Long-Term Safety and Efficacy of Abatacept in Children With Juvenile Idiopathic Arthritis

Objective. We previously documented that abatacept was effective and safe in patients with juvenile idiopathic arthritis (JIA) who had not previously achieved a satisfactory clinical response with disease-modifying antirheumatic drugs or tumor necrosis factor blockade. Here, we report results from the long-term extension (LTE) phase of that study.Methods. This report describes the long-term, open-label extension phase of a double-blind, randomized, controlled withdrawal trial in 190 patients with JIA ages 6-17 years. Children were treated with 10 mg/kg abatacept administered intravenously every 4 weeks, with or without methotrexate. Efficacy results were based on data derived from the 153 patients who entered the open-label LTE phase and reflect >= 21 months (589 days) of treatment. Safety results include all available open-label data as of May 7, 2008.Results. of the 190 enrolled patients, 153 entered the LTE. By day 589, 90%, 88%, 75%, 57%, and 39% of patients treated with abatacept during the double-blind and LTE phases achieved responses according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30), Pedi 50, Pedi 70, Pedi 90, and Pedi 100 criteria for improvement, respectively. Similar response rates were observed by day 589 among patients previously treated with placebo. Among patients who had not achieved an ACR Pedi 30 response at the end of the open-label lead-in phase and who proceeded directly into the LTE, 73%, 64%, 46%, 18%, and 5% achieved ACR Pedi 30, Pedi 50, Pedi 70, Pedi 90, and Pedi 100 responses, respectively, by day 589 of the LTE. No cases of tuberculosis and no malignancies were reported during the LTE. Pneumonia developed in 3 patients, and multiple sclerosis developed in 1 patient.Conclusion. Abatacept provided clinically significant and durable efficacy in patients with JIA, including those who did not initially achieve an ACR Pedi 30 response during the initial 4-month open-label lead-in phase.

Preliminary Criteria for Global Flares in Childhood-Onset Systemic Lupus Erythematosus

Objective. To develop widely acceptable preliminary criteria of global flare for childhood-onset systemic lupus erythematosus (cSLE).Methods. Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-double-stranded DNA antibodies, disease activity index scores, protein: creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets.Results. The highest-ranked candidate criteria considered absolute changes (Delta) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD-global, P:C ratio, and ESR; flare scores can be calculated (0.5 x Delta SLEDAI + 0.45 x Delta P:C ratio + 0.5 x Delta MD-global + 0.02 x Delta ESR), where values of >= 1.04 are reflective of a flare. Similarly, BILAG-based flare scores (0.4 x Delta BILAG + Delta 0.65 x Delta P:C ratio + 0.5 + Delta MD-global + 0.02 x Delta ESR) of >= 1.15 were diagnostic of a flare. Flare scores increased with flare severity.Conclusion. Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.

Achados bucais e laboratoriais em pacientes com lúpus eritematoso sistêmico

INTRODUÇÃO: O lúpus eritematoso sistêmico (LES) é uma doença inflamatória crônica caracterizada por manifestações clínicas variadas. Os poucos trabalhos existentes na literatura relatam uma prevalência entre 6,5% e 21% de acometimento bucal. OBJETIVO: Investigar os achados bucais e laboratoriais em pacientes com LES. MATERIAL E MÉTODO: Foram analisados 155 pacientes com diagnóstico de LES, segundo critérios do American College of Rheumatology (ACR). O índice de dentes cariados, perdidos e obturados (CPO-D) foi registrado e avaliou-se a necessidade de tratamento periodontal por meio do índice periodontal comunitário (IPC). Foram realizados esfregaços e biópsias das lesões e bordas laterais de língua para exames citopatológicos. Exames laboratoriais foram correlacionados com os achados bucais destes pacientes. RESULTADOS: Dos 155 pacientes, 94,1% eram mulheres. Altos níveis de anticorpos circulantes (FAN-Hep2) foram observados em todos os pacientes, sendo 41,9% positivos para a pesquisa de anticorpos anti-DNA de fita dupla. O índice CPO-D médio correspondeu a 18,5 e de acordo com o IPC, 18% apresentaram bolsas periodontais de 4-5 mm e 5,9% de 6 mm ou mais. Foram biopsiadas oito lesões bucais, mas somente três casos foram considerados compatíveis com a indicação clínica de LES. Os principais sítios acometidos foram dorso de língua, mucosa jugal e lábios. A prevalência de candidíase correspondeu a 20,1% e a de leucoplasia pilosa oral a 3,7%. CONCLUSÃO: Pacientes com LES apresentam condição periodontal precária e baixa prevalência de lesões bucais e, além disso, a citopatologia mostrou-se importante no diagnóstico de infecções relacionadas com imunossupressão, como candidíase e leucoplasia pilosa oral.

