Enhancing performance of berseem clover genotypes with better harvesting management through farmers' participatory research at smallholder farms in Punjab

A field study was conducted on smallholder farmer fields between 2012 to 2014 to evaluate the performance of cv. Agaitti Berseem-2002, against local landraces exchanged between farmers (LBF1) or available from local markets (LBM1). The effects of genotype and harvesting regimen on forage production, quality and seed production were evaluated. Significant differences (P < 0.05) among genotypes and cutting treatments were recorded for forage and seed yields, and forage quality across all research sites in both years. Maximum cumulative fresh forage (89.7 t/ha) and dry matter (DM; 13.4 t/ha) yields were obtained with Agaitti Berseem-2002 when harvesting occurred five times over the season. However, maximum seed yield (1048 kg/ha) with higher 1000-seed weight (3.63 g) were obtained if forage was only harvested three times and the crop then left for seed set. Agaitti Berseem-2002 also produced forage with the higher crude protein content (27%), DM digestibility (69%), digestible organic matter (DM basis; 65%) and metabolizable energy content (10%) compared to the local landraces (LBF1 and LBM1). Therefore, the harvesting regimen for greatest economic return which produced optimum fresh and DM forage yields of highest nutritive values and maximum seed yield, were comprised of taking three forage cuts (at 65, 110 and 150 days after sowing) prior to seed harvest.

Displaced intracapsular neck of femur fractures in the elderly: bipolar hemiarthroplasty may be the treatment of choice; a case control study

Management of the mobile elderly patient who sustains an intra-capsular neck of femur fracture remains controversial. Current evidence is mixed as to whether total hip arthroplasty (THA), which confers higher surgical and dislocation risk, is significantly superior in function and in reduced rates of reoperation when compared to bipolar hemi-arthroplasty. A group of 110 patients with an intra-capsular NOF fracture who had undergone either THA or Bipolar hemi-arthroplasty and were still alive at the time of follow up were retrospectively identified and matched using the National Hip Fracture Database. Matching criteria included ASA, age, sex, pre-op mobility, pre-op AMTS and source of admission. Follow up was by postal questionnaire. Mean follow up was 24 months in both groups (Range; Bipolar 12-36 months, THA 12-38 months). There was no significant difference in pre-operative Tonnis grade, postoperative Oxford Hip Score (OHS) or Short Form 36 (SF-36) scores between the two groups. 12 dislocations in 5 patients occurred in the THA group and none in the bipolar group. 33/55 Bipolar patients were discharged to their own home compared to 35/55 in the THA group. None of the bipolar hemi-arthroplasties were revised to THA. Higher complication rates were experienced in the THA group with no increase in function.

The Equivalence of Remote Electronic and Paper Patient Reported Outcome (PRO) Collection

Individual patient level Patient Reported Outcomes (PROs) are increasingly important in clinical practice. Web-based collection enables clinicians to remotely collect scores at regular intervals, away from the clinic setting. In this randomized crossover study, 47 patients, having undergone hip surgery, were allocated to two groups. Group 1 completed the web-based scores followed by the paper equivalents one week later; Group 2 completed the scores the other way around. The Intraclass Correlation Coefficient (ICC) for the Oxford Hip Score was 0.99, 0.98 to 0.99 (ICC, 95% CI) and the ICCs for the other scores were between 0.95 and 0.97. We conclude that remote ePRO collection using this web-based system reveals excellent equivalence to paper PRO collection of the Oxford Hip, McCarthy, UCLA and howRu scores.

Audit-induced change reduces complications of the Ganz trochanteric flip approach

INTRODUCTION

The Ganz trochanteric flip approach aims to avoid the potential risk of avascular necrosis in hip conserving surgery and may reduce the risk of femoral neck fractures, neck thinning and femoral head implant migration in hip resurfacing. Our initial audit revealed the complications of non-union and trochanteric screw irritation to be associated with this approach. We, therefore, modified our selection criteria and re-audited our results.

SUBJECTS AND METHODS

The initial audit (IA) ran between January 2003 and November 2007 after which an age limit of 50 years was recommended. The re-audit (RA) ran between November 2007 and December 2008 where one of the senior authors stopped using the approach in the over 50 year age group whilst the other senior author continued on selected patients over 50 years.

RESULTS

There were 545 hips in the IA and 152 hips in the RA group. The incidence of non-union decreased in the RA after the change of selection criteria (6.2% [IA] vs 1.3% [RA]). In both audit groups, the incidence of non-union increased with age, and in the RA no non-unions were observed under the age of 50 years. The incidence of screw irritation and the necessity for removal remained relatively unchanged (20.7% [IA] vs 28.3% [RA]) with a combined incidence of 22.4%.

