Serial Transthoracic Ultrasonography Studies in Hematopoietic Cell Transplant Patients: A Tool for Early Lung Pathology Detection

Early detection of pulmonary complications can improve outcomes for patients with hematological malignancy (HM). For detecting lung injuries, lung ultrasound (LUS) images have been found to be of greater sensitivity than radiographic images. Our group performed a pilot study of LUS imaging to enhance early detection of pulmonary complications in HM patients. This prospective single-center feasibility study evaluated LUS for detecting pulmonary complications in 18 HM patients enrolled while hospitalized for a hematopoietic cell transplant (HCT) (concurrent-HCT group) or re-hospitalized for complications (post-HCT group). Serial LUS exams were performed and assigned a score from 0 to 5 based on pleural line, B-line, consolidation and pleural effusion features. Correlations between patients' clinical characteristics and LUS features were analyzed. Comparisons between the LUS and radiographic images were evaluated. In the concurrent-HCT patients (79 LUS exams), non-significant fluctuating findings were commonly identified, but one-third of the patients presented pathologic findings (LUS scores ≥ 3). In the post-HCT patients (29 LUS exams), LUS images revealed severe pathologic findings (LUS score = 5) in every patient and, compared with radiographic images, were more sensitive for detecting pleural effusions (p < 0.05). LUS can be routinely performed on hospitalized HM patients, allowing point-of-care early detection of pulmonary complications.

Extracellular vesicles impose quiescence on residual hematopoietic stem cells in the leukemic niche

Progressive remodeling of the bone marrow microenvironment is recognized as an integral aspect of leukemogenesis. Expanding acute myeloid leukemia (AML) clones not only alter stroma composition, but also actively constrain hematopoiesis, representing a significant source of patient morbidity and mortality. Recent studies revealed the surprising resistance of long-term hematopoietic stem cells (LT-HSC) to elimination from the leukemic niche. Here, we examine the fate and function of residual LT-HSC in the BM of murine xenografts with emphasis on the role of AML-derived extracellular vesicles (EV). AML-EV rapidly enter HSC, and their trafficking elicits protein synthesis suppression and LT-HSC quiescence. Mechanistically, AML-EV transfer a panel of miRNA, including miR-1246, that target the mTOR subunit Raptor, causing ribosomal protein S6 hypo-phosphorylation, which in turn impairs protein synthesis in LT-HSC. While HSC functionally recover from quiescence upon transplantation to an AML-naive environment, they maintain relative gains in repopulation capacity. These phenotypic changes are accompanied by DNA double-strand breaks and evidence of a sustained DNA-damage response. In sum, AML-EV contribute to niche-dependent, reversible quiescence and elicit persisting DNA damage in LT-HSC.

Increased width of the apical periodontal membrane space in endodontically treated teeth may represent favourable healing

AIM

To examine cases showing increased width of the periodontal space (IW) at a long-term follow-up examination and to determine whether this finding could be explained by endodontic or nonendodontic factors.

METHODOLOGY

A series of intraoral radiographs was obtained from 131 patients 20-27 years after root canal treatment. The same individuals had been examined 10 years earlier, and radiographs taken immediately after treatment were also available. Fourteen roots (5.6%) demonstrated increased width of the apical periodontal space at the end of the study period. These were subjected to further analysis in an attempt to disclose possible explanatory factors.

RESULTS

Two of the 14 cases had reduced marginal bone levels interpreted as the origin of the IW. In three cases, overextended root filling material present 10 years earlier had disappeared and the persistent IW was interpreted as representing a remodelling process. In six cases the findings were explained as being caused by physical and anatomical factors that represented healing without complete re-formation of the apical periodontal structures, or both. Three cases were judged as unfavourable, on the basis of lacking progress in healing, unsatisfactory obturation of the apical portion of the root canal or dentine resorption close to the apical end of the root filling.

CONCLUSION

Most of the 14 IW cases examined after 20-27 years could be explained by reduced marginal bone support, or by physical and anatomical factors or they might represent incomplete reformation of the typical apical morphology and were thereby recorded as favourable outcomes.

Nonsurgically retreated root filled teeth--radiographic findings after 20-27 years

AIM

To identify periapical changes in nonsurgically retreated root-filled teeth 20-27 years after root canal treatment.

METHODOLOGY

From an original material of 429 roots, retreated by undergraduate students in a teaching clinic, 112 roots in 70 individuals could be evaluated radiographically 20-27 years after treatment. The same roots had been studied 10-17 years earlier. The periapical condition was registered and compared by three observers in two series of intraoral radiographs taken 10-17 and 20-27 years after treatment. A retrospective analysis was performed to gain information about probable endodontic and nonendodontic reasons for extractions of lost roots, by evaluating their periapical status immediately after retreatment and at the 10-17-year follow-up.

