3-Year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible

Background: The long-term success rates achieved in dental implantology suggest that flexibility might well exist within the various implant systems to a degree that an altered protocol (ie, one-stage surgery and immediate or early loading) can be performed under controlled conditions. However, before variations of the protocol can be considered for general use, they must be subjected to critical analysis, particularly with respect to the predictability of osseointegration, alteration of soft tissue barrier, and relative change in bone height around the implants. Purpose: The aim of this prospective multicenter study was to evaluate implant survival and periimplant conditions around endosseous implants placed in a one-stage surgical procedure and early loading. Materials and Methods: A total of 170 implants were placed in 40 patients with mandibular edentulism and were functionally loaded within 6 weeks with overdentures (n = 30) or fixed prostheses (n = 10). All patients and prosthetic constructions were evaluated according to a standardized protocol during 3 years of follow-up. Cumulative implant survival rates were calculated, and implant loss in relation to implant size and bone quality and quantity were evaluated. Furthermore, the protocol included assessment of clinical (plaque and bleeding scores, prosthesis stability) and radiographic parameters. Results: Over a period of 3 years, the implant survival rate was 93% for both implants and prostheses (fixed or removable). No implants were lost after the first year of loading. The periimplant tissues were in a healthy condition. Mean marginal bone resorption from the time of loading to the 3-year follow-up was 0.41 mm (SD 0.52). Conclusions: From this study it may be concluded that early loading results in good implant survival and proper periimplant health in edentulous mandibles.</p

Psychometric validation of the BDI-II among HIV-positive CHARTER study participants.

Rates of depression are high among individuals living with HIV. Accurate assessment of depressive symptoms among this population is important for ensuring proper diagnosis and treatment. The Beck Depression Inventory-II (BDI-II) is a widely used measure for assessing depression, however its psychometric properties have not yet been investigated for use with HIV-positive populations in the U.S. The current study was the first to assess the psychometric properties of the BDI-II among a large cohort of HIV-positive participants sampled at multiple sites across the U.S. as part of the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study. The BDI-II test scores showed good internal consistency (α = 0.93) and adequate test-retest reliability (ICC = 0.83) over a 6-month period. Using a ‘gold standard’ of major depressive disorder determined by the Composite International Diagnostic Interview (CIDI), sensitivity and specificity were maximized at a total cut-off score of 17 and a Receiver Operating Characteristic (ROC) analysis confirmed that the BDI-II is an adequate diagnostic measure for the sample (AUC = 0.83). The sensitivity and specificity of each score are provided graphically. Confirmatory factor analyses confirmed the best fit for a 3-factor model over 1-factor and 2-factor models and models with a higher-order factor included. The results suggest that the BDI-II is an adequate measure for assessing depressive symptoms among U.S. HIV-positive patients. Cut-off scores should be adjusted to enhance sensitivity or specificity as needed and the measure can be differentiated into cognitive, affective, and somatic depressive symptoms

Proinflammatory Activation of Osteoclasts Due to High Prolactin Level

High concentrations of prolactin (PRL) during the lactation period have an essential role in milk production by mammary glands stimulation. PRL may have an impact on calcium regulation and bone mineral density. We investigated if the PRL concentration during the lactation period could influence osteoclast (OC) activation and bone mineral density (BMD). In vivo, the Calcium Detection Assay, and ELISA were used to detect serum calcium, PRL, and inflammatory cytokines, respectively. BMD was evaluated by µ-CT in six months old female mice during lactation. The osteoclast (OC) activity was detected by Tartrate-resistant acid phosphatase (TRAP), Immunohistochemistry (IHC), and hematoxylin and eosin (H&E). In vitro, osteoclast differentiation, resorption and their activity markers TRAP, Matrix metallopeptidase 9 (MMP-9), Cathepsin K (CTSK), C-reactive protein (CRP), Receptor activator of nuclear factor kappa-Β (RANK) and inflammatory cytokines were measured in osteoclasts stimulated with recombinant prolactin protein (rPRL) or with an anti-prolactin blocker. We found that serum calcium, PRL, and inflammatory markers were increased. BMD was significantly reduced in lactating mice; TRAP activity was increased and tubercular was reduced in lactating mice compared to normal mice. In vitro, the osteoclast number, resorption, and activation markers TRAP, MMP-9, CTSK, CRP, and RANK were significantly increased after treatment with rPRL protein, but not in osteoclasts treated with anti-prolactin receptor antibody and rPRL. The gene expression of TNF-α, IL-6, and Monocyte chemoattractant protein-1 (MCP-1) but not IL-1b were significantly increased in osteoclasts with PRL treatment compared to the untreated osteoclasts. Taken together, the high level of PRL could activate osteoclasts and proinflammatory cytokines expression which reduce BMD in the lactation period

Differential improvements in lipid profiles and Framingham recurrent risk score in patients with and without diabetes mellitus undergoing long-term cardiac rehabilitation.

