Neue Drähte und deren Kraftabgabe-Konsequenzen für die kieferorthopädische Therapie

Zusammenfassung Nivellierungsbögen aus verseilten Stahldrähten wurden mit Nickel-Titanium-Drähten der neuen Generation, ausgezeichnet durch Formgedächtnis, Superelastizität und exzellentes Rückstellvermögen, verglichen. Die im Biegeversuch ermittelten Werte wurden statistisch aufbereitet und ergaben eine lineare Kraftweg-Kennlinie der verseilten Stahldrähte. Die Nickel-Titanium-Drähte zeigten aber eine deutliche Abweichung von der Linearität mit kurviger Verlaufsform. Neben der atypischen Kraftweg-Kennlinie mit einer konstanten Kraftabgabe im Mittel der Kurve gaben diese Drähte, unabhängig vom Aktivierungsgrad (das heißt unabhängig davon, ob die Stufe zwischen den Brackets 1 oder 4 mm betrug), dieselbe Kraft ab. Je größer die Aktivierung zwischen den Brackets war, desto länger stellte sich der Bereich der konstanten Kraftabgabe-die Superelastizität-im Diagramm dar. Daher eignen sich die Drähe für große Niveauunterschiede oder Deflektionen. Bei geringer Aktivierung verläuft die Kennlinie sehr steil und annähernd linear. In diesen Fällen ist verseilten Stahldrähten aufgrund ihrer kleineren Federrate und Flexibilität der Vorzug zu geben.

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Summary Levelling arches made of stainless-steel wires were compared with nickel-titanium wires of the new generation which are distinguished by their shape memory, superelasticity and their excellent spring-back. The data received from a bending test have been analysed statistically and revealed a linear unloading curve of the twisted stainless-steel wires. The nickel-titanium wires, however, showed a clear deviation form the linearity with a curviform course. Besides the unusual unloading curve with a constant force mechanism in the middle range of deactivation the wires give off the same amount of force irrespective of the degree of activation (that is to say, regardless whether the level difference between the brackets amounts to 1 or to 4 mm). The diagram shows that the greater the activity between the brackets, the longer the period of superelasticity. Therefore the nickel-titanium wires are suited for large level differences or deflections. At a low activation rate the characteristic line takes a very steep and almost linear deactivation curve. In these cases twisted stainless steal wires should be preferred because of their lower load deflection rate and flexibility.

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Résumé Les arcs de nivelage de fils d'acier tressés ont été comparés avec les fils nickel-titane de la nouvelle génération, se distinguant par leur mémoire de forme, superélasticité et capacité excellente de rappel. Les valeurs relevées au cours de l'essai de pliage ont été enregistrées statistiquement et ont montré une caractéristique linéaire du tracé de force des fils d'acier tressés. Les fils nickel-titane ont cependant montré une déviation significative en présentant non une linéarité mais un tracé curviligne. A côté de leur caractéristique atypique de leur tracé de force avec un dégagement constant de force au centre de la courbe, ces fils ont produit la même force, indépendamment, du degré d'activation (c.-à-d., indépendamment du fait que l'espace entre les brackets fut de 1 ou 4 mm). Plus l'activation était grande entre les brackets, plus la zone du dégagement de la force constante-la superélasticité, paraissait longue sur le diagramme. C'est pourquoi ces fils sont indiqués pour de fortes différences de niveau ou déflexions importantes. En cas d'activation peu considérable, le tracé est très raide et presque linéaire. Dans ces cas, la préférence doit être accordée aux fils d'acier tressés, en raison de leur force élastique et flexibilité inférieures.

     

Die Entwicklung des Parodontiums nach Zahnkeimtransplantationen im Rahmen der kieferorthopädischen Behandlung

Zusammenfassung Durch Tierversuche an jungen Beagle-Hunden konnte die normale Entwicklung des Parodontiums nach Zahnkeimtransplantationen histologisch nachgewiesen werden. Die klinisch-röntgenologischen Untersuchungen zeigten keine pathologischen Befunde im Parodontiumbereich nach Zahnkeimtransplantationen beim Menschen. Die transplantierten Zähne können wie die anderen kieferorthopädisch bewegt werden. In diesem Beitrag wird auf die häufigsten Indikationen von Zahnkeimtransplantationen von Molaren, Prämolaren und Eckzähnen hingewiesen.

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Summary The normal development of the periodontal structures was confirmed histologically on young Beagle-dogs following tooth-germ transplants. In humans, clinical and radiographic examinations revealed no pathology of the periodontium following transplantation of tooth germs. The grafted teeth could be moved orthodontically in the same way as any other teeth. No precautions need to be taken. This paper describes the most common indications for transplanting the tooth-germs of canines, bicuspids and molars.

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Résumé Dans les expérimentations animales chez de jeunes chiens-Beagles, on a prouvé que les structures parodontales sont normalement développées après la transplantation de germes dentaires. Les examens cliniques et radiologiques chez de jeunes sujets d'espèce humaine n'ont pas montré de résultats pathologiques au niveau du parodonte après la greffe de germes dentaires. Les dents transplantées peuvent être déplacées orthodontiquement comme les autres dents sans mesures spéciales. Dans cet article, on a donné les indications concernant les greffes des germes de molaires, prémolaires et canines.