CONCLUSIONS

The trochanteric flip approach to the hip can be used safely with an acceptable complication rate in young adult impingement and resurfacing surgery. Caution must, however, be exercised in patients over 50 years of age as they have a higher incidence of trochanteric non-union. In addition, all patients should be consented for the possibility of screw removal as a second procedure.

Genetic influences in the aetiology of femoroacetabular impingement: a sibling study

Femoroacetabular impingement causes pain in the hip in young adults and may predispose to the development of osteoarthritis. Genetic factors are important in the aetiology of osteoarthritis of the hip and may have a role in that of femoroacetabular impingement. We compared 96 siblings of 64 patients treated for primary impingement with a spouse control group of 77 individuals. All the subjects were screened clinically and radiologically using a standardised protocol for the presence of cam and pincer deformities and osteoarthritis. The siblings of those patients with a cam deformity had a relative risk of 2.8 of having the same deformity (66 of 160 siblings hips versus 23 of 154 control hips, p < 0.00001). The siblings of those patients with a pincer deformity had a relative risk of 2.0 of having the same deformity (43 of 116 sibling hips versus 29 of 154 control hips, p = 0.001). Bilateral deformity occurred more often in the siblings (42 of 96 siblings versus 13 of 77 control subjects, relative risk 2.6, p = 0.0002). The prevalence of clinical features in those hips with abnormal morphology was also greater in the sibling group compared with the control group (41 of 109 sibling hips versus 7 of 46 control hips, relative risk 2.5, p = 0.007). In 11 sibling hips there was grade-2 osteoarthritis according to Kellgren and Lawrence versus none in the control group (p = 0.002). Genetic influences are important in the aetiology of primary femoroacetabular impingement. This risk appears to be manifested through not only abnormal joint morphology, but also through other factors which may modulate progression of the disease.

Measurement of summer dormancy in temperate perennial pasture grasses

The search to improve drought survival in temperate perennial grasses has led to a renewed interest in summer dormancy and how to quantify it. This endogenously controlled trait, found in some temperate perennial grasses, is associated with drought that normally occurs in summer. While cessation of leaf growth and senescence of herbage occurs in all grasses in response to drought, it is under summer irrigation that these same responses are observed only in summer-dormant germplasm and hence the trait can be identified in germplasm. Across the spectrum from completely summer-dormant to non-dormant, there is a range of expression. Our objective here is to highlight differences in characteristics of indices which measure summer dormancy and to identify aspects for incorporation into a superior index for use in measuring this trait. The experimental program comprised three field trials that compared 6 cultivars and a fourth that assessed a larger group of 12 cultivars of the same three species, cocksfoot (Dactylis glomerata L.), tall fescue (Festuca arundinacea Schreb.), and phalaris (Phalaris aquatica L.). Seasonal herbage yield and foliage senescence were measured under three summer watering regimes: complete drought, mid-summer storm, and full irrigation at Mauguio, France. Different indices were calculated to compare against the approach which evaluates senescence under drought. The key outcomes are as follows. (1) The assessment of summer dormancy needs to be viewed as the plant response to a period of non-limiting water supply over summer. It makes little difference whether this is produced by full summer irrigation or a mid-summer simulated storm after a drought. Assessment of this trait under conditions of unbroken drought is discouraged because it can result in false scores. (2) The determination of summer dormancy intensity under full summer irrigation is most appropriate for the intensive study of the dynamics of dormancy expression over the entire summer. A simulated mid-summer storm within a drought gives an instantaneous view of dormancy intensity at a specific observation date and may be well adapted to the requirements of plant breeding. These methods are complementary. (3) Summer dormancy intensity can be assessed either by measuring herbage production or by a visual assessment of the level of herbage senescence. (4) An index of summer dormancy based on comparing irrigated summer herbage yield of any cultivar with that of a high, summer-yielding, non-dormant control cultivar was able to provide a reliable score of dormancy intensity. This index functions across a range of cultivars and species of perennial grasses. Further refinement of the index is needed to identify ‘standard’ high and low summer-dormant populations.

Fractures of Corin 'Taper-Fit' CDH stems used in 'cement-in-cement' revision total hip replacement

We describe two cases of fracture of Corin Taper-Fit stems used for cement-in-cement revision of congenital dysplasia of the hip. Both prostheses were implanted in patients in their 50s, with high offsets (+7.5 mm and +3.5 mm), one with a large diameter (48 mm) head and one with a constrained acetabular component. Fracture of the stems took place at nine months and three years post-operatively following low-demand activity. Both fractures occurred at the most medial of the two stem introducer holes in the neck of the prosthesis, a design feature that is unique to the Taper-Fit stem. We would urge caution in the use of these particular stems for cement-in-cement revisions.

