The teaching of osseointegrated implant dentistry in the schools of the UK and Eire

Implant dentistry is now a well recognised treatment modality. This paper examines the extent to which it is taught by dental schools in the United Kingdom and Eire to undergraduate and postgraduate students, hospital staff and general practitioners. The details of this teaching have been supplied by Heads of Departments of Prosthetic Dentistry.

A retrospective study comparing duplication and conventionally made complete dentures for a group of elderly people

The duplication technique is a well recognised method of replacing complete dentures. Advantages claimed for this technique are that patients adapt more easily to their new complete dentures and the numbers of treatment visits are reduced. The case notes of 100 patients were examined retrospectively, 50 of whom had had dentures constructed by undergraduates using a duplication technique and 50 with a conventional technique. In addition, a questionnaire was sent to the patients to obtain their views on the replacement dentures. The 'duplication group' required fewer visits for the delivery of the dentures, but there was no statistical difference between the numbers of post-insertion visits, for the two groups, needed to make the dentures comfortable. The only identifiable reason for selecting a duplication technique was the failure of construction of new dentures by a conventional method in 15 patients. Apart from this the two groups appeared remarkably similar when comparing age of dentures being replaced, period of edentulousness, number of previous complete dentures and medical histories. As judged by the questionnaire more patients in the duplication group continued to wear their new dentures compared to the conventional group.

Factors contributing to dyspnoea during bronchoconstriction and exercise in asthmatic subjects

The purpose of the present study was to identify: 1) whether dyspnoea during bronchoconstriction and exercise is related, in asthmatic subjects; and 2) to what extent baseline pulmonary function and respiratory muscle strength contribute to dyspnoea under both conditions. One hundred and seventy five consecutive subjects, referred with suspected asthma, rated the intensity of dyspnoea (Borg scale 0-10): 1) during the administration of doubling concentrations of methacholine to 32 mg.ml-1 methacholine, or until the baseline forced expiratory volume in one second (FEV1) was reduced by 20%; and 2) during incremental cycle ergometry (100 kpm.min-1 each minute) to maximal capacity. 138/175 subjects achieved a 20% reduction in their baseline FEV1; 18 of the 138 were excluded, 2 children and 16 with complicating pulmonary disorders (diffusing capacity of the lung for carbon monoxide (DLCO) and/or total lung capacity (TLC) < 70% predicted). The remaining 120 out of 175 constituted the study population. Dyspnoea following a 20% reduction in the baseline FEV1 (Dys20%) was linearly interpolated, using the rating of dyspnoea and the FEV1 at the two final concentrations of methacholine. In the 120 asthmatic subjects, the mean intensity of dyspnoea was "moderate" (2.9, SD 1.91; Borg 0-10) and the intensity across subjects was not significantly related to baseline FEV1, vital capacity (VC), FEV1/VC, DLCO, TLC and maximal static inspiratory pressure (MIP), alone or in combination.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors contributing to dyspnoea during bronchoconstriction and exercise in asthmatic subjects

The purpose of the present study was to identify: 1) whether dyspnoea during bronchoconstriction and exercise is related, in asthmatic subjects; and 2) to what extent baseline pulmonary function and respiratory muscle strength contribute to dyspnoea under both conditions. One hundred and seventy five consecutive subjects, referred with suspected asthma, rated the intensity of dyspnoea (Borg scale 0-10): 1) during the administration of doubling concentrations of methacholine to 32 mg.ml-1 methacholine, or until the baseline forced expiratory volume in one second (FEV1) was reduced by 20%; and 2) during incremental cycle ergometry (100 kpm.min-1 each minute) to maximal capacity. 138/175 subjects achieved a 20% reduction in their baseline FEV1; 18 of the 138 were excluded, 2 children and 16 with complicating pulmonary disorders (diffusing capacity of the lung for carbon monoxide (DLCO) and/or total lung capacity (TLC) < 70% predicted). The remaining 120 out of 175 constituted the study population. Dyspnoea following a 20% reduction in the baseline FEV1 (Dys20%) was linearly interpolated, using the rating of dyspnoea and the FEV1 at the two final concentrations of methacholine. In the 120 asthmatic subjects, the mean intensity of dyspnoea was "moderate" (2.9, SD 1.91; Borg 0-10) and the intensity across subjects was not significantly related to baseline FEV1, vital capacity (VC), FEV1/VC, DLCO, TLC and maximal static inspiratory pressure (MIP), alone or in combination.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal lupus erythematosus syndrome: late detection of isolated heart block

