The Science of Communicating the Art of Esthetic Dentistry. Part I: Patient-Dentist-Patient Communication

Many contemporary restorative procedures are primarily esthetically driven, and patients have high expectations. It is imperative for the restorative dentist to understand patients' desires and expectations prior to initiating irreversible therapy. It is equally important for patients to understand the anatomic and technical limitations inherent with restorative therapy.
CLINICAL SIGNIFICANCE
This article describes several relatively straightforward techniques that can assist in dentist-patient-dentist communication and allow the patient to visualize a reasonable facsimile of the definitive result prior to initiation of irreversible therapy. By using these techniques where indicated, the frustrating cycle of rejection and failure may be avoided.     

The Science of Communicating the Art of Esthetic Dentistry. Part II: Diagnostic Provisional Restorations

Provisional restorations fulfill many functions in restorative dentistry. Quality provisional restorations can provide the clinician, the patient, and the laboratory technician much valuable information prior to fabrication of the definitive restoration. Such diagnostic provisional restorations fabricated with acrylic resin are easily adjusted and modified until both esthetic and functional results are approved by the patient. Once this approval has been obtained, the definitive restorations can be fabricated with confidence, using the esthetic form of the provisional restorations as a blueprint.
CLINICAL SIGNIFICANCE
Routine use of provisional restorations for esthetic diagnostic purposes can prevent the destructive cycle of failure and frustration frequently experienced when performing elective esthetic restorative dentistry.     

Humoral responses in mice following vaccination with DNA encoding glutathione S-transferase of Fasciola hepatica: effects of mode of vaccination and the cellular compartment of antigen expression

The humoral responses in mice following vaccination with DNA constructs encoding Fasciola hepatica glutathione S-transferase (GST) have been evaluated. GST47 cDNA was subcloned into two DNA vaccine vectors, VR1012 and VR1020, which direct expression to the cytoplasmic and extracellular compartments, respectively. Expression was confirmed by transfection into COS 7 cells. Groups of mice were vaccinated with these constructs, by either intramuscular injection with the VR1012-or VR1020-based constructs, or intradermal vaccination (with a gene gun) with the VR1020-based construct. Vaccination with the construct designed for secretion resulted in an increased humoral response compared to vaccination with the nonsecretory construct. The level of the total humoral response after vaccination with the secretion construct was not dependent on the route of vaccination. However, the isotype profile of the response differed between the groups; intramuscular vaccination with the construct directing cytoplasmic expression yielded an immuoglobulin (Ig)G2a dominant (Th1-type) response, intradermal vaccination with the secretory construct a IgG1/IgE dominant (Th2-type) response, and intramuscular vaccination with the secretory construct a mixed isotype response. These results demonstrate that the immunogenicity of a DNA vaccine based on Fasciola GST, as well as the isotype of the response against GST, is determined by the mode of vaccine administration.     

FAT GRAFT MYRINGOPLASTY—A PROSPECTIVE TRIAL

Fat graft myringoplasty—a prospective trial A prospective trial to determine the success rate of the fat graft myringoplasty technique is reported. A success rate of 76% overall was attained at review 1 year postoperatively with increased success for smaller perforations of the tympanic membrane.     

Mucous Cell Metaplasia in the Airways of Rats Exposed to Machining Fluids

Occupational exposure to microbial-contaminated machining fluidsis associated with a variety of adverse pulmonary effects includingchronic bronchitis and increased sputum production. We havepreviously demonstrated in F344 rats that inhaled endotoxincan increase the amount of stored intraepithelial mucosubstances(Vs) in the respiratory tract. The purpose of the present studywas to examine the effect of endotoxin-contaminated machiningfluid aerosols on mucous production. Rats were exposed to aerosolsof pyrogen-free water, 1 or 10 mg/m³ used machining fluid, or10 mg/m³ unused machining fluid for 3 hr/day for 3 days. Twenty-fourhours after the final exposure, right lung lobes were lavagedand the nasal cavity and left lung were fixed in formalin. Theamount of Alcian blue/periodic acid-Schiff-stained mucosubstanceswas determined by morphometry. Exposure to 10 mg/m³ used machiningfluid (equivalent to 0.8 µg/m³ endotoxin) produced a significantincrease in Vs in the epithelial lining of both the nasal septumand intrapulmonary airways. These changes in Vs were accompaniedby a significant increase in total cells and neutrophils inthe lavage fluid. No changes in stored mucosubstances or lavageparameters were found in animals exposed to 1 mg/m³ used machiningfluid aerosols. A significant increase in Vs was observed inthe nasal septum but not in the intrapulmonary airways of animalsexposed to 10 mg/m³ unused machining fluids (no measurable endotoxin).These results suggest that in addition to endotoxin, nonendotoxincomponents of machining fluids may contribute to the increasein sputum and chronic bronchitis reported for workers exposedto machining fluid aerosols.     

Comparative Toxicology of Temelastine: A Novel H1 Antagonist in Dog, Rat, and Monkey

Comparative Toxicology of Temelastine: A Novel H, Antagonistin Dog, Rat, and Monkey. POOLE, A., BETTON, G. R., SALMON, G.,SUTTON, T., AND ATTERWILL, C. K. (1990). Fundam. Appl. Toxwol.14, 71–83. The toxicity of temelastine 2-[4-(5-bromo-3-methylpyrid-2-yl)butyl-amino]-5-[(6-methylpyTid-3-yl)methyl]-4-pyrimidone a potent, selective, competitive hista-mineHrreceptor antagonist was examined in dogs and rats. The majortoxicologjcal response seen in the dog was marked, but intermittentand reversible, increases in the plasma activity of a numberof liver-associated enzymes, viz alanine aminotransferase (ALT),glutamate dehydro-genase (GLDH), and alkaline phosphatase (ALP).The increases first seen in two male dogs treated for 30 consecutivedays at a dose of 300 mg/kg became apparent at lower doses,i.e., 100 and 33.3 mg/kg/day, in 6- and 12-month studies. Althoughthe increases were suggestive of hepatotoxicity, the only histologicalchanges were increases in hepatocellular lipofuscin pigmentand foci of macrophages seen in dogs treated at 300 mg/kg for12 months. Rats treated for up to 12 months at doses as highas 300 mg/kg/day showed no treatment-related increases in plasmaenzymes although increases in liver weights and hepatocellularlipofuscin pigment together with centrilobular hypertrophy wereseen in the 300 mg/kg/day treatment group. To investigate differencesin hepatic responsiveness between species dogs, rats, and monkeyswere exposed to high concentrations of temelastine by continuous24-hr intravenous infusion. The results of the study showedthe dog to be most sensitive to the hepatic effects of temelastine.The major toxicological effect of temelastine in the rat wasa histopathological lesion of the thyroid gland characterizedby agglomeration and depletion of colloid, follicular epithelialhypertrophy and reduced follicular size. The no-effect dosefor this lesion was between 10 and 33.3 mg/kg/day. These histopathologicalchanges, characteristic of a "TSH-driven" thyroid gland, werenot seen in the thyroid glands of dogs.     

Down to the Wire: Tricuspid Stenosis in the Setting of Multiple Pacing Leads

Tricuspid stenosis in the setting of endocardial pacing leads is a rare entity, attributed to infection or lead malposition. We report the case of a 37‐year‐old man without these risk factors, who presented with new onset severe tricuspid stenosis in the setting of multiple chronic pacing leads. (PACE 2010; e49–e52)