This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) base...Shilpa Shiv
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile, JCP 2015
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) base...Shilpa Shiv
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile, JCP 2015
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case P...Shilpa Shiv
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case Presentations of a Novel Approach to Immediate Implant Placement at Multirooted Molar Sites, IJPRD 2013.
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoec...Shilpa Shiv
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoectomy andRoot-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures.
A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.
Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event . Dr Harshavardhan Patwal
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
Immediate implant placement following tooth extraction a case reportAbu-Hussein Muhamad
Immediate dental implants are an attractive option to patients and dentists. This paper report the management of a
fractured right permanent maxillary central incisor with extraction of the root followed by immediate implant placement
with two years follow-up.
Partial or complete edentulism has multiple implications in relation to function, esthetics and future rehabilitative treatment. This case report illustrates the management of a patient with extreme consequences of partial edentulism in the maxillary arch and total edentulism in the mandibular arch. The main clinical findings were unopposed remaining teeth, over eruption of the remaining teeth, loss of vertical dimension of occlusion, and significant disfigurement of the occlusal plane. Following the diagnostic procedure, a well-coordinated prosthodontic treatment involving liaison with other dental disciplines was indicated. The management involved an innovative combination of fixed and removable prostheses in conjunction with intentional root canal therapy of the remaining natural teeth. Series of provisional prostheses were applied to facilitate the transition to the final treatment.
Key-words: Edentulism, Vertical dimension, Provisional Restoration, Fixed and Removable prosthesis
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case P...Shilpa Shiv
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case Presentations of a Novel Approach to Immediate Implant Placement at Multirooted Molar Sites, IJPRD 2013.
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoec...Shilpa Shiv
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoectomy andRoot-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures.
A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.
Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event . Dr Harshavardhan Patwal
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
Immediate implant placement following tooth extraction a case reportAbu-Hussein Muhamad
Immediate dental implants are an attractive option to patients and dentists. This paper report the management of a
fractured right permanent maxillary central incisor with extraction of the root followed by immediate implant placement
with two years follow-up.
Partial or complete edentulism has multiple implications in relation to function, esthetics and future rehabilitative treatment. This case report illustrates the management of a patient with extreme consequences of partial edentulism in the maxillary arch and total edentulism in the mandibular arch. The main clinical findings were unopposed remaining teeth, over eruption of the remaining teeth, loss of vertical dimension of occlusion, and significant disfigurement of the occlusal plane. Following the diagnostic procedure, a well-coordinated prosthodontic treatment involving liaison with other dental disciplines was indicated. The management involved an innovative combination of fixed and removable prostheses in conjunction with intentional root canal therapy of the remaining natural teeth. Series of provisional prostheses were applied to facilitate the transition to the final treatment.
Key-words: Edentulism, Vertical dimension, Provisional Restoration, Fixed and Removable prosthesis
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
“Comparative Evaluation between Physics Forceps and Conventional Extraction F...inventionjournals
:Tooth extraction procedure, although known as a minimal traumatic procedure, some sort of trauma is subjected to underlying soft and hard tissues, resulting in immediate destruction and loss of alveolar bone. Conventional extraction forceps are designed on the principle of simple machine incorporating two first-class levers, connected with a hinge. The physics forceps are the newly invented forceps. The design of physics forceps which implements a first class lever, creep, and type of force that provides a mechanical advantage, which makes it more efficient. AIM: The aim of the present study to evaluate the efficacy between the conventional extraction forceps and physics forceps in orthodontic extraction of maxillary premolars. Patients & Methods:A total of 50 healthy patients with indicated for extraction of bilateral maxillary premolar for orthodontic reasons; split mouth design (control side, test side) in a randomized manner; were included in the present study. Results:Ease of technique, buccal cortical plate fracture, fracture of tooth or root, gingival laceration, soft tissue healing was not significant. The extraction time and bleeding associated with extraction socket were significant. Post operative days 1-4 are not significant and on day 5-7 the pain on VAS score is 0. Conclusion:The results of present study suggest that, extraction using any forceps can produce predictable results and it totally depends on surgeon’s expertise in a particular technique.
