Demineralization In Patients Research Articles

Preventive Effect of Professional Fluoride Supplements on Enamel Demineralization in Patients Undergoing Fixed Orthodontic Treatment: A Systematic Review and Meta-Analysis.

The current study aimed to systematically review the randomized clinical trials assessing the preventive effect of professional fluoride interventions on enamel demineralization in patients undergoing fixed orthodontic treatment. The electronic search was performed in PubMed and Cochrane library in September 2021. No restriction was set on the publication date. Randomized clinical trials assessing the preventive effect of fluoride varnish, gel, mouthwash, and high-fluoride toothpaste on white spot lesions compared to the control group by clinical or radiographic methods in more than 10 patients were included. A total of 7 articles consisting of 1418 participants were included. In 4 articles, fluoride varnish (contained a range of 1000-50 000 ppm fluoride) was applied multiple times (4-20 times) in test groups. Their results indicated that the test groups significantly had lesser new white spot lesions or advanced white spot lesions. One study used fluoride varnish only once at the beginning of treatment and reported no significant difference in white spot lesions compared to the control group. Application of high-fluoride toothpaste as well as fluoride mouthwash, also, showed significantly lower white spot lesions. Three studies were included in the meta-analysis and revealed that the relative risk of white spot lesions was 0.64 (95% CI = 0.40 to 0.89; P < .01) in favor of fluoride varnish. Multiple applications (4-20 times) of fluoride varnish or daily use of fluoride mouthwash or high-fluoride toothpaste seem to reduce white spot lesions in patients undergoing orthodontic treatment. However, single use of fluoride varnish was not effective. Further research is needed to establish the required number of fluoride applications for the prevention of white spot lesions during orthodontic treatment.

Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry.

The application of dual-energy X-ray absorptiometry (DXA) examinations in the assessment of bone mineral density (BMD) in the lumbar spine, hip, and forearm is the basic diagnostic method for recognition of osteoporosis. The constant development of DXA technique is due to the aging of societies and the increasing importance of osteoporosis as a public health problem. In order to assess the degree of bone demineralization in patients with hyperparathyroidism, forearm DXA examination is recommended. The vertebral fracture assessment (VFA) of the thoracic and lumbar spine, performed by a highly-skilled technician, is an interesting alternative to the X-ray examination. The DXA total body examination can be useful in the evaluation of fat redistribution among patients after bariatric surgery, in patients infected with HIV and receiving antiretroviral therapy, and in patients with metabolic diseases and suspected to have sarcopenia. The assessment of visceral adipose tissue (VAT) and detection of abdominal aortic calcifications may be useful in the prediction of cardiovascular events. The positive effect of anti-resorptive therapy may affect some parameters of DXA hip structure analysis (HSA). Long-term anti-resorptive therapy, especially with the use of bisphosphonates, may result in changes in the DXA image, which may herald atypical femur fractures (AFF). Reduction of the periprosthetic BMD in the DXA measurements can be used to estimate the likelihood of loosening the prosthesis and periprosthetic fractures. The present review aims to present current applications and selected technical details of DXA.

Use of Bisphosphonates, Calcium and Vitamin D for Bone Demineralization in Patients with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome: A Systematic Review and Meta-Analysis of Clinical Trials.

Background The present study performed a systematic review and meta-analysis of clinical trials using bisphosphonates for bone demineralization in human immunodeficiency virus (HIV) patients.Methods A comprehensive literature search was performed from January 2004 to January 2020 considering the bone mineral density (BMD) of the lumbar spine (LS) as the main outcome. Out of 214 titles that met criteria, 9 studies fulfilled the selection criteria.Results A total of 394 patients were identified, and they were allocated into 2 groups: the intervention group (200 patients), to whom a combination of alendronate or zoledronate with calcium and vitamin D was administered; and control group (194 patients), to whom only calcium and vitamin D was administered. Clinical profile and indicators of bone metabolism of the participants were evaluated regarding effect size, homogeneity, and consistency. No substantial heterogeneity between the groups was found for the baseline variables, and there was high consistency to the main outcome. The meta-analysis shows a significant difference in post-treatment BMD, favoring the intervention over the control treatment. The intervention improved LS density up to 0.227 g/cm², raising the average to the levels of general population. Adverse effects related to intervention were fever immediately after zoledronate administration and gastrointestinal complaints during alendronate usage. Other adverse effects were barely reported and poorly connected to intervention by studies’ authors, despite all of them have been successfully resolved.ConclusionsThis study provides evidence that BMD post-treatment is better in HIV patients who used bisphosphonates combined with calcium and vitamin D.

