Clinical Advantages of Angled Screw Access Channels for Implant-Supported Restorations in the Esthetic Zone.

Introduction: Retained cement following delivery of an implant-supported crown is strongly associated with peri-implant mucositis and peri-implantitis, and screw retention is a strategy for avoiding this problem entirely. In the esthetic zone, screw retention compromises esthetics unless the screw access in the crown is concealed to the palatal of the incisal edge. To avoid positioning the implant platform excessively toward the palate, practitioners can design an angled screw access channel in the crown.

Decisions Before Incisions: Technique Selection for the Distal Wedge Procedure.

Focused Clinical Question: What factors identify the optimal surgical technique when a distal wedge procedure is indicated at a terminal maxillary or mandibular molar site?

Summary: Incision design for the distal wedge procedure is based primarily on the dental arch (maxilla or mandible), the distance from the terminal molar to the hamular notch or ascending ramus, and the dimensions of the attached gingiva.

Conclusions: In most situations, favorable clinical results are achievable irrespective of the chosen distal wedge method, and technique selection is based more on operator preference than evidence. However, anatomic limitations can render distal wedge procedures challenging in some cases, and procedural advantages of specific techniques can simplify treatment.

The Tissue-Supported Sling Suture: Technique and Clinical Applications.

Introduction: Continuous and interrupted sling sutures (ISSs) are used around teeth in contemporary periodontics. However, conventional ISSs depend upon favorable tooth morphology for stability through the early healing period. The purpose of this report is to present a variation of the classic ISS that does not rely on favorable tooth morphology.

The Extraction Socket Management Continuum: A Hierarchical Approach to Dental Implant Site Development.

Focused Clinical Question: How should clinicians manage dental extraction sockets when immediate implant placement is contraindicated, and alveolar ridge preservation is expected to result in inadequate bone volume for implant placement?

Summary: Three fundamental options for extraction socket management form a hierarchical continuum in sites where dental implant placement is planned: place an immediate implant, perform ridge preservation, or perform ridge augmentation. The available volume and quality of bone and keratinized mucosa are the primary considerations driving the decision, and each tier in the continuum encompasses a variety of techniques with attendant advantages and disadvantages.

Conclusions: Some immediate implant protocols require no mucoperiosteal flap and possibly produce the most favorable clinical and patient-centered outcomes compared with other extraction socket management approaches.

Focus on Epithelialized Palatal Grafts. Part 3: Methods to Enhance Patient Comfort at Palatal Donor Sites.

Introduction: Postoperative discomfort is a documented complication of the epithelialized palatal graft (EPG) procedure, and the expectation of an unpleasant patient experience may cause some practitioners to avoid EPG altogether. However, EPG affords distinct advantages in a variety of clinical situations, and the postoperative discomfort associated with the procedure can be minimized.

Case Series: Three generally and periodontally healthy patients with gingival recession defects and minimal zones of attached gingiva received mandibular anterior EPG procedures.

Adjunctive Nd:YAG Laser Irradiation for Ridge Preservation and Immediate Implant Procedures: A Consecutive Case Series.

Introduction: Whether or not laser use provides any meaningful benefit at immediate implant and ridge preservation sites remains an open question in periodontics. However, various lasers have been used in conjunction with tooth extraction and immediate implant placement. Evidence supporting adjunctive laser irradiation at immediate implant and ridge preservation sites is mostly limited to preclinical studies and a small number of case reports.

Focus on Epithelialized Palatal Grafts. Part 2: Implant Site Development.

Introduction: The epithelialized palatal graft (EPG), introduced in 1963, has persisted as the gold standard for gingival augmentation, and in the present era, mucosal augmentation around dental implants has become an important concern. A limited body of evidence suggests peri-implant mucosal augmentation may favorably impact bone and mucosal stability and peri-implant health under some circumstances. Although more contemporary procedures for peri-implant mucosal augmentation are often preferred based on convenience and esthetic considerations, EPG augmentation at dental implant sites is distinguishable from methods which do not deepen the vestibule and eliminate unfavorable superficial soft tissue.

Protocol for Maintaining Alveolar Ridge Volume in Molar Immediate Implant Sites.

Introduction: Numerous biomaterials are available for augmenting bone around dental implants. In contained extraction sockets, a demineralized freeze-dried bone allograft (DFDBA) appears capable of maintaining dimensional stability of the alveolar ridge as well as mineralized alternatives but may yield a higher percentage of new vital bone. When DFDBA is used in large horizontal gap defects at molar immediate implant sites, graft containment and protection must occur through provisional restoration, an anatomic custom healing abutment, or by other means.

Nano-Pulse Stimulation is a physical modality that can trigger immunogenic tumor cell death.

Background: We have been developing a non-thermal, drug-free tumor therapy called Nano-Pulse Stimulation (NPS) that delivers ultrashort electric pulses to tumor cells which eliminates the tumor and inhibits secondary tumor growth. We hypothesized that the mechanism for inhibiting secondary tumor growth involves stimulating an adaptive immune response via an immunogenic form of apoptosis, commonly known as immunogenic cell death (ICD). ICD is characterized by the emission of danger-associated molecular patterns (DAMPs) that serve to recruit immune cells to the site of the tumor.

Nanoelectroablation of Murine Tumors Triggers a CD8-Dependent Inhibition of Secondary Tumor Growth.

We have used both a rat orthotopic hepatocellular carcinoma model and a mouse allograft tumor model to study liver tumor ablation with nanosecond pulsed electric fields (nsPEF). We confirm that nsPEF treatment triggers apoptosis in rat liver tumor cells as indicated by the appearance of cleaved caspase 3 and 9 within two hours after treatment. Furthermore we provide evidence that nsPEF treatment leads to the translocation of calreticulin (CRT) to the cell surface which is considered a damage-associated molecular pattern indicative of immunogenic cell death.