RESULTS

Favourable outcomes were observed in 11 roots that had radiolucencies at the 10-17-year follow-up. Eight of these roots had periapical pathosis preoperatively, five of them filled with surplus root filling material. The percentage of cases recorded as normal condition at the final follow-up was 95.5%, including five cases initially recorded with increased width of the apical periodontal space. Delayed healing as a result of surplus root filling material explained most of the cases with favourable outcome assessed many years after treatment. Twenty-eight roots were lost because of extraction during the observation period, 17 during the last 10 years. Based on status at previous follow-ups, endodontic failure seems to represent a minor reason for extraction in the material.

CONCLUSION

Late periapical changes, with more successful cases, were recorded when a 10-17-year follow-up after root canal treatment was extended for another 10 years. Persistent asymptomatic periapical radiolucencies, especially those with overfill, should generally not be classified as failures, as many of them will heal after an extended observation period.

Idiopathic osteosclerosis of the jaws followed through a period of 20-27 years

AIM

The aim of the present study was to examine the prevalence of idiopathic osteosclerosis (IO) in a baseline sample and to follow the patients through an extended period of time.

METHODOLOGY

The sample consisted of 210 patients treated in a dental school and having a complete series of intraoral radiographs at the time of treatment and at a follow-up 10-17 years later. A further 10 years later, 130 patients had another follow-up.

RESULTS

Sixteen of the 210 patients were found to have IO, mostly in the mandibular molar and premolar regions. Fourteen had one lesion, one had two lesions and one had three lesions. The mean age of these patients was 47 years as compared to 44 years for the rest of the patient group. No sex predilection was found. At the first follow-up, one lesion had disappeared, one had reduced in size and one new lesion appeared. At the second follow-up, eight patients with IO could be re-examined. Two lesions, unchanged at the first follow-up, had reduced in size and two new lesions appeared. In the area of the new lesions, residual roots were observed in the earlier radiographs.

CONCLUSION

Our findings support the theory that IO lesions should be considered anatomical variants. In some cases, however, a local aetiological agent may cause development of structures with an identical appearance.

Periapical changes following root-canal treatment observed 20-27 years postoperatively

AIM

The aim of the present study was to identify periapical changes 20-27 years after root-canal treatment.

METHODOLOGY

The periapical condition of 265 roots filled by undergraduate students was evaluated in two series of intraoral radiographs taken 10-17 and 20-27 years after treatment. Roots (72) not recorded with a normal periapical situation on both occasions by two observers, were re-evaluated by other two examiners, separately and jointly. Final decisions about diagnoses were made by all four examiners. A strict definition was used for the identification of cases with an unfavourable outcome.

RESULTS

Favourable outcomes were observed in 6.4% of the roots that had radiolucencies at the 10-17-year follow-up. Periapical radiolucencies after 20-27 years appeared in 1.5% of all other roots. The radiographic failure frequency for the total material was 4.9%. The percentage of cases with normal periapical findings at the final follow-up was 86.4%, whilst 8.7% were recorded with increased width of the apical periodontal space. Delayed healing owing to surplus root-filling material explained nearly all of the cases with favourable outcome assessed many years after treatment.

CONCLUSIONS

Late periapical changes, with more successes than failures, were recorded when a 10-17-year follow-up period after root-canal treatment was extended for another 10 years.

Diagnosing periapical lesions--disagreement and borderline cases

AIM

The aim of this paper is to present a selection of disagreement and borderline cases from a methodological study on the radiographic diagnosis of periapical disease.

METHODOLOGY

Thirty-two roots, 12% of the material in an earlier study, were subjected to joint discussion because of diagnostic problems. The aim was consensus. Six cases representing different teeth/roots illustrating typical problems are presented.

RESULTS

The varying morphology of apical areas and varying density of surrounding bone present a number of challenges. Even so, the joint discussion resulted in an agreement for all the cases. Twenty-five diagnoses were established and seven cases were not diagnosed owing to substandard radiographs.

CONCLUSION

A detailed analysis of the periodontal ligament space, the lamina dura, trabecular pattern and bone marrow spaces is mandatory for the radiographic diagnosis of periapical disease

Long-term reliability and observer comparisons in the radiographic diagnosis of periapical disease

AIM

The aim of this study was to evaluate and compare the long-term diagnostic consistency of two examiners, an endodontist and a radiologist, and to make comparisons with findings recorded by an observer with more recent scientific and clinical experience in endodontics.

METHODOLOGY

Three groups, each consisting of 20 full mouth series of intraoral radiographs, with 79, 93 and 85 endodontically-treated roots, respectively, were successively evaluated for periapical disease. Evaluations were at first performed separately by the three observers. Disagreement and difficult, borderline cases were subjected to joint evaluation. Intra- and interexaminer comparisons were made. For two of the observers the observations were compared with findings recorded several years before for the same cases in the same radiographs.