Heart block in neonatal lupus erythematosus is typically complete and detected in utero or in the neonatal period. We describe a child diagnosed with incomplete heart block at 9 years of age whose mother was diagnosed with Sjögren's syndrome and anti-Ro(SSA) 2 years after diagnosis of heart block in her child. This is the first case of late detection of incomplete heart block in a child felt to be causally related to the presence of anti-Ro(SSA) in the mother.

Effect of a platelet activating factor antagonist, WEB 2086, on allergen induced asthmatic responses

BACKGROUND

Platelet activating factor (PAF) has been implicated in the pathogenesis of airway hyperresponsiveness in asthma. The purpose of this study was to evaluate the effects of a selective PAF antagonist (WEB 2086), given in doses known to antagonise the effects of inhaled PAF in human subjects, on allergen induced early and late asthmatic responses and on airway hyperresponsiveness.

METHODS

Eight atopic, mildly asthmatic subjects were studied during a screening period and two treatment periods. During the screening period subjects inhaled an allergen to which they were known to be sensitised and the response was measured as the fall in the forced expired volume in one second (FEV1) to show the presence of early (0-1 h) and late (3-7 h) asthmatic responses. On another day the subjects inhaled allergen diluent. During the treatment periods subjects inhaled allergen after one week's pretreatment with WEB 2086 (100 mg three times a day) or placebo administered in a randomised, double blind, crossover fashion. Histamine airway responsiveness was measured 24 hours before and 24 hours after allergen and the results were expressed as the provocative concentration causing a 20% fall in FEV1 (PC20).

RESULTS

The maximal early asthmatic response after allergen with placebo treatment was 18.4% (SE 4.4%) and with WEB 2086 18.9% (4.4%). The maximal late response with placebo treatment was 21.7% (5.3%) and with WEB 2086 21.2% (3.0%). The log difference (before and after allergen) in histamine PC20 was 0.35 (0.06) after placebo treatment and 0.30 (0.1) after WEB 2086.

CONCLUSIONS

These results indicate that one week of treatment with an orally administered PAF antagonist (WEB 2086) does not attenuate allergen induced early or late responses or airway hyperresponsiveness.

Criterion based audit in prosthetic dentistry

A criterion based retrospective audit into the provision of complete dentures in an undergraduate teaching programme has been produced. This consisted of a series of questions related to the treatment of the patient and the satisfaction or otherwise expressed about the treatment. The audit revealed where treatment had been successful according to the established criteria. It has been found that an audit of this nature is demanding of clinicians' time but does show where improvements can be made in patient management which will result in better health care. Clinical audit is now recognized as forming an important part of health care. It is applicable to all areas of dentistry, ie general dental practice, the community dental services and the hospital services, and to all specialities eg prosthetics, orthodontics etc. An audit programme needs careful planning and a pilot study is worthwhile to indicate areas of difficulty. This audit has been used in an undergraduate training programme, however, the process by which the audit has been assembled is an example of how an audit could be established in any area of dentistry, provided that the criteria are modified to make them relevant to the clinical speciality.

U1RNP antibody-positive neonatal lupus. A report of two cases with immunogenetic studies

BACKGROUND

Neonatal lupus erythematosus (NLE) is a distinct subset of lupus characterized by cutaneous findings (50%), cardiac conduction defects (50%), and autoantibodies to Ro (SS-A) antigen. HLA typing studies of Ro (SS-A) antibody-positive mothers of infants with NLE have shown an association with the HLA-DR3 phenotype. We report the clinical and serologic features of two infant-mother pairs who are U1RNP antibody positive and Ro (SS-A) antibody negative. HLA typing is reported on these infants, their mothers, and two additional infant-mother pairs with U1RNP antibody-positive lupus whose clinical features have been reported previously.

