Huntington Society of Canada

Background: Immediate implant placement in fresh extraction sockets has become an accepted treatment in dentistry as a predictable procedure to restore failing teeth. One prerequisite for this immediate procedure in the anterior maxillary region is an intact facial wall. Unfortunately, the presence of fenestrations and dehiscences is very common. These defects occur due to the pathology responsible for the extraction of the teeth. Traditionally, hard and soft tissue grafting is necessary to repair these large bony defects before implant placement. However, there are many defects with facial wall deficiencies. Methods: This report reflects procedures used to provide successful functional outcomes using grafting techniques in conjunction with immediate implant placement in defective sockets. This clinical research study followed a qualitative methodology, and the results are based on observational outcomes of four patient surgical implant procedures. Each patient received the same protocol in an attempt to reach similar results. Results: Proper diagnosis, treatment planning, and clinical skills are key factors in achieving predictable results. With each of these four patients, the clinical soft tissue outcomes revealed that the midfacial gingival margin had minimal or no recession at two years with minimal pocket depths less than 3 mm. Conclusions: Although the procedure presented in this article has yet to be clinically validated, it is an available technique that can be used in the hands of an experienced practitioner and can provide excellent results for the patient.

BackgroundDeep brain stimulation (DBS) surgery is offered to a subset of Parkinson's disease (PD) patients. It is unclear if there are features at diagnosis that predict future DBS surgery.ObjectiveTo assess predictors of eventual DBS surgery in de novo PD patients.MethodsSubjects from the Parkinson's Progression Marker Initiative (PPMI) database with newly diagnosed, sporadic PD (n = 416) were identified and stratified by their eventual DBS status (DBS+, n = 43; DBS‐, n = 373). A total of 50 baseline clinical, imaging, and biospecimen features were extracted for each subject and cross‐validated lasso regression was used for feature reduction. Multivariate logistic regression assessed their relationship with DBS status and a receiver operating characteristic curve evaluated model performance. Linear mixed effect models assessed disease progression over 4 years in DBS+ and DBS‐ patients.ResultsAge at symptom onset, Hoehn and Yahr (H&Y) stage, tremor score, and ratio of CSF Tau to amyloid‐beta 1–42 (Tau: Ab) were identified as important baseline features for predicting DBS surgery. Each independently predicted DBS surgery (area under the curve = 0.83). DBS‐ patients had faster memory decline (P < 0.05), while DBS+ patients had faster decline in H&Y stage (P < 0.001) and motor scores (P < 0.05) prior to surgery.ConclusionThe identified features may be used for early identification of patients who may be surgical candidates during the course of their disease. Disease progression in these groups reflects surgical eligibility criteria, with DBS‐ patients having more rapid decline in memory while DBS+ patients experienced a faster decline in motor scores prior to DBS surgery.

Clinical ethics is widely recognised as an essential contribution to the quality of health and psychosocial service delivery. However, the lack of a common understanding of ethics within teams and insufficient organisational support often limits its optimal integration into the workplace. To address this problem, the clinical ethics committee of a rehabilitation centre developed a new clinical ethics framework based on a theoretical model and conducted a pre-implementation evaluation by interviewing future users. The study estimated the acceptability and initial adoption of the new clinical ethics framework. The quantitative results of the study indicated a high level of acceptability for the definitions, tools and supporting strategies, with the exception of the definition of the concept of ethical issues. The qualitative results showed that the future users perceived positively the attributes of the new framework, such as its benefits and its compatibility with their professional concerns. In addition, they appreciated the fact that the framework was easy to understand and could potentially be applied in daily practice. The suggestions provided by future users also helped to improve the content of the clinical ethics framework. Finally, all the results will be useful for the planification of its eventual implementation.

Background:Delayed-onset adverse reactions to hyaluronic acid (HA) fillers are uncommon but have received increased attention, particularly with regard to late-onset nodules. Globally, there is a need for comprehensive prevention and management strategies.Methods:Experts with clinical practices in diverse regions of the world and extensive experience in managing complications related to HA fillers convened to propose and evaluate approaches to prevent delayed-onset adverse reactions after HA filler administration and manage late-onset nodules.Results:The expert panel agreed to define delayed-onset adverse reactions as those presenting more than 4 weeks posttreatment, with swelling, induration, and nodulation being the most common clinical signs. The panel recommended 5 general key approaches for the prevention of delayed-onset reactions (patient selection, anatomic location of injection/product selection, aseptic technique, injection procedure/filler, and posttreatment care). Strategies recommended for managing late-onset nodules included oral antibiotics, oral steroids, nonsteroidal anti-inflammatory drugs if needed, hyaluronidase for noninflammatory nodules (recognizing the limitations and regional availability of this treatment), intralesional antibiotics, intralesional immunosuppressive drugs such as steroids and fluorouracil, and surgical excision as a last resort. The panel noted that late-onset nodules may vary in both clinical presentation and etiology, making them challenging to address or prevent, and stressed individualized treatment based on clinical presentation. Regional differences in aseptic protocols, antibiotic selection, and steroid formulations were described.Conclusion:Insights from global experts on approaches to prevent and manage delayed-onset adverse reactions following HA filler administration, including late-onset nodules, support clinicians worldwide in optimizing patient outcomes and safety.

The purpose of this study was to evaluate the in vitro shearing force performance of orthodontic attachments using two self-etching primers (SEPs): iBOND and G-Bond. In vitro, laboratory study. One hundred and eighty human molars were randomly divided into four groups and again into three sub-groups with 15 teeth each. Teeth were bonded with a stainless steel button (GAC International,Bohemia, NY, USA) using Transbond XT adhesive composite. The bonding agents were iBOND, G-Bond, Transbond Plus SEP and Transbond XT primer. Shearing force tests were carried out immediately, and at 24 hours and 3 months using a universal testing machine. Force to debond (N) and Adhesive Remnant Index (ARI) scores were evaluated and compared. Transbond XT primer required a higher immediate (P<0·05)force to debond when compared to the Transbond Plus SEP, iBOND and G-Bond.After 24 hours, mean force to debond for Transbond XT primer and Transbond Plus SEP showed significant increases. At 3 months, all four bonding agents demonstrated force levels to debond that were not significantly different from one another. Furthermore, comparison of ARI scores indicated a significant difference between the groups at all time points. iBOND and G-Bond may well sufficiently with stand the alignment and occlusal forces imparted by light archwires during immediate archwire tie-in and over the initial levelling and alignment phase.

Notwithstanding the gallant intensions, the Doha Round of multilateral trade negotiations (MTNs) proved to be egregiously problem-prone. It went down in the history of multilateral trade as the first round to be suspended. Potsdam was the final link in this chain of breakdowns. While the G-8 leaders supported the DDA, their trade delegations did not seem to abide by the public pronouncements of their leaders. This article delves into the anatomy of this failure and points toward the salient factors that led to it. There is an imperious need for resuscitating the Doha Round and for the key players to be flexible and take some decisive steps forward. The round is too important for the community of trading economies to be allowed to collapse. Revival is a possible and credible objective. A two-stage revival process is suggested in this article.