RESULTS

The intra- and interobserver long-term reliability of the two original examiners resulted in 83% overall agreement, the kappa values were 0.54, 0.57 and 0.53. Comparisons between all three observers disclosed 82%, 85% and 86% agreement and kappa values 0.55, 0.58 and 0.60. The joint evaluations and decisions did not indicate a dominating influence from any of the observers.

CONCLUSIONS

The long-term reliability of the two original observers was judged as being satisfactory. All three observers judged the overall disease status of the material in the same way. The joint discussions of selected cases might reduce observer variation to an acceptable level, avoid a number of false recordings and increase the reliability and validity of the findings.

Increased frequency of cells secreting interleukin-6 and interleukin-10 in peripheral blood of patients with primary Sjögren's syndrome

Sjögren's syndrome (SS) is a chronic autoimmune disease of exocrine glands. There is increasing evidence that interferon-gamma (IFN-gamma) plays a role in the pathogenesis of SS. It has also been suggested that other type 1 cytokines, as well as interleukin-6 (IL-6), IL-10 and transforming growth factor-beta, are important in the induction and/or maintenance of SS. The aim of this study was to investigate the type 1/type 2 cytokine pattern in peripheral blood of primary SS patients. The enzyme-linked immunospot (ELISPOT) assay was performed to quantify the number of mononuclear cells (MNC) secreting IFN-gamma, IL-6 and IL-10 in peripheral blood samples from 33 patients with primary SS and 12 healthy controls. The mean number of cells secreting IFN-gamma was 9/105 MNC in the SS patient group, and 4/105 MNC in the control group (P = 0.73). Fifteen of the SS patients had anti-Ro 52 kDa antibodies in serum. In this patient group the mean number of cells secreting IFN-gamma was 4/105 MNC, while in the patient group without such antibodies the mean number of cells secreting IFN-gamma was 14/105 MNC (P = 0.04). The mean number of cells secreting IL-6 was 12 000/105 MNC in the SS patient group, and 5000/105 MNC in the control group (P = 0.01). The mean number of cells secreting IL-10 was 270/105 MNC in the SS patient group, and 180/105 MNC in the control group (P = 0.04). The SS patients had a significantly higher number of cells secreting IL-6 and IL-10 in peripheral blood than the healthy controls, which may facilitate B-cell activation and production of autoantibodies.

Stability after Le Fort I osteotomy in cleft lip and palate patients

Le Fort I osteotomies were performed in 20 patients with cleft lip and palate as a one-segment movement, and the fragments were fixed with miniplates without bone grafting. Tracings of preoperative and serial postoperative lateral cephalograms were used to determine changes in maxillary position. The posterior nasal spine, not subjected to extensive changes during surgical procedures and remodeling, was found to be the most reliable landmark for measuring maxillary advancement and stability. The mean maxillary advancement was 5.96 mm. Analysis did not reveal significant changes in linear and angular measurements from immediately postoperative to 6 months postoperative. A modest maxillary advancement by Le Fort I osteotomy, along with alleviation of palatal scar tissue tension and miniplate fixation, is a stable surgical method in patients with cleft lip and palate.

Ro/SS-A-reactive B lymphocytes in salivary glands and peripheral blood of patients with Sjögren's syndrome

The aim of this study was to investigate the production of anti-Ro/SS-A antibodies in labial salivary glands (LSG) and peripheral blood (PB) of Sjögren's syndrome (SS) patients. The ELISPOT method was performed to quantify the frequency of LSG lymphocytes and PB lymphocytes spontaneously secreting anti-Ro/SS-A antibodies. The total number of IgG-, IgA- and IgM-producing cells was also quantified. The bovine Ro 60-kD protein was used as target antigen. Six of six primary SS patients had LSG B cells producing anti-bovine Ro 60 kD of the IgG isotype, and two of two primary SS patients had in addition PB lymphocytes producing anti-bovine Ro 60 kD of the IgG isotype. The six patients who had IgG antibodies against the Ro/SS-A antigen in LSG all had focus scores of >/= 7 in biopsies of LSG. The results indicate that SS patients with a high degree of local inflammation in LSG have B cells producing anti-Ro/SS-A antibodies in both LSG and PB. Thus, the anti-Ro/SS-A antibodies may have pathogenic importance in the progression of the exocrinopathy of SS.