A Clinical Study Resonance Frequency Analysis of Stability during the Healing...Abu-Hussein Muhamad
Implant stability plays a critical role for successful osseointegration, which has been viewed as a
direct structural and functional connection existing between bone and the surface of a load-carrying
implant. Achievement and maintenance of implant stability are prerequisites for successful clinical
Outcome. Therefore, measuring the implant stability is an important method for evaluating the success
of an implant.
The aim of this clinical study was to measure the implant stability quotient using a method called
resonance frequency analysis of dental implants during the healing period.
Material and methods: A number of 43 patients received 152 Shark AL-Technology implant
system either in the maxillary or in the mandibular arch. Implant stability was measured with an Osstell
Mentor device (Osstel, AB, Sweden) using the resonance frequency analysis at the time of implant
placement, 0, 2, 4, 8 and 12 weeks post insertion.
Results: The mean implant stability quotient for all implants placed was 72,18. The lowest value
of the implant stability quotient was at 2 weeks post insertion measuring 60,78.
Conclusions: In relation to the gender the implants placed in female patients showed a higher
mean value of the implant stability quotient. In relation to the location within the dental arch the implants
placed in the anterior areas had a higher implant stability quotient than the ones places in the posterior
areas of the arch.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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2. increase primary implant stability. A histologic study in
rabbits found that bone condensation improved the
peri-implant bone formation during the first 8 weeks
after implantation.17
If localized stress is too great,
however, it could reportedly lead to ischemia and local-
ized bone necrosis at the implant-bone interface.3,12,18,19
A possible correlation between primary stability
and implant insertion torque has been often suggested
in the dental literature.3,8,10,12,14,20–25
Several studies24,25
have used average insertion torque as an indicator
of primary stability in conjunction with under-
dimensioned implant bed preparation. Several research-
ers11,26,27
compared insertion torque values during
implant placement with resonance frequency values of
implant stability after placement, and found no statisti-
cal correlation between the two. One study,28
however,
reported a statistically significant correlation between
the implant cutting torque during crestal bone penetra-
tion in the maxillary jaw and resonance frequency values
of implant stability after placement. Other research-
ers12,20
compared insertion torque and resonance fre-
quency values of tapered and straight implant designs
and found that both values increased for the tapered
implants.12,20
At present, the measurement of insertion
torque values to quantify primary implant stability has
been widely reported, and some researchers3,14,21,29–32
have also attempted to identify a minimum insertion
torque value that would indicate adequate stability for
immediate loading. Although no firm clinical consensus
has yet been reached, minimum insertion torque values
for immediate loading reported in the dental literature
have ranged from 32–50 Ncm.3,14,21,29–32
They advocated
that, even if the amount of micromovement supported
by the implants cannot be recorded, the implants
primary anchorage with such an insertion torque is suf-
ficient for retaining micromovement within limits.14,30
Ottoni et al.,31
in a study on immediate loading
of single-tooth implants, concluded that immediate
loading should only be proposed when insertion torque
was higher than 32 Ncm. Neugebauer et al.32
reached a
similar conclusion, that is, implants placed with an
average insertion torque higher than 35 Ncm were
associated with success.
Highest recorded peak insertion torque values gen-
erally range from 50 to approximately 70 Ncm.3,12,33,34
Some researchers35,36
have used an electric surgical unit
(OsseoCare, NobelBiocare AB, Göteborg, Sweden) as a
torque measuring device, but were technically limited in
measuring insertion torque values beyond 50 Ncm,
especially for implants that had to be manually
placed.35,36
An outlier study by Rabel et al.,27
however,
compared the primary stability of two dental implants
systems and recorded mean insertion torque values of
28.8 and 25.9 Ncm, respectively, but a very high peak
insertion torque value of 178.5 Ncm for both systems.