OBSERVATIONS

Cutaneous findings included malar erythema, annular and polycyclic plaques, and scales that resolved with residual telangiectasia and hyperpigmentation 6 months after birth. Systemic abnormalities, including complete heart block, were absent. HLA typing revealed HLA-DR3 in two of four mothers, HLA-DR4 and HLA-DRw53 in two of four mothers, and either HLA-DQ1 or HLA-DQ3 in four of four mothers. No distinct HLA associations were seen in the three infants examined.

CONCLUSIONS

The spectrum of cutaneous disease in U1RNP antibody-positive infants is similar to Ro (SS-A) antibody-positive infants with NLE. Complete heart block was not a feature of U1RNP antibody-positive NLE. HLA typing studies show a more diverse immunogenetic pattern in U1RNP antibody-positive mothers of infants with NLE compared with Ro (SS-A) antibody-positive mothers.

Cutaneous manifestations of the eosinophilia-myalgia syndrome

We report the cutaneous manifestations of the eosinophilia-myalgia syndrome in 10 patients, with specific reference to their clinical course, histopathological features, and immunogenetic studies. Cutaneous manifestations could be classified into three groups: morphoea-like sclerosis, urticarial and papular lesions, and generalized sclerosis. Despite this polymorphic clinical presentation, the histopathological abnormalities in all cases were strikingly similar, and consisted of superficial and deep perivascular lymphocytic dermal infiltrates, mucin deposition, and fascial inflammation (often in the absence of sclerosis). Immunoperoxidase studies revealed increased numbers of factor XIIIa- and MAC 387-positive cells in the inflammatory infiltrate. Immunogenetic studies demonstrated that 77% (7/9) of patients possessed the HLA-DR3 or HLA-DR4 phenotypes. Mean follow-up of 24 months after discontinuation of L-tryptophan revealed the presence of persistent severe disabling disease in 30% of patients.

Effect of an inhaled thromboxane mimetic (U46619) on airway function in human subjects

Thromboxane A2(TxA2) has been implicated in the pathogenesis of airway hyperresponsiveness. The effects of inhaled TxA2 on human airway function have not been studied because of its short half-life. U46619 is a chemical that mimics the effects of TxA2. The purpose of this study was to evaluate the effects of inhaled U46619 on human airway function and methacholine airway responsiveness. Airway responsiveness to methacholine and U46619 was measured in 19 subjects (13 asthmatic and six normal) and expressed as the provocative concentration causing a 20% fall in FEV1 (PC20). On one day, methacholine alone was inhaled. On a second day, U46619 was inhaled, then 1 h later methacholine was inhaled. On a third day, U46619 was inhaled, then repeated 1 h later. In six subjects, the effects of isotonic saline or a subthreshold concentration of histamine or U46619 were examined on methacholine airway responsiveness. U46619 was 178 times more potent as a bronchoconstrictor than was methacholine. Airway responsiveness to methacholine was correlated to airway responsiveness to U46619 (r = 0.87, p = 0.001). Subthreshold concentrations of U46619, but not of histamine, increased methacholine airway responsiveness. The mean maximal fall in FEV1 after inhaled methacholine was 13.2% (SEM, 3.4%) after saline, 12.4% (SEM, 2.4%) after histamine, and 25.7% (SEM, 2.0%) after U46619 (p = 0.0004). This effect lasted less than 1 h. There was no tachyphylaxis to repeated inhalations of U46619. These results indicate that in human subjects inhaled U46619 is a potent bronchoconstrictor that, when present in the airways, can cause airway hyperresponsiveness to inhaled methacholine in asthmatic subjects.

