Enamel matrix derivative and bone grafts for periodontal regeneration of intrabony defects. A systematic review and meta-analysis

OBJECTIVE The aim of the present systematic review and meta-analysis was to assess the clinical efficacy of regenerative periodontal surgery of intrabony defects using a combination of enamel matrix derivative (EMD) and bone graft compared with that of EMD alone. MATERIALS AND METHODS The Cochrane Oral Health Group specialist trials, MEDLINE, and EMBASE databases were searched for entries up to February 2014. The primary outcome was gain of clinical attachment (CAL). Weighted means and forest plots were calculated for CAL gain, probing depth (PD), and gingival recession (REC). RESULTS Twelve studies reporting on 434 patients and 548 intrabony defects were selected for the analysis. Mean CAL gain amounted to 3.76 ± 1.07 mm (median 3.63 95 % CI 3.51-3.75) following treatment with a combination of EMD and bone graft and to 3.32 ± 1.04 mm (median 3.40; 95 % CI 3.28-3.52) following treatment with EMD alone. Mean PD reduction measured 4.22 ± 1.20 mm (median 4.10; 95 % CI 3.96-4.24) at sites treated with EMD and bone graft and yielded 4.12 ± 1.07 mm (median 4.00; 95 % CI 3.88-4.12) at sites treated with EMD alone. Mean REC increase amounted to 0.76 ± 0.42 mm (median 0.63; 95 % CI 0.58-0.68) at sites treated with EMD and bone graft and to 0.91 ± 0.26 mm (median 0.90; 95 % CI 0.87-0.93) at sites treated with EMD alone. CONCLUSIONS Within their limits, the present results indicate that the combination of EMD and bone grafts may result in additional clinical improvements in terms of CAL gain and PD reduction compared with those obtained with EMD alone. The potential influence of the chosen graft material or of the surgical procedure (i.e., flap design) on the clinical outcomes is unclear. CLINICAL RELEVANCE The present findings support the use of EMD and bone grafts for the treatment of intrabony periodontal defects.

Wound models for periodontal and bone regeneration: the role of biologic research

The ultimate goals of periodontal therapy remain the complete regeneration of those periodontal tissues lost to the destructive inflammatory-immune response, or to trauma, with tissues that possess the same structure and function, and the re-establishment of a sustainable health-promoting biofilm from one characterized by dysbiosis. This volume of Periodontology 2000 discusses the multiple facets of a transition from therapeutic empiricism during the late 1960s, toward regenerative therapies, which is founded on a clearer understanding of the biophysiology of normal structure and function. This introductory article provides an overview on the requirements of appropriate in vitro laboratory models (e.g. cell culture), of preclinical (i.e. animal) models and of human studies for periodontal wound and bone repair. Laboratory studies may provide valuable fundamental insights into basic mechanisms involved in wound repair and regeneration but also suffer from a unidimensional and simplistic approach that does not account for the complexities of the in vivo situation, in which multiple cell types and interactions all contribute to definitive outcomes. Therefore, such laboratory studies require validatory research, employing preclinical models specifically designed to demonstrate proof-of-concept efficacy, preliminary safety and adaptation to human disease scenarios. Small animal models provide the most economic and logistically feasible preliminary approaches but the outcomes do not necessarily translate to larger animal or human models. The advantages and limitations of all periodontal-regeneration models need to be carefully considered when planning investigations to ensure that the optimal design is adopted to answer the specific research question posed. Future challenges lie in the areas of stem cell research, scaffold designs, cell delivery and choice of growth factors, along with research to ensure appropriate gingival coverage in order to prevent gingival recession during the healing phase.

Gingival labial recessions and the post-treatment proclination of mandibular incisors

INTRODUCTION A prerequisite for development of gingival recession is the presence of alveolar bone dehiscence. Proclination of mandibular incisors can result in thinning of the alveolus and dehiscence formation. OBJECTIVE To assess an association between proclination of mandibular incisor and development of gingival recession. METHODS One hundred and seventeen subjects who met the following inclusion criteria were selected: 1. age 11-14 years at start of orthodontic treatment (TS), 2. bonded retainer placed immediately after treatment (T0), 3. dental casts and lateral cephalograms available pre-treatment (TS), post-treatment (T0), and 5 years post-treatment (T5), and 4. post-treatment (T0) lower incisor inclination (Inc_Incl) <95° or >100.5°. Two groups were formed: non-proclined (N = 57; mean Inc_Incl = 90.8°) and proclined (N = 60; mean Inc_Incl = 105.2°). Clinical crown heights of mandibular incisors and the presence of gingival recession sites in this region were assessed on plaster models. Fisher's exact tests, t-tests, and regression models were computed for analysis of inter-group differences. RESULTS The mean increase of clinical crown heights (from T0 to T5) of mandibular incisors ranged from 0.75 to 0.83mm in the non-proclined and proclined groups, respectively (P = 0.273). At T5, gingival recession sites were present in 12.3% and 11.7% patients from the non-proclined and proclined groups, respectively. The difference was also not significant (P = 0.851). CONCLUSIONS The proclination of mandibular incisors did not increase a risk of development of gingival recession during five-year observation in comparison non-proclined teeth.