The effect of sealant on prevention of enamel demineralization in patients with fixed orthodontic appliances: A systematic review

Introduction: One of the common problems of patients undergoing orthodontic treatment with fixed appliances is the evelopment of enamel demineralization. The objective of this review is to evaluate the effectiveness of sealants in preventing the occurrence of enamel demineralization in patients with fixed orthodontic appliances during treatment.Methods: A complex search was performed in Medline (1969 to May 2013), and by hand in individual articles, in order to identify any relevant study based upon various combinations of key words. The included studies are Randomized Controlled Trials (RCTs), or otherwise prospective clinical trials, with patients (teeth) of any age undergoing fixed orthodontic treatmentand with a control group or at least two intervention groups. In the absence of the above, any prospective cohort with more thanten patients was evaluated. To assess the internal validity of the eligible studies, the Cochrane Risk of Bias Tool for Randomized Clinical Trials was applied.Results: The searches originally identified 237 titles and abstracts, 6 fulfilled the inclusion criteria of the review. From these studies, 4 were randomized clinical trials and 2 prospective clinical trials. The results were contradictory, with half of the studies showing significant reductions in the incidence of enamel decalcification for the sealed teeth compared with the control group while the remaining half did not show any important differences.Discussion: Based on the findings from the present systematic review, it was impossible to make any reliable recommendations onthe usage of sealants during orthodontic treatment for the prevention of WSL development. Nevertheless, their use in general seems to be beneficial for caries prevention, depending on the type of material, the method of its application and the caries riskstatus of the patient.

The Assessment of Enamel Demineralisation by Fluorescent Light in Fixed Orthodontics

&lt;p class="TTPAbstract"&gt;The brackets collating technique and microbial factors increase the risk for enamel demineralization in patients with fixed orthodontic appliance. The aim of this study was to determine the risk level of enamel demineralization in fixed orthodontic device bearers. The enamel demineralization was assessed in 187 patients by measuring dental structure by fluorescent light. The measurements were performed with the DIAGNOdent Pen 2190 (KaVo, Biberach, Germany). Except canines which remain in the risk 1 category, without enamel demineralization, the other investigated teeth may have a medium demineralization degree The values recorded with fluorescent light on canine enamel showed low and insignificant differences (p&gt;0.05) as a result of fixed orthodontic appliances, classifying these teeth as healthy teeth with enamel integrity or with low enamel demineralization. The molars presented significantly increased values in the study group as compared to the control group (p&lt;0.05). 6 years molars had a marked predisposition to demineralization and caries as compared to frontal group teeth, after fluorescent light measurements. The measurements include these teeth in the medium to high risk for dental caries. The DIAGNOdent, due to its capacity to determine the demineralization degree of dental surfaces, may be used to monitor patients and to prevent the occurrence of dental caries during fixed orthodontic treatments.&lt;o:p&gt;&lt;/o:p&gt;&lt;/p&gt;

The effect of sealant on prevention of enamel demineralization in patients with fixed orthodontic appliances: A systematic review

Introduction: One of the common problems of patients undergoing orthodontic treatment with fixed appliances is the development of enamel demineralization. The objective of this review is to evaluate the effectiveness of sealants in preventing the occurrence of enamel demineralization in patients with fixed orthodontic appliances during treatment. Methods: A complex search was performed in Medline (1969 to May 2013), and by hand in individual articles, in order to identify any relevant study based upon various combinations of key words. The included studies are Randomized Controlled Trials (RCTs), or otherwise prospective clinical trials, with patients (teeth) of any age undergoing fixed orthodontic treatment and with a control group or at least two intervention groups. In the absence of the above, any prospective cohort with more than ten patients was evaluated. To assess the internal validity of the eligible studies, the Cochrane Risk of Bias Tool for Randomized Clinical Trials was applied. Results: The searches originally identified 237 titles and abstracts, 6 fulfilled the inclusion criteria of the review. From these studies, 4 were randomized clinical trials and 2 prospective clinical trials. The results were contradictory, with half of the studies showing significant reductions in the incidence of enamel decalcification for the sealed teeth compared with the control group while the remaining half did not show any important differences. Discussion: Based on the findings from the present systematic review, it was impossible to make any reliable recommendations on the usage of sealants during orthodontic treatment for the prevention of WSL development. Nevertheless, their use in general seems to be beneficial for caries prevention, depending on the type of material, the method of its application and the caries risk status of the patient.