Summer dormancy in Dactylis glomerata L.: the influence of season of sowing and a simulated mid-summer storm on two contrasting cultivars

A series of trials to increase understanding of the summer dormancy trait in Dactylis glomerata was conducted. Autumn-sown reproductive and younger, spring-sown plants of 2 drought-resistant cultivars, contrasting for summer dormancy, were established and then tested in summer 2002 under long drought, drought + mid-summer storm, or full irrigation. The autumn-sown reproductive plants of cv. Kasbah were summer dormant under all moisture regimes and exhibited the characteristic traits including growth cessation, rapid herbage senescence, and dehydration of surviving organs (–6.7 MPa). Cultivar Kasbah used 8% less soil water over the summer and also began to rehydrate its leaf bases from conserved soil water before the drought broke. The non-dormant cv. Medly grew for 10 days longer under drought and whenever moisture was applied; Medly also responded to the storm with a decline in dehydrin expression in leaf bases, whereas no decline occurred in Kasbah, presumably because it remained dormant and therefore much drier. The irrigated, younger, spring-sown swards of cv. Kasbah had restrained growth and produced only about 25% of the herbage of cv. Medly. Drought reduced activity and growth of young plants of both cultivars, but whereas Medly regrew in response to the storm, cv. Kasbah did not, indicating that dormancy, although only partially expressed after spring sowing, was reinforced by summer drought. A longer drought in 2003 caused a 22% loss of the basal cover in cv. Medly, whereas Kasbah fully maintained its sward and therefore produced a higher post-drought autumn yield. This work confirms summer dormancy as a powerful trait for improving persistence over long, dry summers.

Summer dormancy in Festuca arundinacea Schreb.; the influence of season of sowing and a simulated mid-summer storm on two contrasting cultivars

Due to the shortage of information on summer dormancy in tall fescue (Festuca arundinacea, syn. Lolium arundinaceum), we tested the response of 2 cultivars of differing dormancy expression and growth stage to a range of summer moisture conditions, including full irrigation, drought, and a simulated mid-summer storm and analysed whether traits associated with summer dormancy conferred better survival under severe field drought. Autumn-sown reproductive and younger, spring-sown plants of 2 cultivars, claimed to exhibit contrasting summer dormancy, were established and then tested in summer 2002 under either long drought, drought + simulated mid-summer storm, or full irrigation. The autumn-sown reproductive plants of cv. Flecha exhibited traits that can be associated with partial summer dormancy since under summer irrigation they reduced aerial growth significantly and exhibited earlier herbage senescence. Moreover, cv. Flecha used 35% less soil water over the first summer. However, the water status of leaf bases of young vegetative tillers of both cultivars was similar under irrigation and also throughout most of the drought (leaf potential and water content maintained over –4 MPa and at approx. 1 g H2O/g DM, respectively). The summer-active cv. Demeter did not stop leaf elongation even in drought and produced twice as much biomass as Flecha under irrigation. Cultivar Demeter responded to the simulated storm with a decline in dehydrin expression in leaf bases, whereas no decline occurred in Flecha, presumably because it remained partially dormant. The younger, spring-sown swards of both cultivars had similar biomass production under summer irrigation but whereas Demeter regrew in response to the simulated storm, cv. Flecha did not, indicating that dormancy, although only partially expressed, was reinforced by summer drought. In all trials, cv. Flecha out-yielded Demeter in autumn regrowth. In particular, the severe drought in 2003 caused a 25% loss of the basal cover in cv. Demeter, whereas Flecha fully maintained its sward allowing it to produce a higher post-drought autumn yield. This work links summer dormancy with higher persistence over long, dry summers.

Seasonal patterns of growth, dehydrins and water-soluble carbohydrates in genotypes of Dactylis glomerata varying in summer dormancy

BACKGROUND AND AIMS

Summer dormancy in perennial grasses has been studied inadequately, despite its potential to enhance plant survival and persistence in Mediterranean areas. The aim of the present work was to characterize summer dormancy and dehydration tolerance in two cultivars of Dactylis glomerata (dormant 'Kasbah', non-dormant 'Oasis') and their hybrid using physiological indicators associated with these traits.

METHODS

Dehydration tolerance was assessed in a glasshouse experiment, while seasonal metabolic changes which produce putative protectants for drought, such as carbohydrates and dehydrins that might be associated with summer dormancy, were analysed in the field.

KEY RESULTS

The genotypes differed in their ability to survive increasing soil water deficit: lethal soil water potential (Psi(s)) was -3.4 MPa for 'Kasbah' (although non-dormant), -1.3 MPa for 'Oasis', and -1.6 MPa for their hybrid. In contrast, lethal water content of apices was similar for all genotypes (approx. 0.45 g H(2)O g d. wt(-1)), and hence the greater survival of 'Kasbah' can be ascribed to better drought avoidance rather than dehydration tolerance. In autumn-sown plants, 'Kasbah' had greatest dormancy, the hybrid was intermediate and 'Oasis' had none. The more dormant the genotype, the lower the metabolic activity during summer, and the earlier the activity declined in spring. Decreased monosaccharide content was an early indicator of dormancy induction. Accumulation of dehydrins did not correlate with stress tolerance, but dehydrin content was a function of the water status of the tissues, irrespective of the soil moisture. A protein of approx. 55 kDa occurred in leaf bases of the most dormant cultivar even in winter.

