Fetomaternal outcome in pregnancy with oligohydramnios: a prospective study

Background: Oligohydramnios is defined as amniotic fluid index 30 weeks.Results: The most common risk factor associated with oligohydramnios was hypertensive disorder of pregnancy (35%) followed by intra uterine growth restriction (31%), preterm rupture of membranes (17%), post-datism (5%) and about 12% were due to idiopathic causes. Among cases majority were primigravida (43%). Lower segment caesarean section was done in 86 cases (43%), and main indication was fetal distress. There was no maternal mortality in the study. NICU admission for low birth weight (26%), pre-maturity (20%), meconium aspiration syndrome (8%), congenital anomalies (8%). Among congenital anomalies, posterior urethral valve had highest incidence (50%) followed by renal agenesis (25%). The neonatal mortality was 5%.Conclusions: Oligohydramnios adversely affects the perinatal outcome. Therefore, it requires meticulous assessment, prompt detection, timely management and treating underlying condition. However, a favourable outcome can be expected by good antenatal and intrapartum surveillance and neonatal care

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Adaptation of gingival biotype in response to prosthetic rehabilitation

Background: The gingival biotype is the width of the gingiva in the faciopalatal dimension. It is a feature of the periodontium that is susceptible to change when exposed to physical, chemical or bacterial injury or as a result of surgical or orthodontic treatment. Aim and Objective: The objective of the study undertaken was to assess the adaptation of gingival biotype following prosthetic rehabilitation. Materials and Methods: Forty individuals between 20 and 40 years with healthy periodontium and full complement of teeth with absence of clinical attachment loss or systemic disease were selected for the study. The individuals were restored with a full-coverage porcelain fused to metal with a subgingival margin on root canal-treated teeth with no gingival recession. The gingival biotype of the tooth with the restoration was evaluated in terms of thickness with the help of transparency of the probe method. Twenty individuals were selected with thick biotype and rest with thin biotype. Follow-up was done after 6 months, and the gingival biotype and gingival recession were re-evaluated. Results: It was observed that out of the twenty individuals with thick biotype, eight underwent transformation to thin biotype. Furthermore, thin gingival biotype was more prone to gingival recession as five individuals were found to have gingival recession. Conclusion: Within the limitations of the current study, it was observed that gingival biotype may undergo transformation in response to prosthetic rehabilitation from thick to a thin gingival biotype progressively over a period of time. Hence, supragingival margins should be placed wherever possible. In addition, the thin gingival biotype has a higher susceptibility towards gingival recession

Evaluation of Recurring Esthetic Dental Proportion in Natural Mandibular Anterior Dentition

Aim: The concept of the Recurring esthetic dental (RED) proportion is useful in diagnosing and developing symmetry, dominance and proportion for esthetically pleasing smiles. This study was undertaken to evaluate validity of RED proportion in mandibular anterior teeth. Materials and Method: One hundred and three subjects in age group of 50 yrs. and more were selected for the study. Photographs of subjects were taken using Nikon D200 camera with 135mm lens and analyzed using Adobe Photoshop CS4 extended software. The widths of mandibular central incisor, lateral incisor and canine were measured with this software and their successive proportions were calculated. Results: After calculating proportions in mandibular anterior teeth, P value was found to be statistically insignificant (P > 0.05). Conclusion: Within the limitations of the study, RED proportion was not seen in mandibular natural dentition

Clinical Evaluation of Fixed Dental Prosthesis Failures in Indian Population: An In Vivo Study

Aim: The purpose of this study was to evaluate the prevalence of causes of fixed dental prosthesis failures in Indian population. Materials and method: A total of 158 patients were selected for the study who reported to the OPD of the Department of prosthodontics, Karnavati School of Dentistry, with complaints related to fixed dental prosthesis (FDP). Site and condition of the prosthesis and its abutments were evaluated and the cause of failure was classified accordingly by John J. Manappallil′s classification. Results: Majority of failures (32.27%) were found to be class III failure followed by class VI failure (24.05 %). 13.29 % failures were Class IV, 12.65 % failures were identified as class II, 12.02 % failures as class V and 5.69 % failures were categorized in class I failure. Conclusion: Though earlier literature reported caries as the most common cause of fixed dental prosthesis failure, however present study reported class III failures, which include unserviceable restorations due to defective margins, technical failures or esthetic considerations as the most common cause. Therefore proper design of prosthesis is of utmost importance and should be kept in mind during fabrication of FDP

Importance of Consideration of Age and Gender during Prosthodontic Rehabilitation in the Anterior Esthetic Zone

Aim: To investigate the effect of age and gender on the degree of maxillary and mandibular anterior teeth display while speaking and smiling in Indian population. Materials and Method: A total of 120 subjects (63 females and 57 males) were included in this study. The subject was asked pronounced "ah"& "six" 3 times each sound, closing the mouth and resting between each sound. After these sounds, a smile was provoked. Each image was inserted into a separate slide of presentation software and measurements were taken. Results: There was a statistically significant difference in display of maxillary and mandibular anterior teeth owing to age and gender. Conclusion: Differences in tooth display in relation to aging and gender should be considered when providing esthetic treatment that involves replacement of anterior teeth

An in vitro comparison of retention of provisional crowns cemented with provisional cement enriched with three different additives

Introduction: Dental caries remains a constant problem in clinical practice. The rates of recurrent caries around long-term provisional restorations may be even higher due to poor marginal adaptation and less stable materials. Since provisional crowns luted with provisional cement are susceptible to bacterial infiltration and caries, antibacterial and anticariogenic agents have been added to provisional cement, and retention of the provisional crown has been evaluated in this study. Materials and Methods: Ten extracted maxillary first premolar teeth were selected. Standardised tooth preparation was done. A total of 40 provisional crowns were fabricated using tooth-coloured auto-polymerising acrylic resin. The prepared provisional crowns were divided into four groups of 10 crowns each. Crowns were cemented on the prepared teeth after enriching with the three solutions individually. All specimens were stored in 100% humidity at 37°C for 1 h, thermocycler 100 times between 5°C and 55°C with a dwell time of 10 s and then stored at 100% humidity at 37°C. Cemented crowns were subjected to tensile dislodgement force using a universal testing machine with a crosshead speed of 5 mm/min. Results: Provisional cement enriched with Profluorid Varnish has shown properties of the highest tensile dislodgement force, with chlorhexidine-reduced retention. Conclusion: The present study concluded that Profluorid Varnish, as an additive in non-eugenol provisional cement (Provicol), is more effective in increasing retention

Cast Metal Occlusals: A Vital Tool for Single Complete Denture: A Case Report

Background: Occlusal surface of the acrylic teeth of a single complete denture in opposition to natural dentition wears out with its use for a longer period of time, which may lead to decrease in the chewing efficiency, loss of vertical dimension of occlusion, change in centric occlusion, denture instability, temporomandibular joint disturbances etc. Re-fabrication of new denture set over a period of time, inclusion of highly cross linked acrylic teeth, amalgam or metal inserts on occlusal surface, use of composite, gold or metal occlusal surface, etc. are some of the treatment options available to counteract that problem. Several articles have described methods to construct gold and metal occlusal surfaces, some of which are time-consuming, expensive and require many cumbersome steps. This clinical case describes the sequence of steps for construction of metal occlusal surfaces on single complete denture using the lost wax technique