     

Langzeitergebnisse nach lumbalen Bandscheibenerkrankungen

The therapeutic results of operatively and conservatively treated patients with lumbar disc syndromes were reviewed in a retrospective study. The patients were treated during a 10-years period (1976-1985). A total of 330 patients with lumbar disc prolapses were treated in the hospital during this period 44% were treated surgically. The data on 100 operated and 100 conservatively treated cases, registered in this random test sample, have been compared with respect to: pain; neurological deficits; subjective problems and sociomedical questions. The average patient age of both groups was about 41 years, and the patients predominant were male (about 70%). The therapeutic results of both operatively and conservatively treated patients were good, which is also by the high percentage of employment (80%-90%) in the two treatment groups. The critical evaluation showed more neurological disturbances and limited vocational activity in the group of cases operated upon. More than 70% of the operated cases showed radicular syndromes of the follow-up examination although it was not of essential functional importance. The period inability to work and the percentage of disablement were also much higher in this group. The pain symptoms were particularly relevant in our examination. Only 12%-16% of the patients in the two groups that took part in the follow-up examinations reported freedom from pain. It was apparent that atypical pain syndromes were correlated with personality psychological disturbances. Nearly one-third of our patients mentioned psychological problems. The prognosis of the conservative treatment of lumbar disc prolapse was equivalent to operative therapy (disregarding the absolute indications for operations). There were no definite advantages found for either of the two methods of treatment. The necessity for a specialized follow-up treatment of patients with sciatica due to herniated lumbar discs is discussed, and differentiated selection for operative therapy is given. Here the treatment of pain should be considered most important.     

How do short-term rates of femorotibial cartilage change compare to long-term changes? Four year follow-up data from the osteoarthritis initiative

OBJECTIVE: To compare unbiased estimates of short- vs long-term cartilage loss in osteoarthritic knees. METHOD: 441 knees [216 Kellgren Lawrence (KL) grade 2, 225 KL grade 3] from participants of the Osteoarthritis Initiative were studied over a 4-year period. Femorotibial cartilage thickness was determined using 3?T double echo steady state magnetic resonance imaging, the readers being blinded to time points. Because common measurement time points bias correlations, short-term change (year-1 to year-2: Y1?→?Y2) was compared with long-term change (baseline to year-4: BL?→?Y4), and initial (BL?→?Y1) with subsequent (Y2?→?Y4) observation periods. RESULTS: The mean femorotibial cartilage thickness change (standardized response mean) was?-1.2%/-0.8% (-0.42/-0.28) over 1 (BL?→?Y1/Y1?→?Y2),?-2.1%/-2.5% (-0.56/-0.55) over 2 (BL?→?Y2/Y2?→?Y4),?-3.3% (-0.63) over 3 (Y1?→?Y4), and?-4.5% (-0.78) over 4 years. Spearman correlations were 0.33 for Y1?→?Y2 vs BL?→?Y4, and 0.17 for BL?→?Y1 vs Y2?→?Y4 change. Percent agreement between knees showing progression during Y1?→?Y2 vs BL?→?Y4 was 59%, and 64% for BL?→?Y1 vs Y2?→?Y4. The area under the receiver operating characteristic curve was 0.66 for using Y1?→?Y2 to predict BL?→?Y4, and 0.59 for using BL?→?Y1 to predict Y2?→?Y4 change. CONCLUSION: Weak to moderate correlations and agreement were observed between individual short- vs long-term cartilage loss, and between initial and subsequent observation periods. Hence, longer observation periods are recommended to achieve robust results on cartilage loss in individual knees. At cohort and subcohort level (e.g., KLG3 vs KLG2 knees), the mean cartilage loss increased almost linearly with the length of the observation period and was constant throughout the study.     

Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria

Back ground

Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors.

Objective

To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria.

Methods

All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010).

Results

Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity.

Conclusion

Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.     

Ameloblastoma: current etiopathological concepts and management

Ameloblastoma is a benign odontogenic tumor of epithelial origin. It is locally aggressive with unlimited growth capacity and has a high potential for malignant transformation as well as metastasis. Ameloblastoma has no established preventive measures although majority of patients are between ages 30 and 60 years. Molecular and genetic factors that promote oncogenic transformation of odontogenic epithelium to ameloblastoma are strongly linked to dysregulation of multiple genes associated with mitogen‐activated protein kinase, sonic hedgehog, and WNT/β‐catenin signaling pathways. Treatment of ameloblastoma is focused on surgical resection with a wide margin of normal tissue because of its high propensity for locoregional invasion; but this is often associated with significant patient morbidity. The relatively high recurrence rate of ameloblastoma is influenced by the type of molecular etiological factors, the management approach, and how early the patient presents for treatment. It is expected that further elucidation of molecular factors that orchestrate pathogenesis and recurrence of ameloblastoma will lead to new diagnostic markers and targeted drug therapies for ameloblastoma.