CONCLUSIONS

Drought avoidance and summer dormancy are correlated but can be independently expressed. These traits are heritable, allowing selection in breeding programmes.

Identification of superior native and introduced grasses for low-input pastures in temperate Australia

This paper is the fifth in a series describing trials evaluating native and introduced grasses at eight locations across temperate Australia. In these trials, 62 perennial grass lines were assessed for herbage production, survival and recruitment under low fertiliser conditions using spaced plants produced in glass houses and transplanted into the field. Sites were grouped into three different climatic zones: Eastern Australian permanent pasture, Eastern Australian mixed farming and Mediterranean zone. For each of these zones, superior lines were identified and their potential use in permanent pastures or mixed farming discussed. Among the C3 grasses tested, several lines of Dactylis glomerata from France on the Mediterranean coast near the Spanish border and from north-west maritime France proved to be superior lines in all zones and were better than the standard comparator cv. Currie with regard to the attributes assessed. In general, the D. glomerata lines were superior to the C3 native species except with respect to survival and recruitment. The C4 introduced standard comparator Eragrostis curvula cv. Consol was outstanding with regard to its herbage production and survival in all climatic zones, although its recruitment was generally low. Native C4 lines of Themeda australis and Paspalidium jubiflorum yielded well in all climatic zones, and even produced more herbage than Consol in one zone. Survival rates of T. australis and P. jubiflorum were also very high but recruitment was low under the conditions of the trial. In mixed pastures C4 grasses may reduce fluctuations in feed supply as well as increase water use. As a consequence mixtures of superior C3 and C4 lines identified in this study are likely to be suitable for pastures on infertile soils and in zones subjected to continuous or periodic drought. Further work on the behaviour of these superior lines under sward conditions in association with forage legumes and their responses to grazing is needed; however, for the promising native lines, sward trials are not possible until suitable technology for commercial seed production and broad acre establishment of these lines has been developed.

Evaluation of native and introduced grasses for low-input pastures in temperate Australia: experimental approach, site and genotype descriptions

This paper describes the experimental methodology, sites, seasonal conditions and germplasm used in the Australian Native and Low Input Grass Network (NLIGN). In 1998, eight sites were established across the temperate pastoral zone of southern Australia. These were located at Armidale, Binya, Sutton and Trangie in NSW; Springhurst in Victoria; Jericho in Tasmania; Flaxley in South Australie and Kendenup in Western Australia. A total of 62 lines were evaluated, of which, 29 were Australian native grasses and 33 were introduced. With differences in seed size among species and a lack of information on dormancy and germination characteristics of the native plants, seedlings were transplanted into the field on weed-mat as spaced plants. Lines were compared over a 3-year period from 1998 to 2001. Methods used for determination of forage production, persistence and palatability are described. Information detailing the original collection sites of the germplasm, a list of NLIGN sites where each genotype was evaluated, as well as a detailed description of sites and seasonal conditions is also presented.

Performance of native and introduced grasses for low-input pastures. 2. Herbage production

A total of 62 perennial grasses were evaluated for herbage production under low-fertiliser conditions at eight sites in the temperate zone of southern Australia from 1999 to 2001. A brief assessment of relative preference ranking by sheep was also made at the end of the experimental period. Four sites were in the high rainfall areas of south-east Australia, two in the drier mixed farming areas of western NSW, and two sites in Mediterranean southern Australia. Seven standard cultivars were included in the comparisons. Plants were grown from seed in glasshouses and transplanted to the field as spaced plants at 6–8 weeks age. Plants were harvested at irregular intervals by clipping to determine herbage production. Relative preference was determined by enclosing sheep in the experimental area at high stocking rates and estimating the amount of herbage grazed after 1, 3 and 5 days. Herbage production data were analysed using a multi-environment trial approach in which the environments comprised all combinations of sites and sampling times over the 3-year period. Overall, 73.6% of the total genetic variation for herbage production was accounted for. Average seasonal comparisons revealed good herbage production from Eragrostis curvula cv. Consol in both winter and summer, but in spring, several Dactylis glomerata lines were the most productive. Consol was not generally preferred by sheep, while D. glomerata lines were. Apart from cv. Consol, C4 species, including Bothriochloa macra, Chloris truncata, Enteropogon acicularis and Dichanthium sericeum had low herbage production in winter and spring, and had low acceptability to grazing sheep. These particular grasses were also not highly ranked for production in summer, although other C4 lines, notably selections of Themeda australis, Paspalidium jubiflorum and P. constrictum were. Few native C3 grasses had superior herbage production, although selections of Elymus scaber, Austrodanthonia fulva and A. duttoniana showed good growth rates. When considering further evaluation, grasses with very high recruitment (e.g. A. caespitosa) may need to be included, and the acceptability of grasses to sheep should also be assessed.