beta-carotene and other carotenoids as antioxidants

Carotenoids are natural pigments which are synthesized by plants and are responsible for the bright colors of various fruits and vegetables. There are several dozen carotenoids in the foods that we eat, and most of these carotenoids have antioxidant activity. beta-carotene has been best studied since, in most countries it is the most common carotenoid in fruits and vegetables. However, in the U.S., lycopene from tomatoes now is consumed in approximately the same amount as beta-carotene. Antioxidants (including carotenoids) have been studied for their ability to prevent chronic disease, beta-carotene and others carotenoids have antioxidant properties in vitro and in animal models. Mixtures of carotenoids or associations with others antioxidants (e.g. vitamin E) can increase their activity against free radicals. The use of animals models for studying carotenoids is limited since most of the animals do not absorb or metabolize carotenoids similarly to humans.Epidemiologic studies have shown an inverse relationship between presence of various cancers and dietary carotenoids or blood carotenoid levels. However, three out of four intervention trials using high dose beta-carotene supplements did not show protective effects against cancer or cardiovascular disease. Rather, the high risk population (smokers and asbestos workers) in these intervention trials showed an increase in cancer and angina cases. It appears that carotenoids (including beta-carotene) can promote health when taken at dietary levels, but may have adverse effects when taken in high dose by subjects who smoke or who have been exposed to asbestos. It will be the task of ongoing and future studies to define the populations that can benefit from carotenoids and to define the proper doses, lengths of treatment, and whether mixtures, lather than single carotenoids (e.g. beta-carotene) are more advantageous.

Recommended Guidelines for Submission, Trimming, Margin Evaluation, and Reporting of Tumor Biopsy Specimens in Veterinary Surgical Pathology

Neoplastic diseases are typically diagnosed by biopsy and histopathological evaluation. The pathology report is key in determining prognosis, therapeutic decisions, and overall case management and therefore requires diagnostic accuracy, completeness, and clarity. Successful management relies on collaboration between clinical veterinarians, oncologists, and pathologists. To date there has been no standardized approach or guideline for the submission, trimming, margin evaluation, or reporting of neoplastic biopsy specimens in veterinary medicine. To address this issue, a committee consisting of veterinary pathologists and oncologists was established under the auspices of the American College of Veterinary Pathologists Oncology Committee. These consensus guidelines were subsequently reviewed and endorsed by a large international group of veterinary pathologists. These recommended guidelines are not mandated but rather exist to help clinicians and veterinary pathologists optimally handle neoplastic biopsy samples. Many of these guidelines represent the collective experience of the committee members and consensus group when assessing neoplastic lesions from veterinary patients but have not met the rigors of definitive scientific study and investigation. These questions of technique, analysis, and evaluation should be put through formal scrutiny in rigorous clinical studies in the near future so that more definitive guidelines can be derived.

Recommended Guidelines for the Conduct and Evaluation of Prognostic Studies in Veterinary Oncology

There is an increasing need for more accurate prognostic and predictive markers in veterinary oncology because of an increasing number of treatment options, the increased financial costs associated with treatment, and the emotional stress experienced by owners in association with the disease and its treatment. Numerous studies have evaluated potential prognostic and predictive markers for veterinary neoplastic diseases, but there are no established guidelines or standards for the conduct and reporting of prognostic studies in veterinary medicine. This lack of standardization has made the evaluation and comparison of studies difficult. Most important, translating these results to clinical applications is problematic. To address this issue, the American College of Veterinary Pathologists' Oncology Committee organized an initiative to establish guidelines for the conduct and reporting of prognostic studies in veterinary oncology. The goal of this initiative is to increase the quality and standardization of veterinary prognostic studies to facilitate independent evaluation, validation, comparison, and implementation of study results. This article represents a consensus statement on the conduct and reporting of prognostic studies in veterinary oncology from veterinary pathologists and oncologists from around the world. These guidelines should be considered a recommendation based on the current state of knowledge in the field, and they will need to be continually reevaluated and revised as the field of veterinary oncology continues to progress. As mentioned, these guidelines were developed through an initiative of the American College of Veterinary Pathologists' Oncology Committee, and they have been reviewed and endorsed by the World Small Animal Veterinary Association.