OBJECTIVE: To determine whether lipid profiles and recurrent coronary heart disease (CHD) risk could be modified in patients with and without diabetes mellitus undergoing long-term cardiac rehabilitation (CR). DESIGN: Retrospective analysis of patient case records. SETTING: Community-based phase 4 CR program. PARTICIPANTS: Patients without diabetes (n=154; 89% men; mean ± SD age, 59.6 ± 8.5y; body mass index [BMI], 27.0 ± 3.5 kg/m²) and patients with diabetes (n=20; 81% men; mean age, 63.0 ± 8.7y; BMI, 28.7 ± 3.3 kg/m²) who completed 15 months of CR. INTERVENTIONS: Exercise testing and training, risk profiling, and risk-factor education. MAIN OUTCOME MEASURES: Cardiometabolic risk factors and 2- to 4-year Framingham recurrent CHD risk scores were assessed. RESULTS: At follow up, a significant main effect for time was evident for decreased body mass and waist circumference and improved low-density lipoprotein cholesterol (LDL-C) level and submaximal cardiorespiratory fitness (all P<.05), showing the benefits of CR in both groups. However, a significant group-by-time interaction effect was evident for high-density lipoprotein cholesterol (HDL-C) level and total cholesterol (TC)/HDL-C ratio (both P<.05). TC/HDL-C ratio improved (5.0 ± 1.5 to 4.4 ± 1.3) in patients without diabetes, but showed no improvement in patients with diabetes (4.8 ± 1.6 v 4.9 ± 1.6). CONCLUSIONS: We showed that numerous anthropometric, submaximal fitness, and cardiometabolic risk variables (especially LDL-C level) improved significantly after long-term CR. However, some aspects of cardiometabolic risk (measures incorporating TC and HDL-C) improved significantly in only the nondiabetic group

Maximum occlusal force and medial mandibular flexure in relation to vertical facial pattern: a cross-sectional study

BACKGROUND: Vertical facial pattern may be related to the direction of pull of the masticatory muscles, yet its effect on occlusal force and elastic deformation of the mandible still is unclear. This study tested whether the variation in vertical facial pattern is related to the variation in maximum occlusal force (MOF) and medial mandibular flexure (MMF) in 51 fully-dentate adults. METHODS: Data from cephalometric analysis according to the method of Ricketts were used to divide the subjects into three groups: Dolichofacial (n = 6), Mesofacial (n = 10) and Brachyfacial (n = 35). Bilateral MOF was measured using a cross-arch force transducer placed in the first molar region. For MMF, impressions of the mandibular occlusal surface were made in rest (R) and in maximum opening (O) positions. The impressions were scanned, and reference points were selected on the occlusal surface of the contralateral first molars. MMF was calculated by subtracting the intermolar distance in O from the intermolar distance in R. Data were analysed by ANCOVA (fixed factors: facial pattern, sex; covariate: body mass index (BMI); alpha = 0.05). RESULTS: No significant difference of MOF or MMF was found among the three facial patterns (P = 0.62 and P = 0.72, respectively). BMI was not a significant covariate for MOF or MMF (P > 0.05). Sex was a significant factor only for MOF (P = 0.007); males had higher MOF values than females. CONCLUSION: These results suggest that MOF and MMF did not vary as a function of vertical facial pattern in this Brazilian sample

Effects of hypodontia on craniofacial structures and mandibular growth pattern

Introduction This study was performed to examine craniofacial structures in persons with hypodontia and to reveal any differences, that may occur, when agenetic teeth are only found in the maxilla, the mandible or in both jaws. The groups consistent of 50 children (33 girls, 17 boys) aged between 9 and 13.5 years were analyzed and assigned to three subgroups. Group 1= upper jaw hypodontia. Group 2= lower jaw hypodontia. Group 3= hypodontia in both jaws. Material and methods Eleven angular and three index measurements from lateral encephalographs and two linear measurements from dental blaster casts were calculated. All data was statistically analyzed, parameters with p<5% were investigated for each subgroup respectively. Results In comparison with standards the study group showed bimaxillary retrognathism and a reduction of the lower anterior facial height. Moreover both overbite and overjet significantly increased. Other values laid within the normal ranges. Evaluating results of the subgroups, differences in the means of SNA, SNB and overjet between the groups were observed. Analysis of the mandibular growth pattern revealed, that neither vertical nor horizontal patterns are dominant in hypodontia patients. Conclusions In certain dentofacial parameters differences between persons with hypodontia and such with full dentition exist. According to our findings agenetic teeth may have a negative influence on the saggital development of a jaw and the lower face and may be responsible for increased overbites. This should receive attention in orthodontic treatment of hypodontia patients