Ro/SS-A- and La/SS-B-reactive B lymphocytes in peripheral blood of patients with Sjögren's syndrome

The aim of this study was to investigate the production of anti-Ro/SS-A and anti-La/SS-B antibodies in peripheral blood (PB) of patients with Sjögren's syndrome (SS). The ELISPOT method was performed to quantify the frequency of PB lymphocytes spontaneously secreting anti-Ro/SS-A and/or anti-La/SS-B antibodies. The total number of IgG-, IgA- and IgM-producing cells was also quantified. The recombinant Ro 52-kD, Ro 60-kD and La 48-kD proteins were used as target antigens. Three of 18 SS patients had PB lymphocytes secreting IgG antibodies against the recombinant Ro 52-kD protein. The same three patients had high serum titres of anti-Ro 52-kD antibodies. In addition, these patients were classified as having severe disease, and all three had focus scores of >/= 8 in biopsies of the labial salivary glands (LSG). The correlation between the number of PB cells producing IgG antibodies against the recombinant Ro 52-kD protein and the focus score was significant (P < 0.01). The results indicate that only SS patients with severe disease and high degree of local inflammation in LSG have B cells producing anti-Ro/SS-A antibodies in PB. Thus, most of the spontaneous autoantibody production must take place in other body compartments, e.g. in exocrine glands and probably also in the lymphoid organs and/or other mucosal sites.

Periapical radiolucencies as evaluated by bisecting-angle and paralleling radiographic techniques

Two groups of patients were included in the study. The first group consisted of patients who received root canal treatment of single-rooted teeth (n = 63). The completed roof fillings were exposed to two different radiographic techniques, the paralleling and the bisecting-angle technique. The second group consisted of 1-year review radiographs of patients who had received apicectomies of single-rooted teeth (n = 105). Three observers examined the radiographic images. First, they were asked to identify teeth with a normal apical condition and those with an apical radiolucency. Thereafter pairs of radiographs were compared; cases judged as normal by all observers were excluded. The observers were now asked to ascertain whether the apical radiolucency was largest in the first image, the apical radiolucency was largest in the second picture or both radiolucencies were the same size. Both intraobserver and interobserver agreement, calculated as Cohen's kappa, was high with respect to the presence of lesions within both samples and it was at the same level for both radiographic techniques. The evaluation of the size of the lesions proved to be more inconsistent. Kappa values were in the range 0.38-0.71 for intraobserver comparisons and in the range 0.25-0.48 for interobserver comparisons. No significant difference was found between the size of lesions as recorded by the two techniques (P > 0.05). It is concluded that, when correctly adjusted the bisecting-angle technique and the paralleling technique provide similar diagnostic results.

Craniofacial morphology in young patients with Turner syndrome

The craniofacial morphology of 33 Turner syndrome patients, aged 7-16.7 years, was evaluated by standard cephalometric methods. The sample was subdivided according to karyotype and 72 normal girls aged 7.1-16.1 years served as controls. The size of the calvarium and face was generally smaller in the Turner group than in the controls. The morphology was characterized by a flattened cranial base angle, a marked reduction in posterior cranial base length, facial retrognathism and short and posteriorly rotated jaws. The same morphological pattern was found in all the karyotypes, but the deviations were most pronounced in monosomy X (45X) patients. The results indicate that a deviating pattern of craniofacial size and morphology has already been established in childhood. It is suggested that the deviations originate in the fetal period, when the primary cartilages form the craniofacial skeleton.

Incomplete healing (scar tissue) after periapical surgery--radiographic findings 8 to 12 years after treatment

Twenty-four cases treated by periapical surgery--which 2 to 6 yr after surgery were classified radiographically as incomplete healings (scar tissue)--were further followed, extending the observation period to 8 to 12 yr. One case healed completely, 1 failed, and 22 were still recorded in the same healing group. All the 22 scar tissue cases were characterized by a reduction of the defect in bone. In 13 cases, continuous periodontal structures were seen and the defect thereby separated from the root. The findings support the conclusion that cases clearly showing features of incomplete healing (scar tissue) at the regular follow-up 1 yr after surgery can be regarded as successes. They need not be recorded for further systematic control. A general follow-up program for apicectomy cases is suggested.

Occlusal morphology in Turner syndrome

The prevalence of malocclusion in 32 Turner syndrome patients, age 7-16.7 years, was investigated. The sample was subdivided according to karyotype, and 72 normal girls, aged 7.1-16.1 years, served as controls. Compared with normal girls overjet did not differ significantly while overbite was significantly reduced in 45X patients. The prevalence of distal molar occlusion, anterior and lateral open bite and lateral crossbite was significantly increased. Most significant differences were found between 45X patients and controls. Mosaic and isochromosome for the long arm of X karyotypes showed the same pattern of malocclusion, but with greater variation. No significant differences were found comparing 45X patients with mosaic and isochromosome for the long arm of X karyotypes. The results indicate that patients with structural and/or numerical aberration of the X chromosome, develop a specific pattern of malocclusion with deviations in sagittal, vertical and transversal directions.

Radiopacity of glass ionomer materials

To facilitate the detection of overhangs and defects adjacent to a filling, restorative materials should have a radiographic density higher than or at least similar to that of enamel. In the present study the density of 21 glass ionomer materials was measured and compared with the density of enamel, dentine, amalgam and aluminium. Most materials were more radiopaque than enamel, thereby satisfying the requirements as proposed by several investigators. The materials with lower density were mainly types intended for use in anterior teeth where the entire filling can more easily be examined clinically. They should not be used as a base under approximal fillings in order to avoid a false positive diagnosis of recurrent caries.