These values were recorded by an electric surgical unit
(Frios Unit E, Friadent GmbH, Mannheim, Germany)
and were evaluated after data transmission to a com-
puter.27
No further explanation was given concerning
these peak values obtained with a surgical unit that
normally stops when the 70 Ncm limit is reached.27
The clinical observation period lasted for 12 months
and nine (1.5%) of the 602 study implants failed after
placement.27
The aim of this study was to report on the clinical
outcome of 42 implants placed with an insertion torque
equal or greater than 70 Ncm and evaluate bone levels
around these implants.
This could be a first step to investigate if the com-
pression levels produced by these high insertion torques
lead to any bone injury.
MATERIALS AND METHODS
This was a nonrandomized, non-blinded, prospective
clinical study. Candidates were partially edentulous
patients who presented in a private dental practice with
one or more missing teeth in the maxillary and/or man-
dibular jaw. All patients were subjected to a preliminary
evaluation that included careful review of their medical
and dental histories, detailed clinical examination, and
evaluation of oral hygiene. Radiographic evaluations
were also conducted utilizing panoramic radiographs
and computed tomography scans, and included assess-
ment of bone quality and quantity according to the
Lekholm & Zarb37
index. Those patients who met the
study inclusion criteria (Table 1), exhibited adequate
oral hygiene and expressed a firm commitment to
follow-up visits were admitted into the study after
signed informed consent was obtained.
Tapered Screw-Vent implants (Zimmer Dental,
Carlsbad, CA, USA) were used in this study. These
implants were multithreaded (three threads) and their
surface was both sandblasted and acid etched (Figure 1).
In order to standardize implant geometry, only 4.5 mm
diameter implants were considered for torque measure-
ment. On these tapered implants, the widest thread
2 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2011
3. measured 4.7 mm (most cervical) and the narrowest was
3.8 mm (more apical). A deep internal hex (1.7 mm)
allowed a strong connection to the insertion tools.
Each patient was instructed in the use of chlorhexi-
dine digluconate for the chemical control of plaque,
which commenced 1 day after the implant surgery and
continued for 10 days postoperative. Antibiotic prophy-
laxis involved daily administration of 2 g of amoxycillin
and clavulanic acid, beginning 2 hours before surgery
and for 6 days thereafter. On the day of surgery, the
patient was anesthetized by local infiltration with artic-
aine. A midcrestal incision was performed, followed by
elevation of a mucoperiosteal flap that was kept small to
preserve the periosteal vascular supply. The osteotomy
was prepared and the implant was placed according to
the manufacturer’s protocol except for the bone tap that
was never used.
During implant placement, insertion torque was
manually recorded with an electronic digital torque
measuring device (Tohnichi STC200CN, Hitachi, Tokyo,
Japan), which was able to measure insertion torque
within a range of 30–200 Ncm, with 3% precision.
Torque levels below 30 Ncm could not be measured by
this instrument.
After placement, a healing collar was attached to the
implant and the soft tissues were sutured around it with
4–0 vicryl sutures (Ethicon, Inc., Somerville, NJ, USA).
The implant was allowed a non-submerged healing
period of 2 months in the mandible or 3 months in the
maxilla.
Following the healing period, clinical osseointe-
gration38
was manually evaluated via axial percussion,
lateral pressure movements, and healing collar removal.
The realization of these clinical tests should not produce
any discomfort and the clinician should not perceive any
movement of the implant. Radiographic evaluation was
also performed to determine a lack of peri-implant radi-
olucency.38
In this study, implant failure was defined as
implant mobility, peri-implant radiolucency, and/or
pain or discomfort, altered sensation, or infection attrib-
utable to the implants. With the validation of this clini-
cal assessment, the implant is considered clinically stable
and ready for loading.
