SD of 658 ± 140 cells/mm2. The untreated control group showed the lowest cell density number, with a mean ± SD of 130 ± 80 cells/mm2. Differences between all groups were significant (P <0.0001).Conclusion: The results of the study indicate that untreated control surfaces and ultrasonically treated surfaces exhibited a significantly lower number of attached cells compared to laser‐treated specimens, which showed a significantly higher cell density number.
Digital Volume Tomography in the Diagnosis of Peri‐Implant Defects: An In Vitro Study on Native Pig Mandibles
Authors: Mengel Reiner , Kruse Björn , Flores‐de‐Jacoby Lavin 
Published: June 2006

Background: The aim of this study of native pig mandibles was to investigate the accuracy and quality of the representation of peri‐implant defects by intraoral radiography (IR), panoramic radiography (PR), computer tomography (CT), and digital volume tomography (DVT).Methods: The examination was carried out on 19 native pig mandibles. In the toothless sections of the mandibles, one or two implants were inserted. Following the standardized preparation of peri‐implant defects (11 each of dehiscences, fenestrations, and 2‐ to 3‐walled intrabony defects), IR, PR, CT, and DVT were performed. The peri‐implant defects were measured using appropriate software on the digitized IR and PR image programs. As a control method, the peri‐implant bone defects were measured directly using a reflecting stereomicroscope with measuring ocular. The statistical comparison between the measurements of the radiographic scans and those of the direct readings of the peri‐implant defects was performed with Pearson's correlation coefficient. The quality of the radiographic scans was determined through the subjective perception and detectability of the peri‐implant defects by five independent observers.Results: In the DVT and CT scans, it was possible to measure all the bone defects in three planes. Comparison with the direct peri‐implant defect measurements yielded a mean deviation of 0.17 ± 0.11 mm for the DVT scans and 0.18 ± 0.12 mm for the CT scans. On the IR and PR images, the defects could be detected only in the mesio‐distal and cranio‐caudal planes. In comparison with the direct measurements of the peri‐implant defects, the IR images revealed a mean deviation of 0.34 ± 0.30 mm, and the PR images revealed a mean deviation of 0.41 ± 0.35 mm. The quality rating of the radiographic images was highest for the DVT scans.Conclusions: Overall, the CT and DVT scans displayed only a slight deviation in the extent of the peri‐implant defects. Both radiographic imaging techniques permitted imaging of peri‐implant defects in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.
Rent Extraction and the Survival of the Agricultural Production Cooperative
Authors: McGregor Andrew 
Published: July 2006

AbstractDuring the last twenty years there has been a proliferation of production cooperatives in the agricultural sector of low income countries. This paper examines the prospects for this type of firm in light of their poor historical record. A theoretical model is presented that shows the extraction of scarcity rents is a necessary condition for survival. Several case studies examined are found to be empirically consistent with the model. It is shown that policies can be devised for the extraction of rents.
Latvia: the future in Riga's past
Authors: Lejnieks Janis 
Published: June 2006

AbstractSituated at the crossroads of international trade routes, the historical architecture of Riga, the capital city of Latvia, was shaped by tides of different social and cultural groups that over many centuries left their mark. It is notable for its rich mixture of Gothic, Baroque, Russian Classical, German Art Nouveau and Finnish Modernist buildings. Janis Lejnieks describes why now, after the stultification of the Soviet era, as much of its 19th‐century building stock is threatened by decay and dereliction, Riga needs to invest in new, high‐quality architecture that will revive the dynamic cultural traditions of the city. Copyright © 2006 John Wiley & Sons, Ltd.
Lithuania: assembling in cities
Authors: Karalius Audrys 
Published: June 2006

AbstractA period of accelerated urbanism in Lithuania has coincided with a slackening of the planning system. This has inevitably unleashed a degree of urban chaos ‐ with individual house‐owners and developers building, largely unchecked, whatever they desire. Amidst this unruly, if burgeoning built environment, Audrys Karalius highlights some significant architectural schemes, many of which pick up the torch of the architects who were designing in Lithuania's formative interwar years. Copyright © 2006 John Wiley & Sons, Ltd.