English

Introduction: One of the common problems of patients undergoing orthodontic treatment with fixed appliances is the development of enamel demineralization. The objective of this review is to evaluate the effectiveness of sealants in preventing the occurrence of enamel demineralization in patients with fixed orthodontic appliances during treatment. Methods: A complex search was performed in Medline (1969

Clinical Evaluation of Enamel Demineralization during Orthodontic Treatment: An in vivo Study using GC Tooth Mousse Plus

Aims and objectives: Fixed orthodontic treatment makes oral hygiene procedures difficult and may result in enamel demine ralization. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) with fluorides (GC Tooth Mousse Plus) reduces the incidence of enamel demineralization. The objective of this study was to evaluate the effects of GC Tooth Mousse Plus application, on enamel demineralization in patients undergoing orthodontic treatment. Methodology: Thirty subjects seeking orthodontic treatment were selected from patients visiting Department of Orthodontics in AB Shetty Memorial Institute of Dental Sciences, Mangalore. The subjects were divided into test and control group, and scanning electron microscopic (SEM) evaluation was done to compare level of surface roughness on samples of both the groups. Results: No white spot lesion was clinically appreciable in either test or control group. After extracting the teeth, SEM ima ges of surface of the teeth was graded and statistically eva luated with Pearson’s Chi-square and likelihood ratio test. The results were significant with p-value below 0.001 which indicated increased surface roughness in controls compared to the test group patients.

Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances: A prospective clinical trial

In this study, we tested the efficacy of a tooth sealant polish (Biscover LV; Bisco, Schaumberg, Ill) to prevent enamel demineralization (white spot lesions) for the full duration of orthodontic treatment with fixed appliances. The trial design was an alternating-tooth split-mouth design. Patients starting treatment with bonded appliances in a private practice were enrolled. The 6 maxillary anterior teeth received the test sealant or no sealant. The nonblinded orthodontists visually examined the teeth immediately after debonding and rated the presence and severity of white spot lesions using a 4-point scale. The difference in incidence of white spot lesions on treated and control teeth was tested with multivariate binary logistic regression for repeated measures by using the generalized estimating equations approach. Sixty-five subjects were enrolled, and 3 were lost to follow-up, leaving 62 for analysis. There was a slightly lower incidence of white spot lesions on treated teeth (13.5%; 95% confidence interval, 8.6-18.4) compared with the control teeth (17.7%; 95% confidence interval, 12.4-23.7). This difference was statistically significant in the multivariate model (Wald chi-square, 5.07; df = 1; P = 0.024). The odds ratio was equal to 0.68 (95% confidence interval, 0.47-0.95) that treated teeth would show white spot lesions relative to the control teeth. White spot lesion severity was nearly the same for treated and control teeth (mean ± SD = 1.17 ± 0.47 and 1.20 ± 0.48, respectively; Wald chi-square, 3.03; df = 1; P = 0.082). No serious adverse effects were reported. The sealant did not prevent all white spot lesions for the full duration of treatment. The sealant demonstrated a clinically small but statistically significant ability to prevent white spot lesions.

Plasma prolactin and bone mineral density in patients on long-term risperidone

Having read with interest the article ‘Prolactin, hyperprolactinaemia and antipsychotic treatment: a review and lessons for treatment of early psychosis’ by Cookson J (J Psychopharmacol 2012; 26(5 Suppl.): 42–51) about bone demineralization in patients on long-term risperidone resulting from higher levels of prolactin, I would like to join the discussion, focused on the evolution of bone mineral density (BMD), by providing our own data from a study conducted on a small cohort of patients on long-term parenteral risperidone combined treatment, where we analysed prolactin, sex hormones, cortisol and thyroid-stimulating hormone (TSH) in blood samples, and calculated the BMD as a function of prolactin and estradiol. We observed that the risk of pathological BMD for osteoporosis in women increased year after year reaching the maximum value in the 7th year. The data analysis suggests that hypoestrogenism, produced by the administration of antipsychotics, raises prolactin, thereby increasing the risk of pathological BMD, when risperidone is administered alone or in combination with other antipsychotics, as described in the following brief summary of the research.

