Orthodontic palatal implants: clinical technique

The aim of this paper is to familiarize the readers with some of the clinical considerations necessary to ensure successful use of mid-palatal implants. Both surgical and technical aspects will be discussed along with a description of impression techniques used.

Is the Royal London Space Analysis reliable and does it influence orthodontic treatment decisions?

The purpose of this study was to investigate the reliability of the Royal London Space Analysis (RLSA) and to evaluate its influence on orthodontic treatment decisions. Thirty-one case records were collected to represent various levels of crowding and different types of malocclusions. Seventeen examiners assessed these records and completed a data sheet that recorded information on their treatment decision. One month later, the examiners attended a course on the RLSA and then used the analysis to rescore the 31 cases. The models were also scored by the expert who led the course and these were then considered the 'gold standard' scores. After a further month, the examiners reapplied the RLSA and formulated a treatment plan for each set of patient records. A paired Student's t-test and intraclass correlation coefficient (ICC) were used to assess the agreement in scoring RLSA, a paired sample t-test was used to compare the scores with the gold standard, and finally the reliability in treatment planning was determined using kappa (kappa) statistics. The scores for lower arch crowding showed the highest inter-examiner agreement with an ICC of 0.93 whereas the lowest level of agreement was for upper arch space requirement with an ICC of 0.77. Intra-examiner agreement was generally high, particularly for the assessment of lower arch crowding (ICC = 0.93) and lower arch space requirement (ICC = 0.88). There was excellent validity for all the examiners against the gold standard scores with a paired samples correlation ranging between 0.96 for lower arch crowding and 0.79 for upper arch space requirement. The intra-examiner reliability in treatment decision was only moderate, with an average kappa value of 0.52 (maximum 0.82, minimum 0.24). Intra- and inter-examiner agreement for scoring the RLSA was acceptable. Nevertheless, the additional information obtained from the application of the RLSA did not have a substantial impact on the treatment decisions.

Which orthodontic archwire sequence? A randomized clinical trial

The aim of this study was to compare three orthodontic archwire sequences. One hundred and fifty-four 10- to 17-year-old patients were treated in three centres and randomly allocated to one of three groups: A = 0.016-inch nickel titanium (NiTi), 0.018 x 0.025-inch NiTi, and 0.019 x 0.025-inch stainless steel (SS); B = 0.016-inch NiTi, 0.016-inch SS, 0.020-inch SS, and 0.019 x 0.025-inch SS; and C = 0.016 x 0.022-inch copper (Cu) NiTi, 0.019 x 0.025-inch CuNiTi, and 0.019 x 0.025-inch SS. At each archwire change and for each arch, the patients completed discomfort scores on a seven-point Likert scale at 4 hours, 24 hours, 3 days, and 1 week. Time in days and the number of visits taken to reach a 0.019 x 0.025-inch SS working archwires were calculated. A periapical radiograph of the upper left central incisor was taken at the start of the treatment and after placement of the 0.019 x 0.025-inch SS wire so root resorption could be assessed. There were no statistically significant differences between archwire sequences A, B, or C for patient discomfort (P > 0.05) or root resorption (P = 0.58). The number of visits required to reach the working archwire was greater for sequence B than for A (P = 0.012) but this could not be explained by the increased number of archwires used in sequence B.

The ‘Chesterfield stent’: an aid to the placement of midpalatal implants

A palatal endosseous implant is a valuable adjunct to orthodontic treatment. Its insertion is considerably simplified by the use of a stent that was designed in our department and that we describe here.

A comparison of current Orthodontic Board examinations

Five orthodontic clinical Board examinations were systematically compared. An attempt was made to critically evaluate the procedures, characteristics and requirements of these examinations. Many similarities were found and the differences found between Boards may be due to differences in socio-political goals of the professional orthodontic societies organizing the examinations. By setting a high standard of clinical treatment as a basic goal, all Boards aim to raise the overall quality of clinical performance.

Manipulation of digital photographs

This article provides simple details of what to do with digital images once they have been captured. Inspection of the images as 'thumbnails' using Exif viewer is described, as well as zooming in to check detail contained on the images. Storage of every orthodontic patient using the popular programme, Dentofacial Showcase is described in some detail. For more formal verbal presentations or written material intended for display Microsoft Powerpoint is the programme of choice. Transfer of the images between the three programmes is described in detail, as well as recommended layouts for written and verbal presentations.