Changes in the cellular profile of induced sputum after allergen-induced asthmatic responses

Allergen inhalation causes airway inflammation and an increase in histamine airway responsiveness. We have used cell counts in sputum induced by hypertonic saline aerosol to assess airway inflammation before and 32 h after asthmatic responses to allergen. Twelve asthmatic subjects (mean age, 27.4 yr; range, 20-38 yr) had an inhalation test with D. farinae, ragweed pollen, or cat extract. All of them developed an early response with a fall in FEV1, of 24.8% (SD, 6.3%); nine of 12 had a definite late response (fall in FEV1 greater than or equal to 15%), and 10 of 12 had an increase in airway responsiveness to histamine at 32 h (PC20 reduced by greater than twofold). Sputum was induced by hypertonic saline after the histamine test, before and 32 h after the allergen challenge, at the same time of day. The quality of the sample was scored according to visual inspection and inverted microscopy and by salivary contamination. Plugs arising from the lower respiratory tract were selected for further evaluation. Differential cell counts of eosinophils (Eo) and metachromatic cells (MCC) (mast cell and basophils) were obtained from direct smears, blind to the clinical procedures. The mean fall in FEV1 after hypertonic saline was 6.4% (range, zero to 28%). The sputum samples were adequate in 79.5% of attempts. Eo and MCC increased significantly from 3.8 (4.4) to 18.2 (22.8)% (p = 0.01) and from 0.05 (0.17) to 0.25 (0.76)% (p = 0.04), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal lupus erythematosus syndrome: analysis of C4 allotypes and C4 genes in 18 families

We examined 18 families with infants who had neonatal lupus erythematosus (NLE) syndrome to determine whether abnormalities in C4 phenotypes and genotypes were an additional risk factor for this syndrome. Fifteen of 18 mothers of infants with NLE (83%) had C4 null allotypes compared with 36% of population controls (p = less than .001). This increased frequency was due mainly to the presence of C4A null allotypes (11/18, 61%). C4 gene abnormalities, i.e., deletion or probable duplication, were present in 100% (16/16) of mothers of infants with NLE. The most common molecular genetic abnormality in mothers of infants with NLE in this study was deletion of C4A genes. Duplication of C4A and C4B loci was also commonly seen. Duplication of C4A genes was detected only in mothers of infants with complete congenital heart block (CCHB), and duplication of C4B was detected only in mothers of infants with dermatitis. No significant increase in C4A or C4B null allotypes or protein deficiencies was noted in mothers of infants with neonatal lupus when compared with anti-Ro(SS-A)-positive mothers delivered of clinically normal infants. Fathers of infants with NLE showed a trend toward increase in C4B null allotypes when compared with population controls (75%, 3/4, p = .06). The two infants with CCHB examined were C4B protein-deficient, in contrast to infants with lupus dermatitis, who had frequent C4B null allotypes but no C4B protein deficiency. C4B null allotypes were not seen in unaffected siblings of infants with NLE and in only 1 of 7 anti-Ro(SS-A)-positive mothers who delivered clinically normal infants. We conclude that inheritance of C4A null allotypes is not predictive of increased risk of neonatal lupus when present in anti-Ro(SS-A)-positive women. Examination of paternal and maternal C4 genes of additional infants with NLE, in particular those with CCHB, and of normal infants born to anti-Ro(SS-A)-positive mothers--and of the normal infants' parents--is required to determine if abnormal C4B genes are a critical factor rendering susceptibility to the NLE syndrome.

Considerations in design and fabrication of maxillary implant-supported prostheses

Principles of the design and fabrication of implant-supported maxillary prostheses are described. The significance of the maxillomandibular relationships, maxillary arch size to the location of the implants, and the positioning of the restored dental arch are discussed. Angulated abutments may overcome conflicts between the position of the artificial teeth and the implants. Solutions to design features that may impair achievement of a pleasing appearance, good gingival health, and well-articulated speech are considered.