Replacement arthroplasty in the weight-bearing shoulder of paraplegic patients

We review the early results of shoulder arthroplasty in the weight-bearing shoulder of long-term paraplegic patients. We have been unable to find previously published results of this subgroup of shoulder arthroplasty patients in the literature. Five paraplegic, female patients who had undergone shoulder arthroplasty were analyzed. All patients had been prospectively assessed with the American Shoulder and Elbow Surgeons (ASES) function score and the Constant score. The mean age at the time of surgery was 70 years. Three shoulders had full-thickness rotator cuff tears, and two were repaired at the time of shoulder arthroplasty. The mean preoperative Constant score was 30 out of 100, improving to 52 out of 100 at a mean follow-up of 30 months (range, 24-36 months). The mean preoperative ASES function score was 28 out of 55, improving to 37 out of 55. One patient was pain-free after surgery, and the mean postoperative pain score was 10 out of 15. There were no features of progressive radiolucency around the glenoid or the humeral components at last review apart from one case in which glenoid implant migration occurred. In view of the satisfactory improvement in terms of pain, mobility, and independence, we believe that it is reasonable to continue to offer this procedure to this subgroup of patients. We will, however, remain vigilant with regard to any further complications arising in these prostheses in the medium to long term as a result of increased loading.

The Johnson-Elloy (Accord) total knee replacement. Poor results at 8 to 12 years

We have found poor mid-term results in a multisurgeon series of 94 Johnson-Elloy (Accord) total knee replacements. A total of 27 knees (29%) has required revision, in 26 for aseptic loosening. Only 18 (19%) remain in situ, and these give poor function, are painful and most show radiological evidence of early failure. At 12 to 13 years the survival rate is 43% (confidence interval 29 to 57) with failure requiring revision as the endpoint. Proximal migration of the femoral component is associated with considerable loss of bone stock. We believe that all patients who have this implant should be recalled for regular review in order to anticipate this problem.

The Johnson-Elloy (Accord) total knee replacement

We have found poor mid-term results in a multisurgeon series of 94 Johnson-Elloy (Accord) total knee replacements. A total of 27 knees (29%) has required revision, in 26 for aseptic loosening. Only 18 (19%) remain in situ, and these give poor function, are painful and most show radiological evidence of early failure. At 12 to 13 years the survival rate is 43% (confidence interval 29 to 57) with failure requiring revision as the endpoint. Proximal migration of the femoral component is associated with considerable loss of bone stock. We believe that all patients who have this implant should be recalled for regular review in order to anticipate this problem.

Catastrophic failure of the Elite Plus total hip replacement, with a Hylamer acetabulum and Zirconia ceramic femoral head

We report catastrophic early failure of a cemented total hip replacement comprising a modular femoral component with a Zirconia ceramic head and an acetabular component of cross-linked ultra-high molecular-weight polyethylene (Hylamer). Between 1995 and 1999 we implanted 29 hips in 26 patients with a mean age of 49.2 years. Survivorship analysis in this group revealed a failure rate of 67.6% at five years. All hips which failed did so because of aseptic loosening with progressive osteolysis or radiolucencies. We therefore recommend early and regular review of all patients with this combination of implants and early revision surgery in order to avoid massive bone loss.

Catastrophic failure of the Elite Plus total hip replacement, with a Hylamer acetabulum and Zirconia ceramic femoral head

We report catastrophic early failure of a cemented total hip replacement comprising a modular femoral component with a Zirconia ceramic head and an acetabular component of cross-linked ultra-high molecular-weight polyethylene (Hylamer). Between 1995 and 1999 we implanted 29 hips in 26 patients with a mean age of 49.2 years. Survivorship analysis in this group revealed a failure rate of 67.6% at five years. All hips which failed did so because of aseptic loosening with progressive osteolysis or radiolucencies. We therefore recommend early and regular review of all patients with this combination of implants and early revision surgery in order to avoid massive bone loss.

Biologic and mechanical stability of single-tooth implants: 4- to 7-year follow-up

BACKGROUND

Single-tooth implants have been reported to achieve a high level of surgical and prosthetic success. However, close inspection of the literature reveals a paucity of data on the follow-up of single-tooth implants in function for 5 years or more. Since unsplinted implants may be considered to be subject to greater functional stresses, there is a need to report on the long-term biologic and mechanical integrity of such implant-supported restorations.