Performance Evaluation of the New Connecticut Leading Employment Index Using Lead Profiles and BVAR Models

Dua and Miller (1996) created leading and coincident employment indexes for the state of Connecticut, following Moore's (1981) work at the national level. The performance of the Dua-Miller indexes following the recession of the early 1990s fell short of expectations. This paper performs two tasks. First, it describes the process of revising the Connecticut Coincident and Leading Employment Indexes. Second, it analyzes the statistical properties and performance of the new indexes by comparing the lead profiles of the new and old indexes as well as their out-of-sample forecasting performance, using the Bayesian Vector Autoregressive (BVAR) method. The new indexes show improved performance in dating employment cycle chronologies. The lead profile test demonstrates that superiority in a rigorous, non-parametric statistic fashion. The mixed evidence on the BVAR forecasting experiments illustrates the truth in the Granger and Newbold (1986) caution that leading indexes properly predict cycle turning points and do not necessarily provide accurate forecasts except at turning points, a view that our results support.

Monetary Policy Delegation, Contract Costs, and Contract Targets

We reconsider the optimal central banker contract derived in Walsh (1995). We show that if the government's objective function places weight (value) on the cost of the contract, then the optimal inflation contract does not completely neutralize the inflation bias. That is, a fraction of the inflation bias emerges in the resulting inflation rate after the central banker's monetary policy decision. Furthermore, the more concerned the government is about the cost of the contract or the less selfish (more benevolent) is the central banker, the smaller is the share of the inflation bias eliminated by the contract. No matter how concerned the government is about the cost of the contract or how unselfish (benevolent) the central banker is, the contract always reduces the inflationary bias by at least half. Finally, a central banker contract written in terms of output (i.e., incorporating an output target) can completely eradicate the inflationary bias, regardless of concerns about contract costs.

Financial Liberalization and Inflationary Dynamics in the Context of a Small Open Economy

The paper develops a short-run model of a small open financially repressed economy characterized by unorganized money markets, capital good imports, capital mobility, wage indexation, and flexible exchange rates. The analysis shows that financial liberalization, in the form of an increased rate of interest on deposits and tight monetary policy, unambiguously and unconditionally causes deflation. Moreover, the results do not depend on the degree of capital mobility and structure of wage setting. The paper recommends that a small open developing economy should deregulate interest rates and tighten monetary policy if reducing inflation is a priority. The pre-requisite for such a policy, however, requires the establishment of a flexible exchange rate regime.

Expectations, and Credibility in a Model of Monetary Policy

Recent monetary history has been characterized by monetary authorities which have been, alternatively hard and soft on inflation. In a vintage capital framework, investment decisions are not easily reversed. Therefore, expectations of policy as well as current policy are important to the investment decision. Here, a vintage capital model is used to assess the value of central bank credibility for a policy change. Policy in this model is assumed to be private information of the central banker. Agents learn about that policy which to study the ensuing transitional dynamics following a change in monetary policy regime.

Optimal Central Banker Contracts and Common Agency

This paper considers the contacting approach to central banking in the context of a simple common agency model. The recent literature on optimal contracts suggests that the political principal of the central bank can design the appropriate incentive schemes that remedy for time-inconsistency problems in monetary policy. The effectiveness of such contracts, however, requires a central banker that attaches a positive weight to the incentive scheme. As a result, delegating monetary policy under such circumstances gives rise to the possibility that the central banker may respond to incentive schemes offered by other potential principals. We introduce common agency considerations in the design of optimal central banker contracts. We introduce two principals - society (government) and an interest group, whose objectives conflict with society's and we examine under what circumstances the government-offered or the interest-group-offered contract dominates. Our results largely depend on the type of bias that the interest group contract incorporates. In particular, when the interest group contract incorporates an inflationary bias the outcome depends on the principals' relative concern of the incentive schemes' costs. When the interest group contract incorporates an expansionary bias, however, it always dominates the government contract. A corollary of our results is that central banker contracts aiming to remove the expansionary bias of policymakers should be written explicitly in terms of the perceived bias.