Root length, crown height, and root morphology in Turner syndrome

Root length, crown height, and root morphology were studied on intraoral and panoramic radiographs in 33 Turner syndrome patients aged 7.0-16.7 years, subdivided on the basis of karyotype. Thirty-three normal girls aged 10.2-16.4 years served as controls. In the 45X patients and, with the exception of a few teeth, also in the isochromosome and mosaic karyotypes, root length and crown height of incisors, canines, and premolars were significantly reduced. Some teeth showed altered crown-root proportions. Maxillary first premolars showed a significantly increased number of two-rooted and three-rooted variants. Mandibular premolars and molars had a complex root morphology, and a classification system was established including four premolar and six molar root types. Premolars had a significantly increased number of root components. Some of the variants, such as a molar-like second premolar, are apparently specific for these patients. On several first molars a radix entomolaris was identified. Two separate mesial and one or two separate distal roots were also frequently seen. Our investigation demonstrates that X-chromosome deficiency influences root formation.

Radiographic simulation of a periapical lesion comparing the paralleling and the bisecting-angle techniques

Sixty apical areas of single-rooted teeth were examined in this study. A simulated periapical lesion was produced using an acrylic sphere (diameter 2.0 mm), the surface of which was covered with a thin layer of zinc cement. The sphere was placed in close contact with the apical foramen using a thin orthodontic wire inserted into the apical portion of the root canal. The correctly adjusted parallel projection depicted the simulated lesion with a very low degree of error. Overangulation of the central beam with maintenance of parallelism between tooth and film resulted in a moderate degree of magnification. When correctly adjusted, the bisecting-angle technique produced images with almost the same accuracy as the paralleling technique. Over-angulation resulted in most images showing a reduced size of the simulated lesion. Moderate under-angulation most often recorded the correct dimension of the globe. In some cases a magnified image of the sphere was produced. Generally, this was associated with a palatally curved root. The investigation thus clearly indicated that the paralleling technique provides the most reliable information about the extent of a pathological process.

Tooth crown size and morphology in Turner syndrome

The aims of this investigation were to analyze permanent tooth crown size and morphology and to perform symmetry analysis between corresponding teeth on the right and the left side. The material comprised 32 Turner syndrome patients aged 7-16.7 years. As controls served 33 normal girls 10.2-16.7 years old. The mesiodistal diameter was significantly reduced for every tooth measured except for the maxillary canine. The buccolingual dimension was reduced only for some teeth. Eleven morphologic traits were defined. Ten of these were identified in the Turner patients; seven occurred in the controls as well, but at a lower frequency. Some of the traits have not been described earlier for this group of patients. There was a significant difference between Turner and control patients both in the number of patients with bilateral tooth asymmetries and in the number of corresponding tooth pairs in the maxilla with bilateral asymmetry. No significant differences were found between the 45X patients and the other karyotypes. Maxillary central incisors showed a surprisingly high relative frequency (38.5%) of bilateral asymmetry.

Detection of mineral loss in approximal enamel by subtraction radiography

The purpose of the present study was to determine whether digital subtraction radiography will improve detectability of small, mechanically prepared defects within dental enamel. Lesions with an extent of 1 mm in vertical direction and representing 5% to 10% mineral loss in the direction of the x-ray beam were prepared in eight extracted molars. Radiographs of teeth with defects were subtracted from radiographs taken before the lesions were prepared. Seven observers evaluated the images using a five-point confidence rating scale (receiver operating characteristic technique). Examination of the original radiographs showed increasing accuracy of radiographic interpretation with increasing mineral loss as judged from the areas beneath the receiver operating characteristic curves. The same observation was made using subtraction images with and without contrast enhancement. There was no indication that subtracted images provided better diagnostic validity than the original radiographs. In conclusion, subtraction images do not seem to improve the diagnosis of well-defined lesions within dental enamel.

Digital subtraction radiography after stannous fluoride treatment for occlusal caries diagnosis

The material in this study consisted of 38 fully erupted, extracted third molars without clinical cavitation in the occlusal surface. A radiograph was made of each tooth before and after 5, 10, and 20 minutes of stannous fluoride treatment. The radiographs were digitized and subtraction performed between the images obtained after stannous fluoride treatment and the pretreatment image. Two observers assessed the stannous fluoride treated radiographic and the subtraction images on a monitor: 0 = no change, 1 = intensity increase (white area interpreted as a carious lesion) in dentinoenamel area. Caries was assessed on conventional film radiographs made before treatment: 0 = no caries in dentin, 1 = caries in dentin. The presence of caries in dentin was validated histologically. Sensitivity for intensity increase as a sign of caries was overall higher for the subtraction images based on 20-minute treatment than for the radiographic images (0.025 > p > 0.01) but not significantly higher than for the conventional radiographs. However, neither observer gave false-positive scorings in the subtraction images, whereas observer 1 had five false-positive scorings on the conventional films. Observer 2 had none. The subtraction method did not provide a higher sensitivity for dentinal occlusal caries than conventional film radiography, but the intensity increase could be trusted more than the traditional radiolucency as a sign of a dentinal lesion.