PURPOSE

To report on the long-term follow-up of single-tooth implants, restored and in function for 4 to 7 years.

MATERIALS AND METHODS

Twenty-seven Astra Tech single-tooth implants were subject to a clinical audit to evaluate implant and prosthetic success as well as response of both hard and soft tissues over a 1- to 4-year follow-up. This current report presents data on the biologic and mechanical integrity of 23 of these single-tooth implants, which have been in function for up to 7 years (mean, 63 mo). Data are provided with respect to implant survival, maintenance of marginal bone levels, soft-tissue health, and the recording of any adverse events, including prosthetic complications.

RESULTS

Only 14 implants in 13 patients were available for review, with no failures for this group of implants. One patient from the original group, who was lost to follow-up, was known to have suffered an implant failure. Furthermore, in accordance with established criteria, the remaining 13 implants that are not included in this report must at this time also be considered as potential failures. As such, the best-case scenario would be a 95.6% success rate for the 23 implants included in this review and the worst-case scenario would be a 60.8% success rate. Mean marginal bone loss measured 0.49 mm mesially and 0.76 mm distally, with a frequency of bone loss of 50%. Soft tissues were clinically healthy. There were few adverse events, with only one case of abutment screw loosening, detected at the 6-year review. In addition, crown decementation was recorded three times in two patients.

CONCLUSIONS

It can be concluded that the Astra Tech single-tooth implant can achieve long-term biologic and mechanical stability when used to restore single missing teeth, over the long-term.

Single-tooth implant-supported restorations. Planning for an aesthetic and functional solution

The single-tooth implant has found widespread support within the field of implant dentistry, with numerous studies reporting high success rates that surpass those recorded for splinted implant bridgework. Improvements in implant design, range of prosthetic components and restorative materials have made it possible to achieve optimal functional and cosmetic results. Coupled with an appropriate approach to treatment planning and patient assessment, use of the single-tooth implant may be considered a highly predictable treatment solution.

Bone classification: an objective scale of bone density using the computerized tomography scan

Dental implants are subject to masticatory loads of varying magnitude. Implant performance is closely related to load transmission at the bone-to-implant interface where bone quality will be highly variable. The type and architecture of bone is known to influence its load bearing capacity and it has been demonstrated that poorer quality bone is associated with higher failure rates. To date, bone classifications have only provided rough subjective methods for pre-operative assessment, which can prove unreliable. The results of an extensive analysis of computerized tomography scans using Simplant software (Columbia Scientific Inc., Columbia, MD, USA) demonstrate that an objective scale of bone density based on the Houndsfield scale, can be established and that there is a strong correlation between bone density value and subjective quality score (P = 0.002) as well as between the bone density score and the region of the mouth (P < 0.001).

An in vitro evaluation of the strength of a 1-piece and 2-piece conical abutment joint in implant design

The performance and maintenance of implant-supported prostheses are primarily dependent upon load transmission both at the bone-to-implant interface and within the implant-abutment-prosthesis complex. The design of the interface between components has been shown to have a profound influence on the stability of screw joints. In this in vitro evaluation, implants utilizing an internal conical joint have demonstrated a parity in resistance to bending moments at the fixture-abutment interface, when comparing a 1-piece abutment to a 2-piece abutment, which is tightened via a separate abutment screw, with mean plastic bending moments of 4176 N mm and 4049 N mm respectively. The very small values for coefficient of variance measured in both systems would confirm that whilst the size of data is small it is nonetheless a reliable indication of the relative strength of these conical joint designs.

Irrigation and suction technique to ensure reliable cement penetration for total knee arthroplasty

We describe a new technique to enhance the preparation of the cancellous bone surfaces in total knee arthroplasty using bone suction and pressure lavage irrigation. This technique provides dry bone surfaces on which to cement (which is particularly valuable if a tourniquet is not used) and improves significantly the penetration of cement into the tibial plateau as assessed on plain postoperative radiographs. We review the results of this new technique by analyzing depths of cement penetration on postoperative radiographs to assess whether this technique offers improvements in cement penetration and bone surface preparation. This technique offers a simple, quick, and reliable method of ensuring reliable cement penetration into the bony trabeculae during cemented total knee arthroplasty.

In vitro evaluation of the strength of the conical implant-to-abutment joint in two commercially available implant systems

STATEMENT OF PROBLEM

The cone-screw abutment has been shown to diminish micromovement, reducing the burden of component loosening and fracture. However, it is unclear whether the conical taper and joint design influence strength of the interface, with respect to unfavorable bending moments.

PURPOSE

This comparative study evaluated the resistance to bending for the ITI Straumann and Astra Tech ST implant systems using an 8- and 11-degree internal cone, respectively.

