Permanent teeth with horizontal root fractures after dental trauma. A retrospective study

The purpose of the present retrospective study was to evaluate the post-traumatic healing of the pulp and periodontium of 32 permanent teeth with horizontal root fractures. Twenty-nine patients, 8-48 years old, who presented at our department with a root fracture between January 2001 and April 2007, participated in the study. Root-fractured teeth with a loosened or dislocated coronal fragment were repositioned and splinted for 14-49 days (average: 34 days). In cases of severe dislocation of the coronal fragment, prophylactic endodontic treatment was performed. Follow-up examinations were conducted routinely after 1,2,3,6, and 12 months. For this study, follow-up took place for up to 7 years post trauma. Of 32 root-fractured teeth, 29 (91%) survived. 10 teeth (31%) exhibited pulpal healing; 13 teeth (41%) were prophylactically endodontically treated within 2 weeks of injury. At the fracture line, interposition of calcified tissue was evident in 6 teeth (19%), and interposition of granulation tissue was observed in 8 teeth (25%). The prognosis of the root-fractured teeth was good, and one-third of the teeth with root fractures possessed a vital pulp at the final examination.

Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients

OBJECTIVE: To analyze the clinical outcome of horizontal ridge augmentation using autogenous block grafts covered with an organic bovine bone mineral (ABBM) and a bioabsorbable collagen membrane. MATERIAL AND METHODS: In 42 patients with severe horizontal bone atrophy, a staged approach was chosen for implant placement following horizontal ridge augmentation. A block graft was harvested from the symphysis or retromolar area, and secured to the recipient site with fixation screws. The width of the ridge was measured before and after horizontal ridge augmentation. The block graft was subsequently covered with ABBM and a collagen membrane. Following a tension-free primary wound closure and a mean healing period of 5.8 months, the sites were re-entered, and the crest width was re-assessed prior to implant placement. RESULTS: Fifty-eight sites were augmented, including 41 sites located in the anterior maxilla. The mean initial crest width measured 3.06 mm. At re-entry, the mean width of the ridge was 7.66 mm, with a calculated mean gain of horizontal bone thickness of 4.6 mm (range 2-7 mm). Only minor surface resorption of 0.36 mm was observed from augmentation to re-entry. CONCLUSIONS: The presented technique of ridge augmentation using autogenous block grafts with ABBM filler and collagen membrane coverage demonstrated successful horizontal ridge augmentation with high predictability. The surgical method has been further simplified by using a resorbable membrane. The hydrophilic membrane was easy to apply, and did not cause wound infection in the rare instance of membrane exposure.

Minimally invasive strabismus surgery for horizontal rectus muscle reoperations

AIMS: To study if minimally invasive strabismus surgery (MISS) is suitable for rectus muscle reoperations. METHODS: The study presents a series of consecutive patients operated on by the same surgeon at Kantonsspital St Gallen, Switzerland with a novel MISS rectus muscle reoperation technique. Surgery is done by applying two small radial cuts along the muscle insertion. Through the tunnel obtained after muscle separation from surrounding tissue, a recession, advancement or plication is performed. RESULTS: In 62 eyes of 51 patients (age 35.4 (SD 16.3) years) a total of 86 horizontal rectus muscles were reoperated. On the average, the patients had 2.1 strabismus surgeries previously. Preoperative logMAR visual acuity was 0.38 (0.82) compared with 0.37 (0.83) at 6 months (p>0.1). On the first postoperative day, in the primary gaze position conjunctival and lid swelling and redness was hardly visible in 11 eyes, discrete in 15 eyes, moderate in 11 eyes and severe in 15 eyes. One corneal dellen and one corneal erosion occurred, which both quickly resolved. The preoperative deviation at distance for esodeviations (n = 15) of 12.5 (8.5) degrees decreased to 2.6 (7.8) degrees at 6 months (p<0.001). For near, a decrease from 12.0 (10.1) degrees to 2.9 (1.6) degrees was observed (p<0.001). The preoperative deviation at distance for exodeviations (n = 35) of -16.4 (8.5) degrees decreased to -7.9 (6.5) degrees at 6 months (p<0.005). For near, a decrease from -16.5 (11.4) degrees to -2.9 (1.5) degrees was observed (p<0.005). Within the first 6 months, only one patient had a reoperation. At month 6, in four patients a reoperation was planned or suggested by us because of unsatisfactory alignment. No patient experienced persistent diplopia or necessitated a reoperation because of double vision. Stereovision improved at month 6 compared with preoperatively (p<0.01). CONCLUSIONS: The study demonstrates that a small-cut, minimal dissection technique allows to perform rectus muscle reoperations. The MISS technique seems to reduce conjunctival and lid swelling in the direct postoperative period.

Influence of the background wind on the local soil moisture-precipitation feedback

The importance of soil moisture anomalies on airmass convection over semiarid regions has been recognized in several studies. The underlying mechanisms remain partly unclear. An open question is why wetter soils can result in either an increase or a decrease of precipitation (positive or negative soil moisture–precipitation feedback, respectively). Here an idealized cloud-resolving modeling framework is used to explore the local soil moisture–precipitation feedback. The approach is able to replicate both positive and negative feedback loops, depending on the environmental parameters. The mechanism relies on horizontal soil moisture variations, which may develop and intensify spontaneously. The positive expression of the feedback is associated with the initiation of convection over dry soil patches, but the convective cells then propagate over wet patches where they strengthen and preferentially precipitate. The negative feedback may occur when the wind profile is too weak to support the propagation of convective features from dry to wet areas. Precipitation is then generally weaker and falls preferentially over dry patches. The results highlight the role of the midtropospheric flow in determining the sign of the feedback. A key element of the positive feedback is the exploitation of both low convective inhibition (CIN) over dry patches (for the initiation of convection) and high CAPE over wet patches (for the generation of precipitation).