HLA-DR in Brazilian patients with polyarteritis nodosa (PAN) and microscopic polyangiitis (MPA)

The aim of this study was to evaluate the frequency and clinical associations of HLA-DR alleles in Brazilian Caucasian patients with polyarteritis nodosa (PAN) or microscopic polyangiitis (MPA). We evaluated 29 Caucasian patients with vasculitis classified as PAN or MPA according to the American College of Rheumatology (ACR) 1990 Criteria, Chapel Hill Consensus Conference (CHCC) nomenclature for vasculitis and EULAR recommendations for conducting clinical studies in systemic vasculitis. HLA-DR alleles were typed using polymerase chain reaction-amplified DNA, hybridized with sequence-specific low resolution primers. DNA obtained from 59 Caucasian healthy blood donors were used as control. In order to evaluate if a specific HLA may have influence on the clinical profile of those diseases, we also divided the patients according to Birmingham vasculitis score (BVAS) and Five-Factors Score (FFS) at the time of diagnosis. Increased frequency of HLA-DRB1*16 (p = 0.023) and DRB4*01 (p = 0.048) was found in patients with higher disease activity at the time of diagnosis (BVAS >= 22). Patients with less severe disease (FFS = 0) had a higher frequency of HLA-DRB1*03 (p = 0.011). Patients with gastrointestinal tract involvement had significantly increased frequency of HLA-DRB1*11 or B1*12 (p = 0.046), B1*13 (p = 0.021) and B3 (p = 0.008). In contrast, patients with renal disease, had higher frequency of DRB1*15 or DRB1*16 (p = 0.035) and B5 (p = 0.035). In the subgroup of patients with MPA, increased frequency of HLA-DRB1*15 was found in patients with BVAS >= 22 (p = 0.038) and FFS >= 1 (p = 0.039) suggesting that this allele is associated with more aggressive disease. Antineutrophil cytoplasmic antibodies (ANCA) negative MPA patients had significantly increased frequency of HLA-DRB1*11 or DRB1*12 when compared to ANCA positive patients (p = 0.023). Our results suggest that HLA-DR alleles may influence PAN and MPA clinical expression and outcome and that in MPA they participate in the mechanisms involved in the development to ANCA.

Abatacept in children with juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled withdrawal trial

Background Some children with juvenile idiopathic arthritis either do not respond, or are intolerant to, treatment with disease-modifying antirheumatic drugs, including anti-tumour necrosis factor (TNF) drugs. We aimed to assess the safety and efficacy of abatacept, a selective T-cell costimulation modulator, in children with juvenile idiopathic arthritis who had failed previous treatments.Methods We did a double-blind, randomised controlled withdrawal trial between February, 2004, and June, 2006. We enrolled 190 patients aged 6-17 years, from 45 centres, who had a history of active juvenile idiopathic arthritis; at least five active joints; and an inadequate response to, or intolerance to, at least one disease-modifying antirheumatic drug. All 190 patients were given 10 mg/kg of abatacept intravenously in the open-label period of 4 months. of the 170 patients who completed this lead-in course, 47 did not respond to the treatment according to predefined American College of Rheumatology (ACR) paediatric criteria and were excluded. of the patients who did respond to abatacept, arthritis, and 62 were randomly assigned to receive placebo at the same dose and timing. The primary endpoint was time to flare of arthritis. Flare was defined as worsening of 30% or more in at least three of six core variables, with at least 30% improvement in no more than one variable. We analysed all patients who were treated as per protocol. This trial is registered, number NCT00095173.Findings Flares of arthritis occurred in 33 of 62 (53%) patients who were given placebo and 12 of 60 (20%) abatacept patients during the double-blind treatment (p=0.0003). Median time to flare of arthritis was 6 months for patients given placebo (insufficient events to calculate IQR); insufficient events had occurred in the abatacept group for median time to flare to be assessed (p=0.0002). The risk of flare in patients who contined abatacept was less than a third of that for controls during that double-blind period (hazard ratio 0.31, 95% CI 0.16-0.95). During the double-blind period, the frequency of adverse events did not differ in the two treatment groups, Adverse events were recorded in 37 abatacept recipients (62%) and 34 (55%) placebo recipients (p=0.47); only two serious adverse events were reported, bouth in controls (p=0.50).Interpretation Selective modulation of T-cell costimulation with abatacept is a rational alternative treatment for children with juvenile idiopathic arthritis.Funding Bristol-Myers Squibb.