Protease activities in peri-implant sulcus fluid from patients with permucosal osseointegrated dental implants. Correlation with clinical parameters

The 15 patients included in this study each had 2-6 permucosal Branemark osseointegrated implants that had functioned successfully for 18 months or more. They were given a full oral examination which included measurements of probing depth and gingival, bleeding and plaque indices around the implants. Marginal bone reduction during the functional life of the implants was estimated from radiographs. At a separate visit, peri-implant sulcus fluid (PISF) was collected on filter paper strips from the deepest probing site of each implant. PISF volumes were measured and the samples eluted into buffer. Protease activities in the eluates were determined by fluorimetric assay with peptidyl derivatives of 7-amino-4-trifluoromethyl coumarin. Enzyme levels followed the order: cathepsin B/L greater than elastase greater than dipeptidyl peptidase IV greater than trypsin-like activity. Total enzyme activities and concentrations both correlated positively with all clinical parameters in linear regression analysis. This was true on both a patient level using mean patient values and a site level using pooled patient data. Nearly all of the site level correlations were statistically significant, though coefficients were generally higher for total enzyme activities than concentrations. Elastase-like activity gave the best overall correlations of the different proteases measured. Amongst the clinical parameters, correlations were generally best with gingival index and bone reduction. Total enzyme activities had good diagnostic specificity and sensitivity as predictors of clinical parameters and the figures were especially high for elastase-like activity as a marker of bone reduction. PISF proteases may thus be of value in monitoring tissue responses to osseointegrated implants.

Detection of anti-Ro(SSA) antibodies by gel double diffusion and a 'sandwich' ELISA in systemic and subacute cutaneous lupus erythematosus and Sjögren's syndrome

A newly described Ro 'sandwich' ELISA was compared to the gel double diffusion technique to detect anti-Ro(SSA) antibodies in Sjögren's syndrome, systemic and subacute cutaneous lupus erythematosus patients. This study demonstrates that the ELISA assay increased the frequency of detection of anti-Ro(SSA) antibodies in these well defined connective tissue disease patients by approximately 5-10% compared to the gel double diffusion anti-Ro(SSA) antibody assay. The study also confirms that some patients make anti-Ro(SSA) antibodies directed solely at unique human Ro(SSA) antigen epitopes. We also detected the existence of a significant Sjögren's syndrome patient population failing to make significant anti-Ro(SSA) antibodies. We conclude from our study that the gel double-diffusion technique employing human spleen extract as a source of the Ro(SSA) antigen is, at present, the most cost-effective test to detect anti-Ro(SSA) antibodies.

Subacute cutaneous lupus erythematosus-immunogenetic associations

Thirty-two patients who fulfilled criteria for subacute cutaneous lupus erythematosus (SCLE) were examined for their immunogenetic associations. Our results confirm the previously reported association of HLA-DR3 (15/31 48% P less than 0.01) and also demonstrate an increase in HLA-DR2 (14/31, 45%, P = less than 0.05). These findings indicate there are two distinct immunogenetic (HLA) populations of Ro(SS-A) antibody-positive SCLE patients. The increased frequency of HLA-DR2 and DR3 appears to be associated with expression of the Ro(SS-A) antibody, since no HLA associations were seen in Ro(SS-A)-negative SCLE patients when compared with normal population controls. Furthermore, these data indicate that the distinctive cutaneous lesions of SCLE are not associated with one specific HLA allele, as previously suspected. These findings contrast with the relatively homogeneous immunogenetic background seen in other lupus erythematosus subsets with a high frequency of Ro(SS-A) antibody, i.e., neonatal lupus erythematosus and Sjögren's syndrome/lupus erythematosus overlap (increased frequency of HLA-DR3, DQw2 and DRW52).

Inhibition of exercise-induced bronchoconstriction by MK-571, a potent leukotriene D4-receptor antagonist

BACKGROUND

Exercise is a common stimulus of bronchoconstriction in subjects with asthma, who also have bronchoconstriction after inhaling the sulfidopeptide leukotriene D4 (LTD4). The purpose of this study was to investigate the importance of LTD4 as a mediator of exercise-induced bronchoconstriction.

METHODS

In a double-blind, randomized, crossover study, 12 subjects with stable asthma were treated intravenously with MK-571 (160 mg), a selective and potent LTD4-receptor antagonist, or placebo, 20 minutes before each of two challenges involving exercise at a level previously demonstrated to cause a fall of at least 20 percent in the forced expiratory volume in one second (FEV1). The two exercise challenges were separated by one week. The results of the challenges were expressed as both the maximal fall in FEV1 after exercise and the time to recovery from bronchoconstriction.