Reactive mass transport modelling of a three-dimensional vertical fault zone with a finger-like convective flow regime

For a three-dimensional vertically-oriented fault zone, we consider the coupled effects of fluid flow, heat transfer and reactive mass transport, to investigate the patterns of fluid flow, temperature distribution, mineral alteration and chemically induced porosity changes. We show, analytically and numerically, that finger-like convection patterns can arise in a vertically-oriented fault zone. The onset and patterns of convective fluid flow are controlled by the Rayleigh number which is a function of the thermal properties of the fluid and the rock, the vertical temperature gradient, and the height and the permeability of the fault zone. Vigorous fluid flow causes low temperature gradients over a large region of the fault zone. In such a case, flow across lithological interfaces becomes the most important mechanism for the formation of sharp chemical reaction fronts. The degree of rock buffering, the extent and intensity of alteration, the alteration mineralogy and in some cases the formation of ore deposits are controlled by the magnitude of the flow velocity across these compositional interfaces in the rock. This indicates that alteration patterns along compositional boundaries in the rock may provide some insights into the convection pattern. The advective mass and heat exchanges between the fault zone and the wallrock depend on the permeability contrast between the fault zone and the wallrock. A high permeability contrast promotes focussed convective flow within the fault zone and diffusive exchange of heat and chemical reactants between the fault zone and the wallrock. However, a more gradual permeability change may lead to a regional-scale convective flow system where the flow pattern in the fault affects large-scale fluid flow, mass transport and chemical alteration in the wallrocks

Horizontal ridge augmentation in conjunction with or prior to implant placement in the anterior maxilla: a systematic review.

PURPOSE To systematically review clinical studies examining the survival and success rates of implants in horizontal ridge augmentation, either prior to or in conjunction with implant placement in the anterior maxilla. MATERIALS AND METHODS A literature search was undertaken up to September 2012 including clinical studies in English with ≥ 10 consecutively treated patients and a mean follow-up of at least 12 months. Two reviewers screened the pertinent articles and extracted the data. Key words focused on the outcome parameters (implant success, implant survival, horizontal bone gain, and intra- and postoperative complications) in studies utilizing either a simultaneous approach (ridge augmentation performed at the time of implant placement) or a staged approach (ridge augmentation performed prior to implant placement) were analyzed. RESULTS A total of 13 studies met the inclusion criteria, with 2 studies in the simultaneous group and 11 studies in the staged group. In the simultaneous group, survival rates of implants were 100% in both studies, with one study also reporting a 100% implant success rate. No data on horizontal bone gain were available. In the staged group, success rates of implants placed in horizontally augmented ridges ranged from 96.8% to 100% (two studies), and survival rates ranged from 93.5% to 100% (five studies). However, follow-up periods differed widely (up to 4.1 years). Mean horizontal bone gain determined at reentry (implant placement) ranged from 3.4 to 5.0 mm with large overall variations (0 to 9.8 mm, five studies). Intraoperative complications were not reported. Postsurgical complications included mainly mucosal dehiscences (five studies), and, occasionally, complete failures of block grafts were described in one study. CONCLUSIONS Staged and simultaneous augmentation procedures in the anterior maxilla are both associated with high implant success and survival rates. The level of evidence, however, is better for the staged approach than for the simultaneous one.

Horizontal head titubation in infants with Joubert syndrome: a new finding

AIM Head thrusts are well documented in Joubert syndrome and ocular motor apraxia. We provide a detailed clinical characterization of head titubation in 13 young children with Joubert syndrome. METHOD Detailed characterization of head titubation was assessed by targeted clinical evaluation and/or analysis of videos. RESULTS In 12 of 13 children (eight males, five females; median age 6y, range 2mo-15y) head titubation was first recognized in the first 2 months of age and decreased in severity until spontaneous resolution. In all children, the head titubation was horizontal, high frequency (~3Hz), had small amplitude (5-10°), was never present during sleep, and did not interfere with the neurodevelopment during infancy. In the majority of children, emotion, anxiety, and tiredness were worsening factors for head titubation. INTERPRETATION Head titubation is a benign, early presentation of Joubert syndrome. Head titubation in hypotonic infants should prompt a careful search for Joubert syndrome. Awareness of its occurrence in Joubert syndrome may avoid unnecessary investigations.

Reading performance is not affected by a prism induced increase of horizontal and vertical vergence demand

PURPOSE Dyslexia is the most common developmental reading disorder that affects language skills. Latent strabismus (heterophoria) has been suspected to be causally involved. Even though phoria correction in dyslexic children is commonly applied, the evidence in support of a benefit is poor. In order to provide experimental evidence on this issue, we simulated phoria in healthy readers by modifying the vergence tone required to maintain binocular alignment. METHODS Vergence tone was altered with prisms that were placed in front of one eye in 16 healthy subjects to induce exophoria, esophoria, or vertical phoria. Subjects were to read one paragraph for each condition, from which reading speed was determined. Text comprehension was tested with a forced multiple choice test. Eye movements were recorded during reading and subsequently analyzed for saccadic amplitudes, saccades per 10 letters, percentage of regressive (backward) saccades, average fixation duration, first fixation duration on a word, and gaze duration. RESULTS Acute change of horizontal and vertical vergence tone does neither significantly affect reading performance nor reading associated eye movements. CONCLUSION Prisms in healthy subjects fail to induce a significant change of reading performance. This finding is not compatible with a role of phoria in dyslexia. Our results contrast the proposal for correcting small angle heterophorias in dyslexic children.