Intravenous delivery of targeted liposomes to amyloid-β pathology in APP/PSEN1 transgenic mice.

Extracellular amyloid-β (Aβ) plaques and intracellular neurofibrillary tangles constitute the major neuropathological hallmarks of Alzheimer's disease (AD). It is now apparent that parenchymal Aβ plaque deposition precedes behavioral signs of disease by several years. The development of agents that can target these plaques may be useful as diagnostic or therapeutic tools.

A new, minimally invasive technique for measuring cardiac index: clinical comparison of continuous cardiac dynamic monitoring and pulmonary artery catheter methods.

To assess the utility of a relatively simple bedside method of estimating cardiac index during major surgery or in the intensive care unit, we conducted a prospective study in patients undergoing elective cardiac bypass surgery where a pulmonary artery catheter was inserted as part of routine monitoring. The cardiac index was estimated using standard techniques and compared with estimates from continuous cardiac dynamic monitoring using HEARTSMART software. Two hundred and seventy sets of measurements were suitable for comparison.

Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography Platelet Mapping.

Background: Increasing numbers of patients prescribed clopidogrel and aspirin are presenting for non-elective surgery. No consensus on the timing of surgery exists after withdrawal of antiplatelet and tests of platelet function are not routinely available. The Thrombelastography Platelet Mapping (TEG-PM) assay is designed to assess platelet inhibition secondary to antiplatelet therapy.

Double valve replacement for acute spontaneous left chordal rupture secondary to chronic aortic incompetence.

A 54 years old male with undiagnosed chronic calcific degenerative aortic valve incompetence presented with acute left anterior chordae tendinae rupture resulting in severe left heart failure and cardiogenic shock. He was successfully treated with emergency double valve replacement using mechanical valves. The pathogenesis of acute rupture of the anterior chordae tendinae, without any evidence of infective endocarditis or ischemic heart disease seems to have been attrition of the subvalvular mitral apparatus by the chronic regurgitant jet of aortic incompetence with chronic volume overload.

Remifentanil patient-controlled analgesia following cardiac surgery.

Background: Remifentanil is increasingly used as a component of cardiac anaesthesia. Following cardiac surgery remifentanil is often substituted for alternative opioids on the intensive care unit. We were interested to evaluate postoperative continuation of remifentanil in the form of remifentanil patient control analgesia (RPCA) for those patients who received intraoperative remifentanil.

Alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass.

Atelectasis occurs during general anaesthesia. This is partly responsible for the impairment of gas exchange that occurs peri-operatively. During cardiopulmonary bypass, this atelectasis is exacerbated by the physical collapse of the lungs.

Professional development and appraisal system for school nurses.

Dissatisfied with current school nurse evaluation instruments, school nurse administrators sought to develop an appraisal system that would emphasize the professional role of the school nurse and provide a means to enhance individual practice. The newly revised Standards of Professional School Nursing Practice and the creation of a state teacher evaluation model presented the opportunity to produce an instrument that could be adapted within the educational setting for school nursing practice. The appraisal system included not only the methods to evaluate practice, but the means to involve the individual school nurse through goal setting.

Postoperative radiotherapy following mastectomy for high-risk breast cancer. A randomised trial.

Grade III, node-positive breast cancer carries a high risk of loco-regional relapse after simple mastectomy. A randomised trial was conducted to assess whether this would be significantly reduced by postoperative radiotherapy. Between 1985 and 1991, 76 patients who had undergone a simple mastectomy and axillary sampling, and whose tumours had been found to be grade III and node-positive, were randomised to receive postoperative radiotherapy to the chest wall and axilla or no further loco-regional treatment.

The EORTC clinical research coordinators group. European Organisation for Research and Treatment of Cancer.

The Clinical Research Coordinators Group (CRCG) is an umbrella organisation, compiled from four existing groups, namely the Oncology Nurses Group, the Data Management Group, the Radiation Technologists Group and the Early Clinical Studies Group Research Nurses. From the existing steering committees, a new board was formed and consists of two members per group. The CRCG will function as an independent group within the EORTC.

Giving long-persistent starch as volume replacement can cause pruritus after cardiac surgery.

We reviewed the prevalence and severity of pruritus in 85 patients after cardiac surgery. EloHAES, a long-lasting hydroxyethylated starch, was given to 59 of these patients. None of the patients who did not receive EloHAES developed pruritus, compared with 22% of those who did (P = 0.

Randomized trial of diaspirin cross-linked hemoglobin solution as an alternative to blood transfusion after cardiac surgery. The DCLHb Cardiac Surgery Trial Collaborative Group.

Background: Risks associated with transfusion of allogeneic blood have prompted development of methods to avoid or reduce blood transfusions. New oxygen-carrying compounds such as diaspirin cross-linked hemoglobin (DCLHb) could enable more patients to avoid allogeneic blood transfusion.

Methods: The efficacy, safety, hemodynamic effects, and plasma persistence of DCLHb were investigated in a randomized, active-control, single-blind, multicenter study in post-cardiac bypass surgery patients.

The haemodynamic effects of propofol in combination with ephedrine in elderly patients (ASA groups 3 and 4).

The marked vasodilator and negative inotropic effects of propofol are disadvantages in frail elderly patients. We investigated the safety and efficacy of adding different doses of ephedrine to propofol in order to obtund the hypotensive response. The haemodynamic effects of adding 15, 20 or 25 mg of ephedrine to 200 mg of propofol were compared to control in 40 ASA 3/4 patients over 60 years presenting for genito-urinary surgery.