To Evaluate the Clinical Efficiency of Resin Modified Glass Ionomer Varnish in Preventing Enamel Demineralisation During Orthodontie Treatment

Background and objectives: Fixed orthodontic treatment makes oral Hygiene procedures difficult and may resuit in enamel demineralization. Resin Modified Glass Ionomer Varnish (Clinpro XT Varnish) reduces the incidence of enamel demineralization. The objective of this study has been clinically evaluate the effects of RMGIV (Clinpro XT Varnish) application, incidence and progress of enamel demineralization in patients undergoing orthodontic treatment. 30 subjects seeking orthodontic treatment were selected from patients visiting Department of Orthodontics and Dentofacial Orthopedics A. B. Shetty Memorial Institute of Dental Sciences, Mangalore. The subjects were divided into Test and Control group. The study was divided into two parts: ♦ Visual evaluation – incidence of white spot lesion and their progress for six months. ♦ SEM (Scanning Electron Microscopic) evaluation to compare level of surface roughness on samples of both the groups. No White Spot Lesions was clinically appreciable in either Group A or Group B. Oral Hygiene Index of all patients was scored and compared between Group A and Group B. The scores were statistically evaluated which proved to be statistically significant with ‘p’ value below 0.001 with better oral hygiene in Group A. After extracting the teeth, SEM images of surface of the teeth was graded and statistically evaluated with Pearson's Chi square test.The results were significant with ‘p’ value below 0.001 which indicated increased surface roughness in Group B compared to the Group A patients. Use of Resin Modified Glass Ionomer Varnish (Clinpro XT Varnish) as an adjunctive to thorough oral hygiene measures and has proven to be effective in reducing enamel demineralization significantly although not completely. The oral hygiene also improves but, is it the effect of active ingredient of the varnish is not confirmable under this study design.

Fluoride-Containing Orthodontic Adhesives may Reduce the Occurrence of Enamel Demineralization in Patients with Fixed Orthodontic Appliances

Fluoride-containing orthodontic adhesives and decalcification in patients with fixed appliances: a systematic review. Rogers S, Chadwick B, Treasure E. Am J Orthod Dentofacial Orthop 2010;138(4):390.e1-8. E. Angeles Martinez-Mier, DDS, MSD, PhD To determine if fluoride-containing adhesives provided protection against enamel demineralization in patients with fixed orthodontic appliances. Information not available Systematic review Level 1: Good-quality, patient-oriented evidence Grade B: Inconsistent or limited-quality patient-oriented evidence

Fluoride treatment of demineralization in patients following a vegan diet: Observational study

Fluoride treatment of demineralization in patients following a vegan diet: Observational study

Bone demineralization in adult thalassaemic patients: contribution of GH and IGF‐I at different skeletal sites