A radiographic examination was conducted upon
implant placement and for each follow-up. Standardized
vertical radiographs utilizing a positioning jig were
taken perpendicular to the long axis of the fixtures. The
objective was to identify radiolucencies in the implant
periphery and to accurately assess marginal bone loss. In
TABLE 1 Patient Selection
Inclusion criteria Exclusion criteria
318 years old Heavy smoking (>20 cigarettes daily)
1 or more missing teeth in either jaw Alcohol or drug abuse
Ability and willingness to comply with all study requirements Infection, endodontic or periodontal problems in teeth adjacent
to the implant siteAvailable for clinical follow-up
Adequate oral hygiene Extraction sites with less than 6 months of healing
Sufficient bone volume with or without localized bone grafting
to accommodate implants at least 10 mm in length
General pathologies or contraindications for implant treatment
or surgery (e.g., risk for bacterial endocarditis, uncontrolled
diabetes, history of head or neck irradiation, HIV + serology,
current chemotherapy or corticosteroid use, etc.)
Absence of clinical or systemic conditions that would
contraindicate surgery, implant placement, and/or implant
survival
Accessibility for insertion torque measurement device
Figure 1 A 4.5 mm diameter Tapered Screw-Vent implant.
High Insertion Torques 3
4. order to compare marginal bone resorption around test
and control implants, the distance between the implant
platform and the bone were measured using a magnify-
ing lens with a measuring scale divided into 0.1 gradu-
ations. The average of mesial and distal values for each
fixture was then calculated for radiographs taken at time
of loading and 6 months after loading.
RESULTS
Because of the shape and size of the torque measuring
device and the difficulty of accessing posterior implant
sites, data collection was limited to 66 implants placed in
38 patients (Table 2).
For six patients (four women, two men) with an
average age of 63 years (range 34–75 years old), nine
implants (three implants of 10 mm length, five implants
of 13 mm, and one of 16 mm) were placed with
maximum insertion torques between 30 and 50 Ncm
(control group).
For 32 patients (19 women, 13 men) with an average
age of 64 years (range 32–84 years old), 42 implants
(eight implants of 10 mm length, 30 implants of 13 mm,
and four of 16 mm) were placed with maximum
insertion torques equal or greater than 70 Ncm (experi-
mental group).
Fifteen implants with maximum insertion torques
rangingfrom50to70 Ncmwereexcludedfromthestudy.
They were placed in 10 patients (six women, four men)
with an average age of 59 years (range 32–71 years old).
Mean maximum insertion torque values were
37.1 Ncm (range = 30–50 Ncm) for the control group
and 110.6 Ncm (range = 70.8–176 Ncm) for the experi-
mental group. All study implants successfully osseo-
integrated. Two implants in the experimental group
presented gingival complications in the week following
placement, but this was quickly resolved with antibiotic
therapy and analgesics. All implants were clinically
stable after 1 year of loading.
Mean marginal bone resorption was 1.03 mm
(SD = 0.44) for the control group (low torque) and
0.72 mm (SD = 0.56) for the experimental group (high
torque) at time of loading, and 1.09 (SD = 0.62) and
1.24 mm (SD = 0.75), respectively, after 1 year. There
was no difference between low and high torque groups
(Wilcoxon Rank Sum test, p > .05) at any time. More-
over, there was no correlation between insertion torque
and marginal bone resorption when all measurements
were grouped (Spearman correlation test, p > .05).
A quartile analysis was made; control and test
implants were grouped and sorted with increasing inser-
tion torques. The first 13 implants with the lowest torque
(Q1) (mean 48.2 Ncm,SD 18.4) were compared with the
13 implants showing the highest torque (Q4) (mean
138.3 Ncm, SD 15.9). The mean marginal bone loss at
loadingwas1.0 mm(SD0.4)forQ1and0.6 mm(SD0.5)
for Q4 implants (p < .05). After 1 year of loading, the
corresponding figures were 1.3 mm (SD 0.7) and 1.4 mm
(SD 1.0) for Q1 and Q4 implants, respectively (NS).