Skeletal maturity, dental maturity, and eruption in young patients with Turner syndrome

A major problem for patients with Turner syndrome is their small body height. The rapid biotechnologic development has now made treatment with growth hormone possible at a larger scale. The aim of this investigation was to evaluate skeletal maturity, dental maturity, and eruption in a group of young patients before hormone therapy. The material comprised 33 patients aged 7-16.7 years. The skeletal maturity, as judged from hand radiographs, was on an average 2.3 years retarded (p < 0.001) and showed increasing retardation with increasing age. The dental maturity, assessed from the formation stages of the permanent teeth on panoramic radiographs, was accelerated, with a mean value of 1 year (p < 0.001). The timing of clinical eruption did not differ significantly from that of our reference material; the Turner girls were on an average 3.7 months ahead. Several patients had local eruption problems, especially in the maxillary lateral segments. It is suggested that disharmony between tooth size and arch size may contribute to this problem.

Follow-up after periapical surgery: the value of the one-year control

A total of 474 teeth treated with periapical surgery were examined after one year. Complete healing was unequivocally demonstrated for 250 teeth. Two hundred and fourteen teeth were scheduled for further follow-up, and of these, 194 (91%) could be followed until a stable situation was recorded. Of 41 cases judged as completely healed after one year, but with initial observer disagreement, only 2 (5%) failed later. The 76 cases showing incomplete healing (scars) after one year with few exceptions ended as completely healed or persisted as incomplete healings. The uncertain group (n = 72) was equally re-distributed as successes (completely or incompletely healed) or failures at the end control. Five cases showing no healing after one year all ended as failures. Based on these findings it is concluded that the one-year control will provide a valid diagnosis for the majority of cases. Only a minor number, the uncertain healings, need further follow-up.

Surgical management of endodontic failures: indications and treatment results

Two-hundred and twenty-four teeth with failures after conventional endodontic treatment were treated by periapical surgery by one surgeon and followed up for 1-8 years. Indications for surgery were: inaccessibility to the apical part of the root by a coronal approach due to posts, calcifications or procedural accidents. Cysts, a few acute cases and wide-open apices were also treated surgically. Healing was judged radiographically and classified into one of four healing groups: (1) complete healing, (2) incomplete healing (scar tissue); (3) uncertain healing, and (4) unsatisfactory healing. The grouping was performed separately by the oral surgeon and an endodontist. Deviating cases were then evaluated jointly, difficult cases and borderline cases were judged by an oral radiologist. Complete healing was observed for 76.6 per cent and incomplete healing (scar tissue) for 8.1 per cent of the teeth. The size of the latter group was strongly influenced by the number of cases with large preoperative rarefaction. A success/failure grouping of the material (success = complete and incomplete healing) revealed that 27 per cent of the retrofilled cases failed compared with 3.6 per cent in the orthograde group. The main conclusion is that retrofills should be avoided whenever possible.

Periapical surgery in a Norwegian county hospital: follow-up findings of 477 teeth

Four-hundred seventy-seven teeth treated by periapical surgery by one surgeon were followed up until a stable radiographic situation was recorded. Radiographic findings were classified into one of four groups: 1, complete healing; 2, incomplete healing (scar tissue); 3, uncertain healing; or 4, unsatisfactory healing. Evaluation was performed independently by an endodontist and the oral surgeon and cases of disagreement were subjected to joint evaluation. Difficult cases and borderline cases were judged by an oral radiologist. Complete healing was observed for 78% and incomplete healings (scar tissue) for 9% of the teeth. The size of the latter group was strongly influenced by the number of cases with large preoperative lesions. When the material was grouped as "success" (complete healing, scar tissue healing) and "failure" (uncertain healing, unsatisfactory healing), a 13% failure frequency was recorded. Twenty-eight percent of the cases treated with retrograde fills failed compared with 4% in the orthograde group.

Visualization of stannous fluoride treatment of carious lesions by subtraction radiography

To determine whether treatment with SnF2 results in changes in radiographic density, eight extracted teeth with lesions confined to the enamel and five with lesions extending into the dentin were radiographed before and after treatment with a 10% SnF2 solution. Although visual comparison of pretreatment and post-treatment radiographs showed increased density in some areas where the pretreatment radiographs had shown demineralization and unchanged conditions in other instances, subtraction images of these radiographs revealed density increase in all the demineralized areas. Even in cases with white spot lesion not visible on radiographs, the subtraction images disclosed an increase in radiographic density.

