T-Bar clasp-retained removable partial denture as an alternative to implant-based prosthetic treatment

This article reports the case of a 55-year-old female patient who presented with unsatisfactory temporary crowns in the right mandibular premolars and molars, and a premolar-to-molar fixed partial denture in the left side. The clinical and radiographic examinations revealed a fracture of the left first premolar that was a retainer of the fixed partial denture and required extraction. Initially, the acrylic resin crowns were replaced by new ones, and a provisional RPD was made using acrylic resin and orthodontic wire clasps to resolve the problem arising from the loss of the fixed partial denture. Considering the patient's high esthetic demands, the treatment options for the definitive prosthetic treatment were discussed with her and rehabilitation with implant-supported dentures was proposed because the clinical conditions of the residual alveolar ridge were suitable for implant installation, and the patient's general health was excellent. However, the patient did not agree because she knew of a failed case of implant-retained denture in a diabetic individual and was concerned. The patient was fully informed that implant installation was the best indication for her case, but the arguments were not sufficient to change her decision. The treatment possibilities were presented and the patient opted for a clasp-retained removable partial denture (RPD) associated with the placement of crowns in the pillar teeth. The temporary RPD was replaced by the definitive RPD constructed subsequently. Although RPD was not the first choice, satisfactory esthetic and functional outcomes were achieved, overcaming the patient's expectations. This case report illustrates that the dentist must be prepared to deal with situations where, for reasons that cannot be managed, the patient does not accept the treatment considered as the most indicated for his/her case. Alternatives must be proposed and the functional and esthetic requirements must be fulfilled in the best possible manner.Este artigo relata o caso de uma paciente de 55 anos que apresentava no arco mandibular coroas provisórias insatisfatórias nos pré-molares do lado direito e uma prótese parcial fixa de molar a pré-molar no lado esquerdo. Os exames clínico e radiográfico revelaram uma fratura do primeiro pré-molar esquerdo que era um retentor da prótese parcial fixa e teve a extração indicada. Inicialmente, as coroas provisórias foram substituídas por novas e uma prótese parcial removível provisória foi confeccionada com resina acrílica e grampos de fio ortodôntico a fim resolver os problemas relacionados à perda da prótese parcial fixa. Considerando a forte demanda estética da paciente, foram discutidas as opções de tratamento protético definitivo. Foi proposta a reabilitação com prótese implanto-suportada uma vez que as condições clínicas do rebordo alveolar se apresentavam adequadas para instalação de implantes e a saúde geral da paciente era excelente. Entretanto, a paciente não concordou com o tratamento proposto, alegando saber de um caso clínico em que houve insucesso na reabilitação por prótese implanto-suportada em um paciente diabético. Ela foi inteiramente informada de que a colocação de implantes era a melhor indicação para seu caso, mas os argumentos não foram suficientes para mudar sua decisão. As possibilidades de tratamento foram apresentadas e a paciente optou por uma prótese parcial removível (PPR) retida a grampos associada com coroas nos dentes pilares. Na seqüência, a PPR provisória foi substituída por uma PPR definitiva. Embora a PPR não tivesse sido a primeira escolha, foram obtidos resultados estéticos e funcionais satisfatórios, superando as expectativas da paciente. Este relato de caso ilustra que o dentista deve estar preparado para enfrentar situações em que, por razões que não possam ser administradas, o paciente não aceite o tratamento considerado mais indicado para seu caso. Alternativas devem ser propostas e as exigências estéticas e funcionais devem ser contempladas da melhor maneira possível

Protocol for north of England and Scotland study of tonsillectomy and adeno-tonsillectomy in children (NESSTAC). A pragmatic randomised controlled trial comparing surgical intervention with conventional medical treatment in children with recurrent sore throats

BACKGROUND: Uncertainties surrounding the effectiveness and cost-effectiveness of childhood tonsillectomy for recurrent sore throat led the NHS Health Technology Assessment Programme to commission this research to evaluate the effectiveness and cost-effectiveness of tonsillectomy and adeno-tonsillectomy in comparison with standard non-surgical management in children aged under 16 with recurrent throat infections. The aim is to evaluate if tonsillectomy and adeno-tonsillectomy reduces the number of episodes of sore throats among children to a clinically significant extent. METHODS/DESIGN: A simple prospective pragmatic randomised controlled trial with economic analysis and prospective cohort study of non-trial participants comparing surgical intervention with conventional medical treatment. The treatment arm will receive tonsillectomy and adeno-tonsillectomy while in the control arm non-surgical conventional medical treatment only will be used. The primary outcome measure will be reported number of episodes of sore throat over two years with secondary outcomes measures of reported number of episodes of sore throat, otitis media and upper respiratory tract infection which invoke a GP consultation; reported number of symptom-free days; reported severity of sore throats and surgical and anaesthetic morbidity. The study will take place in five hospitals in the UK. The trial population will be 406 children aged 4–15 on their last birthday with recurrent sore throat referred by primary care to the 5 otolaryngology departments. The duration of the study is seven years (July 2001- July 2008). DISCUSSION: As with all pragmatic randomised controlled trials it is impossible to control the external environment in which the research is taking place. Since this trial began a number of factors have arisen which could affect the outcome including; a reduction in the incidence of respiratory tract infections, marked socio-economic differences in consultation rates, the results from the National Prospective Tonsillectomy Audit and the Government's waiting list initiatives

Radical-carbanion cyclo-coupling in armed aromatics: overriding steric hindrance to ring closure

omega-(2-Halophenyl)alkyl-2-oxazolines were prepared and reacted via base promoted intramolecular coupling of radical with carbanionic centres to yield 1-phenyl-1-oxazolino-indan and -tetralin derivatives containing quaternary C-atoms.</p

Effect of Chain Length on Radical to Carbanion Cyclo-Coupling of Bromoaryl Alkyl-Linked Oxazolines: 1,3-Areneotropic Migration of Oxazolines

2-Halophenylalkyl-2-oxazolines with alkyl chain spacers of two to six C atoms (n = 0-4) were prepared and their S(RN)1-type reactions with several base systems examined. The best conditions to promote cyclo-coupling to the corresponding benzocycloalkane derivatives involved use of LDA in THF. The precursors with 3-C-atom and 4-C-atom spacers gave good yields of 2-(1'-phenylindan-1'-yl)-2-oxazolines and 2-(1-phenyl-1,2,3,4-tetrahydronaphthalen-1-yl)-2-oxazoline, respectively. The major products from the precursor with a 5-C-atom spacer were derivatives of benzocycloheptane in which the oxazoline group had undergone a novel areneotropic migration from the end of the spacer to the benzo ring. The product from reaction of the corresponding 2-C-atom precursor was a 9-oxazolinophenanthrene derivative. EPR spectroscopy showed the intermediates of the LDA-promoted reactions to be radical anions of the product benzocycloalkanes. This supported an S(RN)1-type chain mechanism involving initial production of aryl radicals connected to azaenolate ions via the spacer groups. Intramolecular radical to carbanion coupling then generated ring-closed benzocycloalkane radical anions that transferred an electron to more precursor. Diastereoselective radical to carbanion cyclo-coupling reactions were carried out with 2-bromophenylpropyl precursors containing chiral 2-oxazolines. The diastereoselectivity achievable was modest, but the product diastereoisomeric Indane derivatives were easily separable by chromatography.</p