Tooth loss and implant outcomes in patients refractory to treatment in a periodontal practice

Aim: The aim of this study was to investigate the factors associated with continued significant tooth loss due to periodontal reasons during maintenance following periodontal therapy in a specialist periodontal practice in Norway.
Material and Methods: A case-control design was used. Refractory cases were patients who lost multiple teeth during a maintenance period of 13.4 (range 8-19) years following definitive periodontal treatment in a specialist practice. Controls were age- and gender-matched maintenance patients from the same practice. Characteristics and treatment outcomes were assessed, and all teeth classified as being lost due to periodontal disease during follow-up were identified. The use of implants in refractory cases and any complications relating to such a treatment were recorded.
Results: Only 27 (2.2%) patients who received periodontal treatment between 1986 and 1998 in a specialist practice met the criteria for inclusion in the refractory to treatment group. Each refractory subject lost 10.4 (range 4-16) teeth, which represented 50% of the teeth present at baseline. The rate of tooth loss in the refractory group was 0.78 teeth per year, which was 35 times greater than that in the control group. Multivariate analysis indicated that being in the refractory group was predicted by heavy smoking (p=0.026), being stressed (p=0.016) or having a family history of periodontitis (p=0.002). Implants were placed in 14 of the refractory patients and nine (64%) of these lost at least one implant. In total, 17 (25%) of the implants placed in the refractory group were lost during the study period.
Conclusions: A small number of periodontal maintenance patients are refractive to treatment and go on to experience significant tooth loss. These subjects also have a high level of implant complications and failure. Heavy smoking, stress and a family history of periodontal disease were identified as factors associated with a refractory outcome.

Delayed post-surgical development of dural arteriovenous fistula after cervical meningocele repair

A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.

An unusual delayed complication of inferior alveolar nerve block

Systemic and localised complications after administration of local anaesthetic for dental procedures are well recognised. We present two cases of patients with trismus and sensory deficit that arose during resolution of trismus as a delayed complication of inferior alveolar nerve block.

Direct versus delayed pathways in strong-field non-sequential double ionization

We report full-dimensionality quantum and classical calculations of double ionization (DI) of laser-driven helium at 390 nm. Good agreement is observed. We identify the relative importance of the two main non-sequential DI pathways, the direct|with an almost simultaneous ejection of both electrons|and the delayed. We find that the delayed pathway prevails at small intensities independently of total electron energy but at high intensities the direct pathway predominates up to a certain upper-limit in total energy which increases with intensity. An explanation for this increase with intensity is provided.

Microcomputed tomography imaging in a rat model of delayed union/non-union fracture

We aimed to develop a clinically relevant delayed union/non-union fracture model to evaluate a cell therapy intervention repair strategy. Histology, three-dimensional (3D) micro-computed tomography (micro-CT) imaging and mechanical testing were utilized to develop an analytical protocol for qualitative and quantitative assessment of fracture repair. An open femoral diaphyseal osteotomy, combined with periosteal diathermy and endosteal excision, was held in compression by a four pin unilateral external fixator. Three delayed union/non-union fracture groups established at 6 weeks-(a) a control group, (b) a cell therapy group, and (c) a group receiving phosphate-buffered saline (PBS) injection alone-were examined subsequently at 8 and 14 weeks. The histological response was combined fibrous and cartilaginous non-unions in groups A and B with fibrous non-unions in group C. Mineralized callus volume/total volume percentage showed no statistically significant differences between groups. Endosteal calcified tissue volume/endosteal tissue volume, at the center of the fracture site, displayed statistically significant differences between 8 and 14 weeks for cell and PBS intervention groups but not for the control group. The percentage load to failure was significantly lower in the control and cell treatment groups than in the PBS alone group. High-resolution micro-CT imaging provides a powerful tool to augment characterization of repair in delayed union/non-union fractures together with outcomes such as histology and mechanical strength measurement. Accurate, nondestructive, 3D identification of mineralization progression in repairing fractures is enabled in the presence or absence of intervention strategies. (c) 2007 Orthopaedic Research Society.

Signatures of delayed detonation, asymmetry, and electron capture in the mid-infrared spectra of supernovae 2003hv and 2005df

We present mid-infrared (5.2-15.2 mu m) spectra of the Type Ia supernovae (SNe Ia) 2003hv and 2005df observed with the Spitzer Space Telescope. These are the first observed mid-infrared spectra of thermonuclear supernovae, and show strong emission from fine-structure lines of Ni, Co, S, and Ar. The detection of Ni emission in SN 2005df 135 days after the explosion provides direct observational evidence of high-density nuclear burning forming a significant amount of stable Ni in a SN Ia. The SN 2005df Ar lines also exhibit a two-pronged emission profile, implying that the Ar emission deviates significantly from spherical symmetry. The spectrum of SN 2003hv also shows signs of asymmetry, exhibiting blueshifted [Co (III)], which matches the blueshift of [Fe (II)] lines in nearly coeval near-infrared spectra. Finally, local thermodynamic equilibrium abundance estimates for the yield of radioactive Ni-56 give M-56Ni approximate to 0.5 M-circle dot, for SN 2003hv, but only M-56Ni approximate to 0.13-0.22 M-circle dot for the apparently subluminous SN 2005df, supporting the notion that the luminosity of SNe Ia is primarily a function of the radioactive 56Ni yield. The observed emission-line profiles in the SN 2005df spectrum indicate a chemically stratified ejecta structure, which matches the predictions of delayed detonation (DD) models, but is entirely incompatible with current three-dimensional deflagration models. Furthermore, the degree that this layering persists to the innermost regions of the supernova is difficult to explain even in a DD scenario, where the innermost ejecta are still the product of deflagration burning. Thus, while these results are roughly consistent with a delayed detonation, it is clear that a key piece of physics is still missing from our understanding of the earliest phases of SN Ia explosions.