A clinical and roentgenological study of 55 cases of root perforation

The treatment outcome of 55 root perforations in man were related to pretreatment conditions and various treatment procedures used, with a mean recall period of 3 years 5 months. In this study maxillary teeth were perforated three times more often (74.5 per cent) than mandibular teeth (25.5 per cent); 47 per cent of the perforations were due to endodontic and 53 per cent due to prosthodontic treatment. The buccal and mesial root surfaces as well as the midroot areas were most often perforated. In 25 per cent, radiographic changes were directly related to the perforated areas. Twenty-eight perforations were repaired by orthograde fillings with gutta-percha and Kloro-percha N-phi; eight received a combined orthograde and surgical repair, and in only three cases a surgical approach was used. Four cases received no treatment but were recalled, and twelve perforations showed a size and location hopeless for repair; the teeth were therefore extracted. Five failures of the primary orthograde treatment group later underwent surgical treatment and were followed up for 3 years 3 months. The overall success rate in the primary treatment group of teeth was 56 per cent while 36 per cent became failures. Five failures were retreated, and four of these became successful. A combined orthograde and surgical repair of the perforations provided the most favourable outcome with 92 per cent successful. The study stresses the importance of preventing this type of treatment complication.

Clinical recommendations for the use of D-speed film, E-speed film, and xeroradiography

This article assesses the diagnostic utility, radiation dose, equipment reliability, patient acceptance, and costs associated with D-speed film, E-speed film, and dental xeroradiographs for intraoral imaging. From the analysis and review of laboratory studies and clinical trials, conclusions and recommendations are offered.

Observer strategy and the radiographic classification of healing after endodontic surgery

An observer strategy involving trained and experienced examiners was used in a large series of endodontic surgery cases, evaluated radiographically 1 year after the operation. The cases were grouped in 1 of the following 4 healing groups; complete healing, incomplete healing (scar tissue), uncertain healing and unsatisfactory healing (failures). The radiographs were first examined separately by an oral surgeon and an endodontist. Deviating cases were subjected to joint evaluation. The overall agreement before joint interpretation was satisfactory: 63% when corrected for chance agreement. Agreement after joint evaluation reached 94% of the total material. Disagreement and difficult borderline cases were judged by an oral radiologist. He was more pessimistic than the 2 main examiners. The identification of healed cases with apical bone which had not yet obtained normal radiopacity and structure was difficult. Altogether, the observer consistency was satisfactory; the selection of experts increased the chances of "true" diagnoses; the important screening function of the one-year control was confirmed. The applied strategy and the classification are recommended for follow-up studies.

Overextended gutta-percha and Kloroperka N-O root canal fillings. Radiographic findings after 10-17 years

A representative sample, 55%, of the patients treated endodontically by undergraduate students in a teaching clinic during the years 1963 to 1969 were reexamined 10-17 years later. Gutta-percha/Kloroperka-NO root fillings (282), classified as having surplus material at the time of treatment, were evaluated in follow-up radiographs. In about 80% of the cases of overfilling, no excess root filling material could be traced at the reexamination. In a few cases only, the appearance of the excess material was nearly identical to that at the time of treatment, whereas the remaining overfillings (18%) showed a reduced size. Among the recorded variables only one seemed to have a major impact on the prognosis--namely, the presence or absence of an apical radiolucency at the time of treatment, indicating that infection was the important factor when failures occurred. Apical overfilling per se had little influence on the long-term healing result as judged radiographically.

Number of teeth and tooth loss of former dental school patients. Follow-up study after 10-17 years

Persons (n = 431) who had received endodontic and other treatment at the School of Dentistry in Bergen in the 1960s were invited to attend an examination in 1980, some 10-17 years after their first course of treatment. The age range initially had been 16-55 years. The attendance rate was 55% (149 women and 89 men) and was higher for the older age groups. Data from pre- and post-treatment records were added to the information obtained in 1980. Those who attended in 1980 had had 22.8 teeth at the initial examination and 21.2 teeth after their first course of treatment in the 1960s. In 1980 they had 19.3 teeth. About 20% of the persons had the same number of teeth at all three examinations, and 43% had not lost teeth after completing treatment at the school. Molars and maxillary teeth were most likely to have been extracted. This was also the case for teeth lost during the first course of treatment. Some 4% of the individuals had become edentulous. Conventional dental treatment had not prevented further tooth loss; the number of remaining teeth within each age group was about the same in 1980 as in the 1960s.

The effect of a NaF solution and a fluoride varnish on the acid resistance of root dentin

Sectioned root dentin surfaces were treated with either a NaF solution for 10 min or a fluoride varnish for 48 h and then exposed to 1 M acetate buffer pH 5.8 for 20 h. Microradiographs of non-fluoride treated specimens (controls) regularly showed a partially demineralized zone extending from the surface. The NaF-treated specimens exhibited a lesion with alternating radiopaque and radiolucent zones, which had a mean total depth equal to that of the controls. The varnish-treated specimens showed a demineralized zone which was significantly less deep than those observed in the two other groups. Elemental analyses performed by an electron microprobe showed a positive correlation between the amount of F incorporated and the acid resistance of the tissue.