Clinical photographs--the gold standard

This survey was carried out to allow a minimum data set required for intra- and extra-oral photographs to be established. In 1999 a questionnaire was sent to members of the Angle Society of Europe to establish their current clinical practice with regard to extra- and intra-oral photography. The Angle Society was chosen because of their stated commitment to a high standard of record keeping and of clinical care. Results showed that a full series of extra- and intra-oral photographs were taken both before and after treatment, as well as stage photographs during treatment on many cases. The need for each of these photographs will be discussed in some detail, and recommendations will be made as to what would be considered the Gold standard before, during, and after a course of orthodontic treatment.

The two by four appliance: a versatile appliance

The 2 x 4 appliance comprises bonds on the maxillary incisors, bands on the first permanent maxillary molars and a continuous archwire. The appliance is used in the early mixed dentition for treatment of both anterior crossbites and alignment of ectopic incisors. Four cases using this appliance are presented. This appliance offers many advantages over alternative techniques as it provides complete control of anterior tooth position, is extremely well tolerated, requires no adjustment by the patient and allows accurate and rapid positioning of the teeth.

Digital records in orthodontics

In this electronic age there is a general move to digital records. In orthodontics this includes digital photography, digital radiography and the latest development, digital study models. The advantages and occasional disadvantages of this digital technology will be discussed in some detail.

Digital photography in orthodontics

A brief history of digital photography is provided along with a critical appraisal of the 'prosumer' and professional systems currently available. Recommendations are made as to the system best suited to current orthodontic practice.

Orthodontic treatment of patients with medical disorders

This article will highlight some of the problems encountered when orthodontic treatment is provided for patients who have serious medical conditions. The way in which various disease processes might influence treatment decisions will be described, as well as recommended methods of avoiding potential problems.

Comparative analysis of the expression patterns of Wnts and Frizzleds during early myogenesis in chick embryos

During embryogenesis, the transduction of Wnt signals through Frizzled receptors is thought to play integral roles in myogenesis and somite patterning. However, little is known about which Wnt-Frizzled interactions are required for skeletal myogenesis. Thus, we sought to determine which Wnts and Frizzled exhibit expression patterns that are spatiotemporally consistent with the expression of two myogenic determination factors: Myf-5 and MyoD. To accomplish this, we first isolated partial cDNAs for six chick Frizzled orthologues and then compared the expression patterns of chick Frizzleds and Wnts to myogenic and somite patterning factors, such as Myf-5, MyoD, Sonic Hedgehog (Shh), Pax-1 and Pax-3 in Hamburger and Hamilton stage 10 chick. We used these data to generate a schematic composite of expression patterns at the level of the segmental plate and developing somites (stage V) that shows multiple Frizzled and Wnt transcripts expressed in tissues that are overlapping and adjacent to Myf-5 and MyoD expressing tissues.

Recent developments in clinical photography

A system comprising a clinical camera, specialized retractors, and a new occlusal mirror are described to maximize the quality of both intra-oral and extra-oral photography in the multi-user situation.

The inclined biteplane--a useful tool

A technique is described to help maintain overjet and overbite reduction achieved with a functional appliances, while waiting to proceed with definitive treatment or for use after a definitive course of fixed appliance therapy to help maintain the achieved result.

Comments on the conceptualisation of clinical facts in psychoanalysis

Perception is an active process involving a complex system of perceptual and cognitive structures. Facts reflect the ways in which we organise the data received by our senses, and this organisation is highly selective. The private theories of psychoanalysis play a major role in the organisation of facts and in their conceptualisation. It is important that there should be more attention to clinical theories and technical frames of reference, and as an illustration of this a clinico-technical conceptualisation which has been found useful is presented in some detail. This makes use of the concepts of the present and past unconsciouses, in this way emphasising the topographical dimension which had come to be under-stressed in Freud's structural theory and in subsequent ego psychology. The past unconscious can be regarded as a sort of 'template' (structures, rules, schemata, etc.) developed in the child in the first few years of life. This contributes to the form of fantasies and behaviour arising in the depths of the present unconscious, in which system such representational content is acted on by defences and other mechanisms to prevent 'child-like' content from disrupting the older individual's equilibrium. The censorship between the present unconscious and consciousness is considered, and the view taken that the primary focus of the analytic work is in relation to this censorship. The links between the analytical aim of making previously unacceptable mental content acceptable to the individual, on the one hand, and the roles of construction and reconstruction, on the other, are discussed in relation to psychoanalytic technique.