DISCUSSION
Other studies have attempted to record insertion torque
levels with methodologies different from the one used in
the present study. To measure insertion and removal
torque values, Ueda et al.19
and Niimi et al.39
used a dif-
ferent torque gauge (15 BTG-N Tohnichi, Hitachi) from
the same manufacturer as the gauge used in this study.
Its torque range was lower, which would have precluded
its use in measuring the high insertion torque values
recorded in the present study. O’Sullivan et al.12
used a
complex mathematic method that combined a modified
electronic torque controller (Nobel Biocare AB, Göte-
borg, Sweden), a digital data acquisition card, and a
laptop computer. In this study, a simpler method was
used. Calandriello et al.3
used a torque controller device
(ATR, Pistoia, Italy) for both site preparation and torque
measurement, but the instrument was only capable
of measuring a maximum torque level of 72 Ncm.
Nikellis et al.14
used a simple insertion ratchet with a
fixture-mount attached to the implant at 32 Ncm. After
implant placement, reverse torque was applied to the
TABLE 2 Distribution of Patients and Implants
Study Group
Number of Patients
Patient Age
Mean (Range)
Number of Implants by Length (mm)
Males Females 10 13 16
Control 2 4 63 (34–75) 3 5 1
Experimental 13 19 64 (32–84) 8 30 4
4 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2011
5. fixture-mount screw. If the implant rotated, it was
assumed that insertion torque was lower than 32 Ncm.
This technique was not meant to provide individual
insertion torque measurements as done in this study.
Several other researchers3,11,14,23,36,40
have also reported
that they sometimes had to use a manual wrench to
finalize implant placement, and therefore had no mean
to register the true peak insertion torque.
In this study, a combination of factors could explain
why high insertion torques were often observed: the
tapered implant design, the slightly wider implant diam-
eter (4.7 mm for the most cervical threads), the absence
of bone tapping and a strong internal connection
between implant and insertion driver (no torque limi-
tation within the scope of this study).
Excessive tightening creates important compression
forces in the surrounding bone. This has been theorized
to disturb microcirculation and lead to bone resorption,
but the theory has never been scientifically investigated.
In this study, all implants successfully osseointegrated.
Throughout the course of this study, no clinical signs
of bone injury were observed. Furthermore, marginal
bone levels were similar to those currently reported
(0.9–2 mm) for implants placed via a traditional, two-
stage surgcial protocol.3,14,20,21,28,29
Based on the implant treatment outcome of a
15-year follow-up study,41
Albrektsson et al.42
included
vertical bone loss as one of the criteria for the assessment
of implant success. An upper limit of 1.5 mm was pro-
posed for bone resorption around successfully osseoin-
tegrated implants during the first year of loading.43
In
this study, marginal bone resorption for both groups
was in that range and did not increase when high inser-
tion torques were applied.
The quartile analysis revealed significantly less
marginal bone loss at time of loading between lowest
torque implants (1.0 mm) and highest torque implants
(0.6 mm).After 1 year, there was no statistical difference.
This finding could not be explained.
In the present study, no negative effects of high
insertion torque on marginal bone loss could be
detected. This may be related to the present implant
design, which has a homogenous tapering with no
marked steps, edges or other design features. The
implant design probably resulted in a continuous lateral
compression of the bone during insertion and an even
distribution of stresses along the implant surface, which
may explain the limited adverse effect at 2–3 months
and the lack of adverse effect at 1 year of loading on the
surrounding bone. It is possible that other more hetero-
geneous implant designs with marked steps and edges
along the implant surface may result in bone resorption
when using high insertion torque because of stress
concentration.
CONCLUSION
The use of high insertion torque (up to 176 Ncm)
neither prevented osseointegration nor increased mar-
ginal bone resorption around tapered multithreaded
dental implants. Further studies on biological reactions
of bone under mechanical strain are needed.
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High Insertion Torques 7