GH and IGF-I exert an important role in the control of bone formation, as shown by decreased bone mineral density and increased fracture risk in adult hypopituitary patients untreated for GH deficiency (GHD). Different degrees of bone demineralization are frequently reported in patients affected by beta-thalassaemia. Considering the high prevalence of GHD recently observed by our group among adult thalassaemic patients, we elected to study the possible role of GH-IGF-I abnormalities in the pathogenesis of the osteopenia/osteoporosis of this disease. Sixty-four adult thalassaemic patients (49 with thalassaemia major and 15 with thalassaemia intermedia, 23 men and 41 women, aged 31.4 +/- 6.8 years) were studied. Bone mineral density was assessed by dual energy X-ray absorptiometry at lumbar spine in 62 patients and at proximal femur in 58. All patients underwent GHRH (1 microg/kg as an i.v. bolus) plus arginine (0.5 g/kg as a 30-min i.v. infusion) testing. Severe GHD was defined by GH peaks < 9 microg/l, whereas partial GHD was defined by GH peaks ranging from 9 to 16.5 microg/l. Blood samples for IGF-I measurement were collected. Lumbar osteoporosis and osteopenia were demonstrated in 46/62 (74.1%) and 14/62 (22.5%) patients, respectively. Femoral osteoporosis and osteopenia were documented in 22/58 (37.9%) and 32/58 (55.1%) patients, respectively. Severe GHD was demonstrated in 16/64 patients (25%), while 11 additional patients (17.1%) displayed partial GHD. IGF-I standard deviation score (SDS) was low, that is, below -1.88, in the majority (54.6%) of patients. Lumbar T-score values were not correlated with either GH peaks or IGF-I SDS values. Femoral T-score values were positively correlated with GH peaks (r = 0.38, P < 0.005) and IGF-I SDS values (r = 0.39, P < 0.005). Multiple regression analysis pointed to both GH peak and IGF-I SDS as predictors of femoral T-score. Furthermore, mean femoral T-score was significantly lower in patients with severe GHD than in those with normal GH secretion (-2.94 +/- 0.25 vs.-2.15 +/- 0.12, P < 0.01). This study, while confirming the high prevalence of both osteopenia/osteoporosis and somatotropin-somatomedin deficiency in adult thalassaemic patients, indicates that defective GH secretion and diminished serum IGF-I levels may contribute to femoral demineralization in these patients. Further studies are worth carrying out to evaluate the efficacy of biosynthetic GH administration on bone abnormalities of GH-deficient thalassaemic adults.

Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency.

It remains controversial whether long-term glucocorticoids are charged of bone demineralization in patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The aim of this study was to know whether cumulative glucocorticoid dose from the diagnosis in childhood to adulthood in patients with CAH had a negative impact on bone mineral density (BMD). This was a retrospective study. Thirty-eight adult patients with classical and non-classical CAH were included. BMD was measured in the lumbar spine and femoral neck. Total cumulative glucocorticoid (TCG) and total average glucocorticoid (TAG) doses were calculated from pediatric and adult files. We showed a difference between final and target heights (-0.82+/-0.92 s.d. for women and -1.31+/-0.84 s.d. for men; P<0.001). Seventeen patients (44.7%) had bone demineralization (35.7% of women and 70% of men). The 28 women had higher BMD than the 10 men for lumbar (-0.26+/-1.20 vs -1.25+/-1.33 s.d.; P=0.02) and femoral T-scores (0.21+/-1.30 s.d. versus -1.08+/-1.10 s.d.; P=0.007). In the salt-wasting group, women were almost significantly endowed with a better BMD than men (P=0.053). We found negative effects of TCG, TAG on lumbar (P<0.001, P=0.002) and femoral T-scores (P=0.006, P<0.001), predominantly during puberty. BMI was protective on BMD (P=0.006). The TCG is an important factor especially during puberty for a bone demineralization in patients with 21-hydroxylase deficiency. The glucocorticoid treatment should be adapted particularly at this life period and preventive measures should be discussed in order to limit this effect.

Computerized Quantification of Joint Space Narrowing and Periarticular Demineralization in Patients With Rheumatoid Arthritis Based on Digital X-Ray Radiogrammetry

The aim of our work was to evaluate digital x-ray radiogrammetry (DXR) for the quantification of disease-related periarticular demineralization and computerized analysis of joint space distances (JSDA) for the measurement of joint space narrowing as a new diagnostic method for the early detection of joint-associated alterations and for monitoring disease progression in patients with rheumatoid arthritis (RA). Digital radiographs in 313 patients with varying severity of RA were performed annually and assessed by 2 radiologists using modified Larsen and also the Sharp scores within an observation period of 3 years. The hand radiographs underwent measurements of bone mineral density (BMD) and metacarpal index (MCI) by DXR, as well as computerized JSDA at the metacarpal-phalangeal articulation (JSD-MCP) for a cross-sectional and longitudinal study design. Both DXR-BMD (-29.6%; P < 0.01) and DXR-MCI (-31.0%; P < 0.01) revealed a notable reduction dependent on the severity of RA (from grade 1 to grade 5 of the modified Larsen score); the severity dependent decrease of mean JSD-MCP ranged from -31.9% (P < 0.01; Sharp erosion part) to -39.1% (P < 0.01) for the modified Larsen score. Over an observation period of 3 years, a significant decrease of DXR-BMD (-22.3%) and DXR-MCI (-23.3%) as well as JSD-MCP mean (-17.5%) was observed (P < 0.05), whereas an accentuated decline of DXR and JSDA parameters was verified for patients without disease-modifying antirheumatic drugs or methotrexate therapy. Computerized analysis of hand radiographs by DXR and JSDA is a promising approach to assess the severity and to monitor the progression of RA because DXR and JSDA are timely able to measure periarticular demineralization and also narrowing of JSD-MCP dependent on the severity, the medical treatment and the course of RA.