International Money and Finance

We discuss the effectiveness of pegged exchange rate regimes from an historical perspective, drawing conclusions for their effectiveness today. Starting with the classical gold standard period, we point out that a succession of pegged regimes have ended in failure; except for the first, which was ended by the outbreak of World War I, all of the others we discuss have been ended by adverse economic developments for which the regimes themselves were partly responsible. Prior to World War II the main problem was a shortage of monetary gold that we argue is implicated as a cause of the Great Depression. After World War II, more particularly from the late-1960s, the main problem has been a surfeit of the main international reserve asset, the US dollar. This has led to generalized inflation in the 1970s and into the 1980s. Today, excessive dollar international base money creation is again a problem that could have serious consequences for world economic stability.

Application of the general linear model to assess the effect of missing data on bone marrow mononuclear cell therapy with infusion timing and follow-up MRI

With most clinical trials, missing data presents a statistical problem in evaluating a treatment's efficacy. There are many methods commonly used to assess missing data; however, these methods leave room for bias to enter the study. This thesis was a secondary analysis on data taken from TIME, a phase 2 randomized clinical trial conducted to evaluate the safety and effect of the administration timing of bone marrow mononuclear cells (BMMNC) for subjects with acute myocardial infarction (AMI).^ We evaluated the effect of missing data by comparing the variance inflation factor (VIF) of the effect of therapy between all subjects and only subjects with complete data. Through the general linear model, an unbiased solution was made for the VIF of the treatment's efficacy using the weighted least squares method to incorporate missing data. Two groups were identified from the TIME data: 1) all subjects and 2) subjects with complete data (baseline and follow-up measurements). After the general solution was found for the VIF, it was migrated Excel 2010 to evaluate data from TIME. The resulting numerical value from the two groups was compared to assess the effect of missing data.^ The VIF values from the TIME study were considerably less in the group with missing data. By design, we varied the correlation factor in order to evaluate the VIFs of both groups. As the correlation factor increased, the VIF values increased at a faster rate in the group with only complete data. Furthermore, while varying the correlation factor, the number of subjects with missing data was also varied to see how missing data affects the VIF. When subjects with only baseline data was increased, we saw a significant rate increase in VIF values in the group with only complete data while the group with missing data saw a steady and consistent increase in the VIF. The same was seen when we varied the group with follow-up only data. This essentially showed that the VIFs steadily increased when missing data is not ignored. When missing data is ignored as with our comparison group, the VIF values sharply increase as correlation increases.^

Pressure, tilt, temperature and conductivity monitoring within the Immerged Santorini Caldera during Jul 2012 - Sep 2013

Bottom pressure, tilt and seawater physical-properties were monitored for a year using two instruments within the immerged Santorini caldera (Greece). Piggy-backed on the CALDERA2012 cruise, this geodetic experiment was designed to monitor evolution of the 2011-2012 Santorini unrest. Conducted during a quiescent period, it allowed us to study oceanographic and atmospheric signal in our data series. We observe periodic oceanographic signals associated with tides, and seiches that are likely linked to both the caldera and Cretan basin geometries. In winter, the caldera witnesses sudden cooling events that tilt an instrument towards the Southeast, indicating cold-water influx likely originating from the north-western passage between Thirasia and Oia. We do not obtain evidence of long-term vertical seafloor deformation from the pressure signal, although it may be masked by instrumental drift. However, tilt data suggests a local seafloor tilt event ~1 year after the end of the unrest period which could be consistent with inflation under or near Nea Kameni. Seafloor geodetic data recorded at the bottom of the Santorini caldera illustrates that the oceanographic signature is an important part of the signal, which needs to be considered for monitoring volcanic or geological seafloor deformation in shallow-water and/or nearshore areas.

(Table 1) Beluga (Delphinapterus leucas) density and abundance, and pod characteristics in west Greenland waters

An aerial survey was conducted to estimate the abundance of belugas (Delphinapterus leucas) on their wintering ground in West Greenland in March-April 2006 and 2008. The survey was conducted as a double platform aerial line transect survey, and sampled approximately 17% of the total survey area of ca. 125 000 km**2. The abundance of belugas was 10 595 (95% confidence interval 4904-24 650). The largest abundance was found at the northern part of Store Hellefiske Bank, at the eastern edge of the Baffin Bay pack ice, a pattern similar to that found in eight systematic surveys conducted since 1981. A clear relationship between decreasing sea-ice cover and increasing offshore distance of beluga sightings was established from all previous surveys, suggesting that belugas expand their distribution westward as new areas on the banks of West Greenland open up earlier in spring with reduced sea-ice coverage or early annual ice recession. This is in contrast to the relatively confined distribution of belugas near the coast in limited open areas in the early 1980s, when sea-ice cover was greater. However, the effects of the changes in coastal availability of belugas can also be observed with the correlation between catches from the local Inuit hunt and sea-ice cover, where the catches increased significantly with increasing sea-ice coverage during the period 1954-2006. These results, based on nearly 30 years of dedicated survey effort, are among the first available evidence showing a shift in distribution of an Arctic cetacean in response to changes in sea-ice coverage.