MATERIAL AND METHODS

Assembled units from each system were mounted in a 3-point bending apparatus. High load tests were performed, 4 mm from the joint, and bending moments necessary to induce first point of plastic deformation and ultimate failure were measured. All units were inspected to determine the critical zone of failure.

RESULTS

Bending moments necessary to induce first point of plastic deformation were considered well above that expected in clinical function for both systems. However, the critical zones of failure differed in that the solid Astra abutment deformed before the cone joint with its 11-degree taper and smooth transition into the neck of the screw, preventing screw fracture. By contrast, all ITI screws fractured at the head of the screw where it met the base of the 8-degree cone. It is unclear which aspects of the joint design were responsible for the difference observed in mode of failure or if it was a direct result of the experimental design.

CONCLUSION

For clinically relevant levels of bending moment, no problems were anticipated with respect to component failure for either system.

The nonresilient hybrid removable prosthesis: treatment of choice for the atrophic maxilla

This article presents the ments of the nonresilient hybrid removable prosthesis, which is the treatment of choice for the atrophic maxilla. The technique described may be adapted to yield a predictable outcome that provides functional and biomechanical stability that are superior to a resilient over-denture, along with a cosmetic and phonetic result that often proves superior to that of the fixed prosthesis.

Assessment of cold welding properties of the internal conical interface of two commercially available implant systems

STATEMENT OF PROBLEM

The cone-screw abutment has been shown to diminish micromovement by reducing the burden of component loosening and fracture. However, anecdotal concern for cold welding of cone-screw joints in implant design has been identified as a potential source for lack of retrievability.

PURPOSE

This comparative study evaluated the loosening torque, as a percentage of tightening torque, for the ITI Straumann and Astra Tech (3.5 and 4.0 mm diameters) implant systems, which use an 8-degree and 11-degree internal cone, respectively.

MATERIAL AND METHODS

Implants and abutments from each system were mounted in a torque device, and a range of tightening torques was applied. Loosening torques were then measured, and the influence of conus angle, interfacial surface area, saliva contamination, and time delay to loosening were all assessed.

RESULTS

The loosening torque only exceeded tightening torque at the highest levels, just before component failure, when plastic deformation was expected. For all clinically relevant levels of torque, both in a dry environment and with components bathed in artificial saliva at 37 degrees C, loosening torque was always seen to be 80% to 90% of tightening torque, demonstrating that cold welding does not occur. There was a high correlation between loosening and tightening torque for all systems tested, but no statistical difference when comparing wet versus dry or comparing individual data for each system.

CONCLUSIONS

It can be concluded that for clinically relevant levels of tightening torque, no problems are anticipated with respect to retrievability.

Marginal bone levels at single tooth implants with a conical fixture design. The influence of surface macro- and microstructure

The concept of a conical implant design to accommodate single tooth replacement, has previously been shown to result in excessive bone loss, around the machined titanium conical collar, usually down to the 1st thread. This unusually aggressive loss of bone was shown to occur within a short period of time, post loading, with greater than 3 mm of bone loss occurring within the 1st 6 months to 1 year. The influence of implant design, surface texture and microleakage have all been highlighted as a potential cause. A modification of the surface structure, both at the macroscopic and microscopic level, as well as an altered fixture-abutment interface design has resulted in the maintenance of marginal bone around a single tooth titanium implant with a similar conical design. The radiographic follow-up of 33 implants loaded for up to 4 years, has revealed, by comparison, a most favourable maintenance of marginal bone around the conical collar, with a mean marginal bone loss of 0.32 mm mesially and 0.34 mm distally for the whole group. The cumulative mean marginal bone loss mesially and distally is 0.42 mm and 0.40 mm from 1 to 2 years, 0.54 mm and 0.43 mm from 2 to 3 years, 0.51 mm and 0.24 mm from 3 to 4 years, and 0.62 mm and 0.60 mm for implants past their 4 year recall.

The Astra Tech Single-Tooth Implant System: a report on 27 consecutively placed and restored implants

This article presents the components and treatment protocol for the Astra Tech Single-Tooth Implant System, whose concept and design has been tailored to the specific needs of single-tooth replacement. Since July 1991 the author has consecutively placed 39 single-tooth implants, of which 27 are restored and in function. To date there have been no recorded fixture failures, and the bone loss seen around fixtures in the first and subsequent years is insignificant. Two crowns have had to be replaced, and three were recemented over the follow-up period. All patients have expressed considerable satisfaction with their restorations from an esthetic perspective, and the system has been shown to avoid undesirable complications when employed in patients with normal masticatory function.