RESULTS

Treatment with MK-571 attenuated exercise-induced bronchoconstriction in all the subjects. The mean (+/- SEM) maximal percent decrease in FEV1 after exercise was 25.2 +/- 3.5 percent in the subjects taking placebo and 9.2 +/- 2.5 percent in the subjects taking MK-571 (P less than 0.001). The mean percent inhibition for the entire group was 69.5 percent. The mean time to recovery after exercise was 33.4 +/- 4.0 minutes in the placebo group and 8.4 +/- 2.5 minutes in the MK-571 group (P less than 0.001).

CONCLUSIONS

This study demonstrates that pretreatment with a potent and selective LTD4 antagonist markedly attenuates exercise-induced bronchoconstriction, and it suggests that LTD4 is a major mediator of this type of bronchoconstriction.

Barriers to dental care in an elderly population resident in an inner city area

A sample of 765 elderly people living in London was interviewed and examined. Barriers to dental care stemmed from: elderly people's beliefs that dentures should last a life-time and dental visits are unnecessary for edentulous persons: mobility difficulties; fear; problems with access to NHS care and with access to satisfactory care. The attitudes of general dental practitioners, community dentists and final year dental students towards elderly people were favourable. Sixty per cent of surgeries were on the ground floor, and 46 per cent of premises were unsuitable for wheelchair access. Carers wanted improvement in domiciliary services. The provision of domiciliary care was significantly related to training. There was a paucity of experience in this field amongst dental students. Community dentists recognized a need for retraining before providing care for handicapped elderly people.

Tachyphylaxis to inhaled methacholine in normal but not asthmatic subjects

Methacholine inhalation tests measure airway responsiveness in asthmatic and normal subjects. Tachyphylaxis occurs with repeated methacholine inhalations in normal subjects. The purpose of this study was to examine the time course and mechanisms of methacholine tachyphylaxis in normal subjects and to determine whether this occurs in mildly asthmatic subjects. Fifteen normal and nine asthmatic subjects were studied on 2 study days, at least 48 h apart. Each day, two inhalation tests were carried out. On one day, subjects performed two methacholine inhalation tests 3 h later by a methacholine test. Results were expressed as the provocation concentration causing a 20% fall in forced expiratory volume in 1 s (FEV1), (PC20). All normal subjects developed methacholine tachyphylaxis. The mean PC20 increased from 47.3 mg/ml (%SE 1.34) to 115.6 (%SE 1.51) (P less than 0.0001) in a 3-h interval. This increase lasted for greater than or equal to 6 h (P = 0.012). Asthmatic subjects did not develop methacholine tachyphylaxis. Their mean methacholine PC20s were 1.6 mg/ml (%SE 1.4) and 1.5 (%SE 1.4) (P = 0.75) 3 h later. In two other series of experiments, normal subjects were pretreated with the cyclooxygenase inhibitors indomethacin (100 mg/day) or flurbiprofen (150 mg/day) or a placebo for 3 days before two methacholine tests 3 h apart. Both indomethacin and flurbiprofen significantly inhibited the development of methacholine tachyphylaxis. These results confirm that methacholine tachyphylaxis occurs in normal subjects, lasts greater than or equal to 6 h, and may occur through the release of inhibitory prostaglandins. By contrast, methacholine tachyphylaxis does not occur in asthmatic subjects.

Methacholine airway responsiveness decreases during exercise in asthmatic subjects