Dental findings in patients with Aarskog syndrome

Dental manifestations of the Aarskog syndrome were studied in 10 individuals. There was retarded development and eruption of the permanent teeth in six boys. Dental age was less retarded than height age and bone age. The prevalence of hypodontia and the prevalence and degree of orthodontic anomalies were higher than in the general population. Caries prevalence was high.

Radiopaque zones in the dentin beneath silicate fillings analyzed by electron microprobe

Seven teeth which showed radiopaque zones beneath silicate fillings were sectioned and studied by microradiography and electron microprobe analysis in order to elucidate which elements were responsible for the increased absorption of X-rays and whether the presence of carious lesions could be masked by foreign elements in the tissue. The Ca concentration was frequently found to be either slightly increased or reduced compared with radiographically unaltered dentin. Increased concentrations of F and Zn occurred in the radiopaque zones. The highest F concentrations (0.4--1%) were recorded in zones with an increased Ca content. The highest Zn concentrations (5--8%) were found in the three specimens having a reduced Ca content. The possible conditions responsible for the increased Ca, F and Zn concentrations are discussed. The results indicate that both Ca and Zn may contribute to the increased absorption of X-rays. The hypothesis that carious dentin may be obscured in intraoral radiographs by the presence of foreign elements in the tissue, was not substantiated.

May fast screen-film combinations be used for cephalometry?

Five fast screen-film combinations were tested and compared with a conventional high-definition system. A phantom head was radiographed using different tube voltages. One linear distance and four angles were measured on films with the same density. All the combinations were subjectively judged to be qualitatively inferior to the reference system. The loss in definition had little influence on the reliability of the cephalometric measurements as estimated from duplicate readings on identical films. The exposure required to obtain adequate film density was low, especially for the systems based on salts of rare earth metals.

Electron probe microanalysis of secondary carious lesions adjacent to silicate fillings

Secondary caries associated with silicate fillings is characterized by lesions at the tooth surface and lesions of the cavity wall. The mineral content of the cavity wall lesions and the penetration of elements originating from the silicate fillings were studied in experimental in vitro and in vivo lesions as well as in natural carious lesions. Dentine wall lesions, where microradiographs had shown increased radiopacity relative to intact tissue, exhibited increased Ca and P values. Elements derived from the silicate fillings were regularly found in enamel and dentine. The concentrations of fluorine (F) and of zinc (Zn) amounted to 2-3% by weight close to the cavity wall and decreased gradually to less than 0.1% at depths of 600 mum and 400 mum, respectively, from the cavity. Aluminum (Al) most often occurred in a 20-40 mum-wide zone, showing a maximum concentration of 2-3% near the cavity. Sulfur (S) was often present in the dentinal cavity walls of natural secondary caries, but not in the in vitro specimens. The findings indicate that F released from the silicate filling significantly modifies the progress of a carious lesion in the adjacent enamel and dentine. Through its tendency to form complexes with F, Al may possibly enhance the cariostatic effect of F.

Structure of enamel surface as demonstrated by absorbed electrons

The current induced by absorbed electrons in electron microprobe analysis was utilized to illustrate the surface structure of dental enamel. The electron images depicted a typical arcade or key-hole pattern on the surface of human incisors, while the surface of rat incisors was characterized by polygonal structures. Differences in electron density of the two specimen materials were observed, probably due to differences in their chemical composition. Absorbed electron images appear to be a valuable supplement to light microscopy, especially in the study of curved surfaces.

Gardner's syndrome

A 22-year-old woman had multiple osteomas of the facial skeleton that were thought to represent Gardner's syndrome. At the first examination, however, other symptoms were not present. The diagnosis was established when colonic polyposis developed four years later.

The ultrastructural localization of iron in rat incisor enamel

Previous studies have shown that the pigmented surface layer of rat incisor enamel contains up to 30% iron but have left the question open as to whether iron is bound to the hydroxyapatite crystals or is present as a separate crystalline phase. Maxillary incisors from adult rats were demineralized for an extended period of time in EDTA. An insoluble membranous structure representing the remaining superficial portion of the enamel was collected and analyzed in the electron microprobe. The analyses showed that the demineralization procedure had removed calcium and phosphorus nearly completely, whereas the iron content of the surface layer had not been appreciably reduced. Electron microscopic examination of these specimens showed that the residual material contained electron-dense particles whose size, form and orientation indicated that they were remnants of the original crystal population. Several other demineralized and undemineralized specimens were also examined electron microscopically. The results indicate that iron is not present as a separate particulate phase but is, probably, bound to the surface of hydroxyapatite crystals.