β-carotene and other carotenoids as antioxidants

Carotenoids are natural pigments which are synthesized by plants and are responsible for the bright colors of various fruits and vegetables. There are several dozen carotenoids in the foods that we eat, and most of these carotenoids have antioxidant activity. β-carotene has been best studied since, in most countries it is the most common carotenoid in fruits and vegetables. However, in the U.S., lycopene from tomatoes now is consumed in approximately the same amount as β-carotene. Antioxidants (including carotenoids) have been studied for their ability to prevent chronic disease. β-carotene and others carotenoids have antioxidant properties in vitro and in animal models. Mixtures of carotenoids or associations with others antioxidants (e.g. vitamin E) can increase their activity against free radicals. The use of animals models for studying carotenoids is limited since most of the animals do not absorb or metabolize carotenoids similarly to humans. Epidemiologic studies have shown an inverse relationship between presence of various cancers and dietary carotenoids or blood carotenoid levels. However, three out of four intervention trials using high dose β- carotene supplements did not show protective effects against cancer or cardiovascular disease. Rather, the high risk population (smokers and asbestos workers) in these intervention trials showed an increase in cancer and angina cases. It appears that carotenoids (including β-carotene) can promote health when taken at dietary levels, but may have adverse effects when taken in high dose by subjects who smoke or who have been exposed to asbestos. It will be the task of ongoing and future studies to define the populations that can benefit from carotenoids and to define the proper doses, lengths of treatment, and whether mixtures, rather than single carotenoids (e.g. β-carotene) are more advantageous.

Investigation into the use of the Laryngeal Mask Airway in pentobarbital anesthetized dogs

Objective - To investigate the use of the laryngeal mask airway (LMA) in dogs. Study Design - Prospective experimental study. Animals - Eight healthy adult mixed breed dogs weighing from 15 to 20 kg. Methods - The dogs were anesthetized with intravenous pentobarbital. An LMA was introduced after the induction of anesthesia and 1 L/min O2 plus 1 L/min air was delivered using a circle anesthetic system. Respiratory rate, tidal volume, arterial O2 saturation (pulse oximetry), end tidal CO2, inspired fraction of O2, pulse rate, and mean arterial blood pressure were measured after the insertion of the LMA and 30, 60, 90, and 120 minutes afterwards. Results - There were no changes in respiratory rate, tidal volume, arterial O2 saturation, and pulse rate during anesthesia. End tidal CO2 decreased significantly by the end of anesthesia and ventilation appeared satisfactory. Conclusions - An LMA appeared to be an alternative option to maintain the patency of the airway in dogs. Clinical Relevance - This device may allow safe maintenance of an airway in dogs when intubation is difficult or when it interferes with the procedure (eg, cervical myelography). ©Copyright 1999 by The American College of Veterinary Surgeons.

The effect of changing the mode of ventilation on the arterial-to-end-tidal CO2 difference and physiological dead space in laterally and dorsally recumbent horses during halothane anesthesia

Objective - To evaluate the effect of changing the mode of ventilation from spontaneous to controlled on the arterial-to-end-tidal CO2 difference [P(a-ET)CO2] and physiological dead space (VD(phys)/VT) in laterally and dorsally recumbent halothane-anesthetized horses. Study Design - Prospective, experimental, nonrandomized trial. Animals - Seven mixed breed adult horses (1 male and 6 female) weighing 320 ± 11 kg. Methods - Horses were anesthetized in 2 positions - right lateral and dorsal recumbency - with a minimum interval of 1 month. Anesthesia was maintained with halothane in oxygen for 180 minutes. Spontaneous ventilation (SV) was used for 90 minutes followed by 90 minutes of controlled ventilation (CV). The same ventilator settings were used for both laterally and dorsally recumbent horses. Arterial blood gas analysis was performed every 30 minutes during anesthesia. End-tidal CO2 (PETCO2) was measured continuously. P(a-ET)CO2 and VD(phys)/VT were calculated. Statistical analysis included analysis of variance for repeated measures over time, followed by Student-Newman-Keuls test. Comparison between groups was performed using a paired t test; P < .05 was considered significant. Results - P(a-ET)CO2 and VD(phys)/VT increased during SV, whereas CV reduced these variables. The variables did not change significantly throughout mechanical ventilation in either group. Dorsally recumbent horses showed greater P(a-ET)CO2 and VD(phys)/VT values throughout. PaCO2 was greater during CV in dorsally positioned horses. Conclusions and Clinical Relevance - Changing the mode of ventilation from spontaneous to controlled was effective in reducing P(a-ET)CO2 and physiological dead space in both laterally and dorsally recumbent halothane-anesthetized horses. Dorsal recumbency resulted in greater impairment of effective ventilation. Capnometry has a limited value for accurate estimation of PaCO, in anesthetized horses, although it may be used to evaluate pulmonary function when paired with arterial blood gas analysis. © Copyright 2000 by The American College of Veterinary Surgeons.