Tab. 1: Age of biogene material from the ice margin, Kofoed-Hansen Bræ and Storstrømmen

Early Holocene recession of the ice cover over Germania Land in North-East Greenland 7.5 ka B.P. brought the Inland Ice margin back to a position close to the present. Continued recession after that time lead to the formation of a "Storstrømmen Sound" which separated Germania Land from mainland Greenland in the period from about 6 to 1 ka B.P. The present filling of the approximately 100 km long sound by the glaciers of Storstrømmen and Kofoed-Hansen Bræ must therefore have taken place during the Little lce Age. In an archaeological sense this implies deterioration of the living conditions of Neo-Eskimos compared to those of Palaeo-Eskimos. The neoglacial re-formation and present existence of the glaciers as a Little Ice Age relict may imply a present-day instability in their dynamics, as demonstrated by the pulsations (surge-like behaviour) in the last part of the 20th century. An earlier Little Ice Age advance might possibly have had the same amplitude as that documented from the 20th century but its exact age and character is not known. The glacio-isostatic response of the earth's crust to the variations in the Holocene glacier load implies a relatively slow and slight emergence and subsequent submergence. The shift from emergence to submergence must have taken place between about 2 and 1 ka B.P.

Stable isotope and geochemical analyses of sediment core SO164-17-2 from the southern Florida Straits

Modeling and proxy studies indicate that a reduction of Atlantic Meridional Overturning Circulation (AMOC) strength profoundly impacts temperatures and salinities in the (sub)tropical Atlantic, especially on subsurface levels. While previous studies focused on prominent periods of AMOC reduction during the last deglaciation, we aim to test whether similar reconfigurations of the subtropical hydrography occurred during the moderate climatic alterations punctuating the last interglacial, Marine Isotope Stage (MIS) 5. Here, we present temperature and salinity records from a Florida Straits core by combining d18O and Mg/Ca analyses on surface (Globigerinoides ruber, white) and deep-dwelling (Globorotalia crassaformis) foraminifera, covering MIS 5 in high resolution. The data reveal increasing salinities at intermediate depths during interglacial cooling episodes, decoupled from relatively stable surface conditions. This probably indicates the spatial expansion of saline Subtropical Gyre waters due to enhanced Ekman downwelling and might also point to a changed density structure and altered geostrophic balance in Florida Straits. Notably, these oceanographic alterations are not consistently occurring during periods of AMOC reduction. The data suggest that the expansion of gyre waters into Florida Straits was impeded by the increasing influence of Antarctic Intermediate Water (AAIW) from MIS 5.5 to ~107 kyr BP. Afterwards, increasingly positive benthic d13C values imply a recession of AAIW, allowing the temporary expansion of Gyre waters into Florida Straits. We argue that the inferred transient subtropical salt accumulation and warm pool expansion might have played a pivotal role in reinvigorating meridional overturning and dampen the severity of interglacial cold phases.

Age determination and geochemical composition of sediment core DA04-31P

There is limited knowledge pertaining to the history of the Greenland Ice Sheet (GIS) during the last glacial-interglacial transition as it retreated from the continental margins to an inland position. Here we use multiproxy data, including ice-rafted debris (IRD); planktonic isotopes; alkenone temperatures; and tephra geochemistry from the northern Labrador Sea, off southwest Greenland, to investigate the deglacial response of the GIS and evaluate its implications for the North Atlantic deglacial development. The results imply that the southern GIS retreated in three successive stages: (1) early deglaciation of the East Greenland margins, by tephra-rich IRD that embrace Heinrich Event 1; (2) progressive retreat during Allerød culminating in major meltwater releases (d18O depletion of 1.2 per mil) at the Allerød-Younger Dryas transition (12.8-13.0 kyr B.P.); and (3) a final stage of glacial recession during the early Holocene (~9-11 kyr B.P.). Rather than indicating local temperatures of ambient surface water, the alkenones likely were transported to the core site by the Irminger Current. We attribute the timing of GIS retreat to the incursion of warm intermediate waters along the base of grounded glaciers and below floating ice shelves on the continental margin. The results lend support to the view that GIS meltwater presented a forcing factor for the Younger Dryas cooling.