An in vitro evaluation of the strength of an internal conical interface compared to a butt joint interface in implant design

Dental implants are subject to large and highly complex loads of varying magnitude, duration and vector. Bridge performance is closely related to load transmission both at the bone to implant interface and between components within the implant-abutment-bridge cylinder complex. The design of the interface between components within this complex may have a profound influence on the long term function of the implant supported prosthesis. An in vitro evaluation of implants 3.5 mm in diameter, utilizing an internal conical interface has demonstrated increased resistance to bending moments at the fixture-abutment interface (P = 0.00010) and at the abutment-bridge cylinder interface (P < 0.01), when compared to a standard 3.75 mm implant with a hex mediated, butt joint interface. The relatively small values for coefficient of variance measured in both systems would confirm that whilst the size of data is small, it is nonetheless a reliable indication of the relative strength of these implant designs.

Plant parasitic nematodes in white clover and soil from white clover pastures in Australia

Summary. Seventeen sites, including locations in all the major white clover growing regions of Australia, were surveyed for the presence of plant parasitic nematodes in autumn and spring 1993. Trifolium repens L. cvv. Haifa and Irrigation, plus 1 other cultivar, were sampled at each site and nematodes extracted from roots, stems and soil. Thirteen genera of plant parasitic nematodes were detected. The clover cyst nematode, Heterodera trifolii, and root knot nematodes, Meloidogyne spp., were each recorded at over 75% of the sites. The most common genera of plant parasitic nematodes detected were Tylenchus, which was present at all sites, and Pratylenchus (root lesion nematode), which was present at all but 1 site. Other plant parasitic nematode genera found included Ditylenchus, Helicotylenchus and Paratylenchus. The widespread presence of nematodes in white clover pastures, and the high populations at some sites, suggest that they may be economically important to the Australian dairy industry.

Rotation effects on sustainability of crop production: the Glen Innes rotation experiment

This study, which commenced in 1921, is the longest running crop rotation experiment in the summer rainfall region of Australia. The 7 rotation treatments comprise various frequencies and combinations of maize and spring oat crops with and without autumn oats and red clover ley. The maize and oat yields are analysed separately using principles described by Paterson (1964). Spline regressions are used to describe the trends of yields with time and to make comparisons amongst the rotations. Yield performance of maize and oats was improved as legume ley duration increased, although as maize cropping became more frequent this effect was reduced. Autumn-sown oats benefited both maize and spring oat yields, independent of the presence of a legume ley. Crop yields were generally maintained in those rotations containing a grazed clover ley. After alteration of ley management in the mid 1960s so that clover crops were subsequently removed as hay, crop yields in these rotations declined. The benefits of clover ley to crop productivity were considered to be primarily due to the maintenance of those soil chemical, physical, and biological properties associated with sustainable crop production.

A histomorphometric evaluation of bone-to-implant contact on machine-prepared and roughened titanium dental implants. A pilot study in the dog

This investigation was performed to assess the bone-to-implant surface contact at fixtures of titanium that either had a standard machine prepared or a TiO2-blasted surface. Five beagle dogs were used in the experiment. Extractions of the premolars were performed in the maxilla. After 4 months of healing, 5 standard machine-prepared fixtures and 5 prepared according to the TioBlast technique were inserted. Two months later another 5 "standard" and 5 TioBlast-prepared implants were inserted. Four months after the first fixture installation, the animals were killed and ground sections prepared from each implant site. Of the 20 implants installed, 19 were successfully incorporated. The mean bone-to-implant surface for "standard" fixtures was about 40% both at the 2 and 4 months observation interval. The corresponding figures for the TioBlast-prepared fixtures were similar during the first 2 months of observation, while subsequently the TioBlast-prepared fixture surface seemed to stimulate to a more close bone-to-implant contact (65%) than the "standard" one.

Bilateral accessory digastric muscles

Anomalies of the anterior bellies of the digastric muscles are uncommon. The description of such anomalies do exist in the literature dating from the 19th Century, but recently radiologists have drawn attention to their existence to avoid confusion with abnormal lesions when scanning the floor of the mouth and the submental space. Bilateral accessory muscles crossing the midline are described.

Chewing sticks versus toothbrushes in West Africa. A pilot study

Chewing sticks are used for tooth cleaning by many populations. Despite the fact that they contain antimicrobial substances that could conceivably benefit oral hygiene, there have been few attempts to evaluate properties in vivo. This pilot, cross-sectional study recorded the oral hygiene and gingival health of adult Ghanaens who used chewing sticks, toothbrushes, or a combination of both for tooth cleaning. Plaque and gingivitis scores were higher in the chewing stick users, although these were primarily due to differences in men. Men had poorer oral hygiene and gingival health than women, irrespective of the oral hygiene regimen. The same differences were apparent for city and rural dwellers, with no overall differences observed between these two groups. The longer time that is necessary for cleaning with chewing sticks may explain the apparent reduced cleaning efficiency in men. The antimicrobial substances contained in chewing sticks appear to provide no additional benefits to those produced by the antimicrobial activity of commercially available toothpastes.