Effect of disinfectants on the hardness and roughness of reline acrylic resins

Purpose: Potential effects on hardness and roughness of a necessary and effective disinfecting regimen (1% sodium hypocholorite and 4% chlorhexidine) were investigated for two hard chairside reline resins versus a heat-polymerizing denture base acrylic resin. Materials and Methods: Two standard hard chairside reliners (Kooliner and Duraliner II), one heat-treated chairside reliner (Duraliner II +10 minutes in water at 55°C), and one standard denture base material (Lucitone 550) were exposed to two disinfecting solutions (1% sodium hypochlorite; 4% chlorhexidine gluconate), and tested for two surface properties [Vickers hardness number (VHN, kg/mm2); Roughness (Ra, μm)] for different times and conditions (1 hour after production, after 48 hours at 37 ± 2°C in water, after two disinfection cycles, after 7 days in disinfection solutions, after 7 days in water only). For each experimental condition, eight specimens were made from each material. Data were analyzed by analysis of variance followed by Tukey's test, and Student's t-test (p= 0.05). Results: For Kooliner (from 6.2 ± 0.3 to 6.5 ± 0.5 VHN) and Lucitone 550 (from 16.5 ± 0.4 to 18.4 ± 1.7 VHN), no significant changes in hardness were observed either after the disinfection or after 7 days of immersion, regardless of the disinfectant solution used. For Duraliner II (from 4.0 ± 0.1 to 4.2 ± 0.1 VHN), with and without heat treatment, a small but significant increase in hardness was observed for the specimens immersed in the disinfectant solutions for 7 days (from 4.3 ± 0.2 to 4.8 ± 0.5 VHN). All materials showed no significant change in roughness (Kooliner: from 0.13 ± 0.05 to 0.48 ± 0.24 μm; Duraliner II, with and without heat treatment: from 0.15 ± 0.04 to 0.29 ± 0.07 μm; Lucitone 550: from 0.44 ± 0.19 to 0.49 ± 0.15 μm) after disinfection and after storage in water for 7 days. Conclusions: The disinfectant solutions, 1% sodium hypochlorite and 4% chlorhexidine gluconate, caused no apparent damage on hardness and roughness of the materials evaluated. Copyright © 2006 by The American College of Prosthodontists.

Effect of the association of nystatin with a tissue conditioner on its ultimate tensile strength

Purpose: This study evaluated the ultimate tensile strength of a tissue conditioner without nystatin incorporation (GI - control group) and the same tissue conditioner modified by the addition of nystatin in two concentrations: GII - 500,000 International Units (U) and GIII - 1,000,000 U, in which each milligram of the medicament corresponded to 6079 U. Materials and Methods: Dumbbell-shaped specimens (N = 7) with a central cross-sectional area of 33 × 6 × 3 mm were produced for the three experimental groups. After polymerization following manufacturer's instructions, specimens were immersed in distilled water at 37°C for either 24 hours or 7 days and then tested in tension in the MTS 810 at 40 mm/minute. Data were analyzed by two-way ANOVA followed by Tukey's test, at 95% level of confidence. Results: The means (force-grams (gf) ± standard deviation) of the ultimate tensile strength were: GI - 634.29 ± 122.80; GII - 561.92 ± 133.56; and GIII - 547.30 ± 73.47 for 24-hour storage, and GI - 536.68 ± 54.71; GII - 467.50 ± 143.51; and GIII - 500.62 ± 159.76 for 7-day storage. There were no statistically significant differences among the three experimental groups (p > 0.05). The ultimate tensile strength means of all experimental groups after 7 days were significantly lower than those observed after 24 hours (p = 0.04). Conclusions: The results of this study suggest that the addition of nystatin into the tissue conditioner investigated in concentrations below 1,000,000 U did not affect its ultimate tensile strength. Copyright © 2006 by The American College of Prosthodontists.