Theoretical and technical comments on regression and anti-regression

Following a discussion of the 'classical' formulations on regression and fixation, the view is put forward that the distinction between various types of regression is on the whole superfluous. However, it is important to distinguish between 'latent' regression in the patient's 'present unconscious', the contents of which are defended against and kept from consciousness on the one hand, and 'manifest' regression on the other, in which current versions of developmentally earlier wishes and fantasies emerge overtly in acceptable form in thought and behaviour. The anti-regressive function can be regarded as being operative from early in development, and functions to a greater or lesser extent throughout our daily lives. As a concept it reflects the operation of all the defence mechanisms and manoeuvres which operate to protect consciousness and conscious awareness of behaviour. Because it reflects a general tendency of the mind to defend consciousness from unwelcome content arising in the present unconscious, it is consequently a major source of resistance in analysis. Analytic progress takes place when the patient gains sufficient security in an analysis-syntonic way to allow a progressively increasing capacity for controlled relaxation of the anti-regressive function to take place, and for previously unacceptable wishful phantasies to be tolerated and accepted by the patient. This relaxation of the anti-regressive function is allied to Ernst Kris's description of 'regression in the service of the ego'.

Phantasy and its transformations: a contemporary Freudian view

Over the past fifty years changes have occurred in the theoretical positions of the Contemporary Freudian and Klein groups in the British Society, but fundamental differences remain. This paper considers the meaning of the term 'the unconscious', with particular reference to the censorship lying between consciousness and the Preconscious system--or, in the authors' model, consciousness and the present unconscious. The distinction between the present unconscious and the past unconscious is described. Emphasis is placed on the difference between phantasies in the present unconscious, which exist in the 'here-and-now' and those in the past unconscious, which are for the most part reconstructions based--among other things--on the analyst's theories of mental functioning and of child development. Thus, transference phantasies are phantasies in the present unconscious. The authors go on to emphasise the implications of the distinction between the present and past unconsciouses for analytic work, stressing the need for focus on phantasies and associated conflicts in the present unconscious before turning their attention to reconstruction of the past. Finally, they point to the concept of dialogue with one's introjects (internal objects) as represented in unconscious phantasy, to the stabilising function of (present) unconscious phantasy and to the need to interpret conflict and resistance.

The past unconscious and the present unconscious. A contribution to a technical frame of reference

Difficulties inherent in the concept of the unconscious are considered, and a formulation is proposed as a contribution to the theory of psychoanalytic technique. The concepts of the past unconscious and the present unconscious are described, each having its own type of functional organization. The past unconscious can be regarded as acting like a dynamic "template," a structuring organization that gives form to current wishes or wishful fantasies, which are then further modified in the present unconscious before gaining access to consciousness. Finally, the implications of the frame of reference for interpretation, construction, and reconstruction in analysis are described.

Preventing relapse in obesity through posttreatment maintenance systems: comparing the relative efficacy of two levels of therapist support

The present study compared the relative effectiveness of a therapist-supported maintenance condition with a minimal contact maintenance condition in preventing relapse following an obesity treatment program. Thirty-two subjects who completed an initial 12-week cognitive/behavioral plus aerobic exercise treatment program were matched on absolute weight loss and randomly assigned to one of two maintenance conditions. Subjects were assessed at pretreatment, posttreatment, and 3, 6, and 12 months following posttreatment using measures of weight, blood pressure, and depression. Three- and six-month follow-up results indicated that subjects who participated in the therapist-supported maintenance group continued to lose weight and/or maintained therapy-induced weight loss to a greater degree than control subjects. At the 12-month follow-up assessment therapist-supported subjects maintained therapy-induced weight loss better than the control subjects. These findings suggest that maintenance programs which provide continued contact emphasizing relapse prevention training may be an important adjunct in the maintenance of therapy-induced weight loss.

On internal object relations

This paper gives an account of the author's attempts to come to terms with the concept of internal object relations, and to find an appropriate theoretical place for it within non-Kleinian mainstream theory. It is proposed that the internal object be regarded as a structure in the nonexperimental realm, being built up during development on the basis of the child's subjective perceptual and fantasy experiences. The internal objects in turn influence perception, thought, fantasy, current object relations, and transference. From the point of view of the clinician, the concepts of internal object and of internal object relation act as useful organizing constructs for both analyst and patient. Finally, the suggestion is made that internal objects can be regarded as the source of internal "presences" with which the person constantly unconsciously interacts.

Sex differences in weight loss among adults with type II diabetes mellitus

The treatment of choice for Type II or non-insulin-dependent diabetes mellitus is a behavioral program for the management of weight. However, compliance with this lifelong dietary regimen is often poor. In the current investigation male and female adults with diagnosed Type II diabetes were randomly assigned to either a behavior modification, a cognitive modification, a cognitive-behavior modification, or a control group. Patients were evaluated in terms of weight, percentage of body fat, and glycosylated hemoglobin measures. Men lost significantly more weight than women and subjects in the behavior modification group lost more weight and demonstrated greater decreases in diabetes control than subjects in the cognitive-behavior modification, cognitive, and control groups. A significant interaction indicated that diabetic men may benefit more from behavioral weight reduction programs than diabetic women. Several explanations for these findings are considered.