In many asthmatic subjects, bronchoconstriction develops 2 to 5 min after exercise, reaches a maximum at approximately 10 min, and declines over the next 60 min. However, bronchodilation is typically observed during and immediately after exercise. We measured the bronchoconstrictor responses to increasing concentrations of inhaled methacholine at rest and during two levels of exercise in seven asthmatic subjects to determine the protection against bronchoconstriction afforded by exercise. On the first day, an incremental Stage 1 exercise test was performed to determine the work capacity (Wcap) of each subject. On the second, third, and fourth days, methacholine was inhaled at rest or during steady-state exercise at one-third or two-thirds of Wcap. The bronchoconstrictor response to methacholine was significantly reduced during exercise (p less than 0.0001). The concentration of methacholine required to produce a 20% reduction in FEV1 (PC20) increased from 2.80 mg/ml (%SEM, 1.62) at rest to 7.29 mg/ml (%SEM, 1.43) during exercise at one-third Wcap, and to 31.03 mg/ml (%SEM, 1.74) during exercise at two-thirds Wcap (p less than 0.001). This study has demonstrated that there is greater than tenfold protection against bronchoconstriction by methacholine during exercise, and the magnitude of the protection depends on the intensity of exercise performed. The mechanism of this protection is not known, but may have clinical utility.

The benefit of dental care to an elderly population assessed using a sociodental measure of oral handicap

The provision of dental care is based on the assumption that it contributes to quality of life. One hundred elderly people requesting dental care were interviewed and treated. Assessment was made using a sociodental index as well as clinical criteria. The index measured four categories of oral handicap (impairment of function, comfort, self-image and social interaction) prior to treatment and any benefit conferred by the treatment. Seventy-four per cent benefited from treatment. The greatest improvements were in self-image and social interaction. Function was the most difficult category to satisfy. One third of subjects whose oral function was compromised before treatment were still in this state after treatment.

The immunogenetic relationship between anti-Ro(SS-A)/La(SS-B) antibody positive Sjögren's/lupus erythematosus overlap syndrome and the neonatal lupus syndrome

We have described previously the clinical features of a unique group of anti-Ro(SS-A) antibody positive Sjogren's patients who have cutaneous features of lupus erythematosus, most commonly subacute cutaneous lupus erythematosus, defined as the Sjogren's/lupus erythematosus overlap syndrome. Three of these patients are also mothers of infants with the neonatal lupus erythematosus syndrome, characterized by cutaneous lesions resembling subacute cutaneous lupus erythematosus or congenital heart block. Patients with Sjogren's/lupus erythematosus overlap syndrome, subacute cutaneous lupus erythematosus, and mothers of infants with the neonatal lupus syndrome characteristically have autoantibodies to Ro(SS-A), and in many cases, La(SS-B) antigens. The present study was designed to test the hypothesis that anti-Ro(SS-A)/La(SS-B) positive Sjogren's/lupus overlap patients and mothers of infants with neonatal lupus erythematosus syndrome are immunogenetically homogenous and closely related. We report a strong association with HLA-B8, DR3, DQw2, and DRw52 phenotypes and the HLA-B8, DR3, DQw2, DRw52 extended haplotype in both patient cohorts. Furthermore, we describe disease associations with HLA-DR3/DRw6 heterozygotes in both patient groups. These data demonstrate that anti-Ro(SS-A)/La(SS-B) positive Sjogren's/lupus overlap patients and neonatal lupus syndrome mothers are immunogenetically closely related to each other and appear to be more closely related to both primary Sjogren's syndrome and subacute lupus erythematosus, than to classical systemic lupus erythematosus.

Osseointegrated implants--principles and practice: 3. Case treatments with the Nobelpharma implant system

In this series of three articles the authors describe some of the principles and practice of osseointegrated implants. Part 1 gave a detailed description of the surgical techniques to establish osseointegrated implants (with special reference to the Branemark system), guidance on patient selection and treatment planning. Part 2 described prosthetic rehabilitation using osseointegrated implant fixtures. This article concludes the series by presenting a number of case studies.

Osseointegrated implants--principles and practice: 2. Prosthetic rehabilitation with osseointegrated implants

In this series of three articles the authors describe some of the principles and practice of osseointegrated implants. Part 1 gave a detailed description of the surgical techniques required to establish osseointegrated implant fixtures (with special reference to the Branemark system), and gave guidance on patient selection and treatment planning. Part 2 now considers prosthetic rehabilitation techniques with osseointegrated implants for complete dentures, complete overdentures, partial bridges, and single tooth replacement cases. Part 3 will conclude the series by presenting a number of case studies.