Effect of microwave disinfection procedures on torsional bond strengths of two hard chairside denture reline materials

Purpose: This study evaluated the potential effects of denture base resin water storage time and an effective denture disinfection method (microwave irradiation at 650 W for 6 minutes) on the torsional bond strength between two hard chairside reline resins (GC Reline and New Truliner) and one heat-polymerizing denture base acrylic resin (Lucitone 199). Materials and Methods: Cylindrical (30 x 3.9 mm) denture base specimens (n = 160) were stored in water at 37°C (2 or 30 days) before bonding. A section (3.0 mm) was removed from the center of the specimens, surfaces prepared, and the reline materials packed into the space. After polymerization, specimens were divided into four groups (n = 10): Group 1 (G1) - tests performed after bonding; Group 2 (G2) - specimens immersed in water (200 ml) and irradiated twice (650 W for 6 minutes); Group 3 (G3) - specimens irradiated daily until seven cycles of disinfection; Group 4 (G4) - specimens immersed in water (37°C) for 7 days. Specimens were submitted to a torsional test (0.1 Nm/min), and the torsional strengths (MPa) and the mode of failure were recorded. Data from each reline material were analyzed by a two-way analysis of variance, followed by Neuman-Keuls test (p = 0.05). Results: For both Lucitone 199 water storage periods, before bonding to GC Reline resin, the mean torsional strengths of G2 (2 days - 138 MPa; 30 days - 132 MPa), G3 (2 days - 126 MPa; 30 days - 130 MPa), and G4 (2 days - 130 MPa; 30 days - 137 MPa) were significantly higher (p < 0.05) than G1 (2 days - 108 MPa; 30 days - 115 MPa). Similar results were found for Lucitone 199 specimens bonded to New Truliner resin, with G1 specimens (2 days - 73 MPa; 30 days - 71 MPa) exhibiting significantly lower mean torsional bond strength (p < 0.05) than G2 (2 day - 86 MPa; 30 days - 90 MPa), G3 (2 days - 82 MPa; 30 days - 82 MPa), and G4 specimens (2 days - 78 MPa; 30 days - 79 MPa). The adhesion of both materials was not affected by water storage time of Lucitone 199 (p > 0.05). GC reline showed a mixed mode of failure (adhesive/cohesive) and New Truliner failed adhesively. Conclusions: Up to seven microwave disinfection cycles did not decrease the torsional bond strengths between the hard reline resins, GC Reline and New Truliner to the denture base resin Lucitone 199. The effect of additional disinfection cycles on reline material may be clinically significant and requires further study. Copyright © 2006 by The American College of Prosthodontists.

Nasal width as a guide for the selection of maxillary complete denture anterior teeth in four racial groups

Purpose: Selecting artificial teeth for edentulous patients is difficult when pre-extraction records are not available. Various guidelines have been suggested for determining the width of the maxillary anterior denture teeth. This study was undertaken to evaluate the use of the nasal width as a guide for the selection of proper width maxillary anterior denture teeth in four racial groups of the Brazilian population. Materials and Methods: One hundred and sixty subjects (40 Whites, 40 Mulattos, 40 Blacks, and 40 Asians) were selected. Using a sliding caliper, the nasal width and the intercanine distance were measured. The Pearson product-moment correlation coefficient was used to determine the relationship between the above measurements. A prediction was made of the percentage of subjects of the White, Mulatto, Black, and Asian populations in which the selection error due to the clinical application of the method of the nasal width would be within 0 to 2 mm, within 2 to 4 mm, and greater than 4 mm. Results: The four racial groups showed a weak correlation between the intercanine distance and the nasal width. In 39.7% of the White, 55.7% of the Mulatto, 81.9% of the Black, and 48.2% of the Asian populations, errors greater than 4 mm would be present with the use of the nasal width. Conclusions: The correlation found between the intercanine distance and the nasal width was not high enough to be used as a predictive factor. The relationship between natural tooth width and artificial tooth width as predicted by the nasal width showed that the nasal width method is not accurate for all the studied groups. Copyright © 2006 by The American College of Prosthodontists.