Effect of somatostatin-induced suppression of postprandial insulin response upon the hypertriglyceridemia associated with a high carbohydrate diet

In an attempt to define the relationship between plasma insulin and triglyceride concentrations, we have studied the effect of suppression of the postprandial insulin response upon the secretion and plasma concentration of very low density lipoprotein (VLDL)-triglycerides. Eight nondiabetic subjects with a wide range of fasting plasma triglyceride levels (100-358 mg/dl) were studied during three dietary periods: base line, high carbohydrate (80% calories), and high carbohydrate (80% calories) with a daily intravenous infusion of somatostatin (SRIF) (1.3 micrograms/min) between 800 and 2,100 h. The significant increase in postprandial insulin response observed during high carbohydrate vs. base line was completely abolished during high carbohydrate-SRIF. However, plasma triglyceride levels rose in all subjects during each high carbohydrate period (with/without SRIF) vs. base line and the mean values reached during each period were the same (476 +/- 165 vs. 482 +/- 152 mg/dl, respectively). The secretion of VLDL-triglyceride into plasma was higher in four subjects, the same in two subjects, and lower in one subject during high carbohydrate-SRIF vs. high carbohydrate alone. The mean production rate of VLDL-triglyceride (mg/kg per h) was 25.6 +/- 4.9 during the high carbohydrate and 40.9 +/- 28.1 during the high carbohydrate-SRIF periods. These values were not significantly different. Postprandial glucose levels were slightly increased during high carbohydrate-SRIF, but overnight glucose concentrations were not affected. Plasma FFA levels were not different during the two high carbohydrate periods. Plasma glucagon levels did not appear to affect the results either. This study indicates that postprandial hyperinsulinemia during a high carbohydrate diet is not necessary for induction of hypertriglyceridemia.

Effectiveness of a modified version of airflow therapy: case studies

Utilizing airflow therapy, Schwartz (1976) has claimed an 89% success rate with stutterers following treatment and an 83% success rate at one year follow-up. Such claims have yet to be documented in the scientific literature. The purposes of this study were: (a) to investigate the effectiveness of a modified version of airflow therapy; (b) to examine the relative importance of its two main components--passive airflow and elongation of the first vowel spoken. The speech of two adult male stutterers with a lengthy history of stuttering, was assessed with spontaneous speaking and reading tasks. Results indicated marked improvement in both subjects' speech on the reading task was maintained at follow-up 10 weeks later. For spontaneous speech, results were generally weaker and less durable. Effects of the two treatment components were cumulative and did not allow determination of any differential effectiveness between components. Implications of these findings were considered and directions for future research discussed.

Character traits and object relationships

Character traits have in the past been viewed as "discharge" phenomena and compromise formations. Many traits can be better understood, however, as devices for evoking particular types of response in others in order to actualize the wished-for relationships existing in unconscious fantasy. Moreover, some "evocative" character traits create the unconscious illusion of the presence of the love objects. The concept of unconscious illusion can also be used to clarify the notion of "introject," which may be understood as an illusory object perceived outside normal consciousness.

The treatment of adult obesity through direct manipulation of specific eating behaviors

The present study investigated the effects of three different conditions on weight loss in adult obese subjects. The three conditions were: (1) Monitoring-Contract (MC) in which subjects were reinforced by the return of a valued possession for changes in eating habits; (2) Monitoring (M); and Attention-Placebo (AP). Subjects in the MC group lost significantly more absolute weight and a significantly greater percentage of weight at the end of treatment than did the subjects in the M and AP groups. These changes were still manifested at a 2 month and a 6 month follow-up. The long-term advantages of a weight reduction program which focuses on a gradual and systematic weight loss through changes in eating habits are discussed.

Utilization of an experimenter-controlled manikin in analysis of social stimuli maintaining behavior of an autistic-like child

A two-part exploratory study was conducted to determine the feasibility of utilizing an experimenter-controlled human-like manikin in analyzing the social stimuli maintaining and controlling the behavior of a 10-yr.-old nonverbal, autistic-like child. In Phase I the frequency and duration of 7 behaviors emitted in the presence of a male, female, or manikin were recorded. Phase II involved measurements of 8 behaviors emitted during 6 conditions in which the social stimulus properties of the manikin were systematically varied with respect to the extent to which the manikin appeared “human-like.” The behaviors emitted by this particular child in the presence of the manikin, during Phase I, were similar to those observed in the presence of humans. In Phase II various behaviors emitted by the child were systematically varied as a function of the degree to which the manikin resembled and behaved like a human. The potential utility of utilizing an experimenter-controlled manikin in the analysis and possible modification of behavior is discussed.