The randomized shortened dental arch study (RaSDA): design and protocol

<p>Abstract</p> <p>Background</p> <p>Various treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion. Besides the placement of implants, two main treatment types can be distinguished: replacement of the missing molars with removable dental prostheses and non-replacement of the molars, i.e. preservation of the shortened dental arch. Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches. High treatment costs and the long time required for the treatment impede respective clinical trials.</p> <p>Methods/design</p> <p>This 14-center randomized controlled investigator-initiated trial is ongoing. Last patient out will be in 2010. Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible. One group received a treatment with removable dental prostheses for molar replacement (treatment A). The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges (treatment B). A pilot trial with 32 patients was carried out. Two hundred and fifteen patients were enrolled in the main trial where 109 patients were randomized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up. The secondary outcome measures encompassed clinical, technical and subjective variables. The study is funded by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG WA 831/2-1, 2-2, 2-3, 2-4, 2-5).</p> <p>Discussion</p> <p>The particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments. The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability. The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health. An array of secondary outcome measures will deliver valuable supplementary information. If the results can be implemented in the clinical practice, the daily dental care should strongly profit thereof.</p> <p>Trial registration</p> <p>The trial is registered at ClinicalTrials.gov under ISRCTN68590603 (pilot trial) and ISRCTN97265367 (main trial).</p

International Society of Sports Nutrition Position Stand: Nutritional recommendations for single-stage ultra-marathon; training and racing

Background. In this Position Statement, the International Society of Sports Nutrition (ISSN) provides an objective and critical review of the literature pertinent to nutritional considerations for training and racing in single-stage ultra-marathon. Recommendations for Training. i) Ultra-marathon runners should aim to meet the caloric demands of training by following an individualized and periodized strategy, comprising a varied, food-first approach; ii) Athletes should plan and implement their nutrition strategy with sufficient time to permit adaptations that enhance fat oxidative capacity; iii) The evidence overwhelmingly supports the inclusion of a moderate-to-high carbohydrate diet (i.e., ~60% of energy intake, 5 – 8 g⸱kg−1·d−1) to mitigate the negative effects of chronic, training-induced glycogen depletion; iv) Limiting carbohydrate intake before selected low-intensity sessions, and/or moderating daily carbohydrate intake, may enhance mitochondrial function and fat oxidative capacity. Nevertheless, this approach may compromise performance during high-intensity efforts; v) Protein intakes of ~1.6 g·kg−1·d−1 are necessary to maintain lean mass and support recovery from training, but amounts up to 2.5 g⸱kg−1·d−1 may be warranted during demanding training when calorie requirements are greater; Recommendations for Racing. vi) To attenuate caloric deficits, runners should aim to consume 150 - 400 kcal⸱h−1 (carbohydrate, 30 – 50 g⸱h−1; protein, 5 – 10 g⸱h−1) from a variety of calorie-dense foods. Consideration must be given to food palatability, individual tolerance, and the increased preference for savory foods in longer races; vii) Fluid volumes of 450 – 750 mL⸱h−1 (~150 – 250 mL every 20 min) are recommended during racing. To minimize the likelihood of hyponatraemia, electrolytes (mainly sodium) may be needed in concentrations greater than that provided by most commercial products (i.e., >575 mg·L−1 sodium). Fluid and electrolyte requirements will be elevated when running in hot and/or humid conditions; viii) Evidence supports progressive gut-training and/or low-FODMAP diets (fermentable oligosaccharide, disaccharide, monosaccharide and polyol) to alleviate symptoms of gastrointestinal distress during racing; ix) The evidence in support of ketogenic diets and/or ketone esters to improve ultra-marathon performance is lacking, with further research warranted; x) Evidence supports the strategic use of caffeine to sustain performance in the latter stages of racing, particularly when sleep deprivation may compromise athlete safety

Analysis of the prevalence of different topographical characteristics of the residual ridge in mandibular free-end arches Análise da prevalência de diferentes características topográficas do rebordo residual em arcos mandibulares com extremidades livres

This study observed the prevalence of different types of residual ridge inclination in free-ends of mandibles and reported possible correlative factors that may affect resorption. For this purpose, periapical radiographs and individual data collected from a sample of 64 hemiarches were used. Two radiographs were taken of each free-end, and tracing was employed to determine the angles formed by the resorption configuration in the area of the 1st mandibular molar. The following conclusions were drawn: 1) the great majority of alveolar ridges were distally descending; 2) the average angle was wider for users of mandibular removable partial dentures; 3) the results obtained suggest that the type of opposing maxillary arch affects the inclination of mandibular ridges; 4) greater inclination was observed when the 2nd bicuspids of the mandible were the abutment teeth; 5) no significant correlation was established between age, sex and residual ridge resorption.<br>Esta pesquisa constatou a prevalência dos tipos de rebordos residuais no sentido ântero-posterior em extremidades livres inferiores, além de correlacionar alguns fatores que possam influenciar as suas reabsorções. Para isso, utilizamos radiografias periapicais e dados individuais colhidos na amostra de 64 hemiarcos; foram obtidas 2 radiografias de cada área de extremidade livre e, a partir de traçados, determinamos os ângulos formados pela reabsorção na altura do 1º molar inferior. Podemos constatar que: 1º) a grande maioria de inclinação encontrada foi de rebordos descendentes para distal; 2º) a média de angulação foi maior para usuários de prótese parcial removível inferior; 3º) os resultados sugeriram existir influência do tipo de arco antagônico superior na inclinação dos rebordos inferiores; 4º) observou-se aumento de inclinação quando os segundos pré-molares inferiores eram os dentes adjacentes ao espaço protético; e 5º) não foram encontradas correlações significantes entre idade, sexo e reabsorção do rebordo residual