Citrate Reverses Cyclosporin A-Induced Metabolic Acidosis and Bone Resorption in Rats

Background: Cyclosporine A (CsA) causes distal renal tubular acidosis (RTA) and osteoporosis. We have recently reported that the reduction of nitric oxide (NO) exacerbates this condition. Distal RTA may deplete bone mineral due to the chronic buffering of acid in the blood. The interaction of CsA and NO in causing metabolic acidosis and bone demineralization has not been studied previously. Nor has the salubrious effect of citrate therapy. Purpose: To examine the effect of systemic pH correction by citrate on renal electrolyte (Na, K, Cl, NH₃, HCO₃) excretion following acute water loading in CsA-treated and NO-reduced rats. We further evaluated femoral bone density and bone demineralization activity after the same treatments. Methods: Rats received CsA, L-arginine (L-Arg), or nitro-L-arginine-methyl ester (L-NAME), or a combination of CsA+L-NAME plus or minus citrate. Urine and blood electrolytes were examined, as well as the urine excretion of deoxypyridinoline and the bone density of both femurs. Results: CsA and L-NAME reduced urine pH and the serum HCO₃^– concentration, and increased serum K⁺ and Cl^– concentrations. The combination of CsA with L-NAME caused more severe deficits in the serum HCO₃^– concentration and elevations in serum K⁺ and Cl^– concentrations than either drug alone. Both CsA and L-NAME reduced urinary nitrate excretion, which was reversed by co-administration of L-Arg. Co-administration of citrate or L-Arg improved the CsA- and L-NAME-induced acidosis and hyperkalemia. Bone resorption and density of the femurs were decreased by CsA and L-NAME and were additive for both drugs. Co-administration of citrate or L-Arg restored both bone resorption and density to normal levels. Conclusion: CsA induces a hyperchloremic metabolic acidosis with hyperkalemia and a reduction in NO. The ensuing systemic acidosis causes bone resorption and demineralization. These effects were corrected by co-treatment with citrate. Citrate, at least in part, directly reduces the protonation of bone in animals treated with CsA and is recommended as a potential adjunct drug to prevent bone demineralization in patients chronically receiving CsA.

Effect of fluoride varnish on demineralization adjacent to brackets bonded with RMGI cement

Far too often a less-than-optimal esthetic result occurs after orthodontic treatment due to demineralization of enamel adjacent to fixed orthodontic appliances in patients with inadequate oral hygiene. In vitro studies have shown that a resin-modified glass ionomer (RMGI) cement and a fluoride varnish might help clinicians combat this problem. The purpose of this study was to evaluate, in vitro, the effect of a fluoride-releasing cavity varnish on inhibition of enamel demineralization adjacent to orthodontic brackets bonded with RMGI and composite resin cements. Brackets were bonded to 48 extracted human third molars. Half were bonded with a composite resin (Transbond, 3M Unitek, Monrovia, Calif) and half with an RMGI (Fuji Ortho LC, GC America, Alsip, Ill). Each group was further divided into 2, with half receiving an application of fluoride-releasing varnish (Duraflor, Pharmascience, Montreal, Québec, Canada). The samples were cycled in an artificial caries solution for an hour twice daily for 31 days. After each caries challenge, the teeth were brushed with a soft toothbrush to simulate normal mechanical wear of the varnish. The loss of fluoride varnish was timed. Teeth were sectioned longitudinally and photographed under polarized light microscopy. Mean lesion depth was measured, and analysis of variance (ANOVA) (P ≤.0001) and the Duncan multiple range test (P ≤.05) indicated significant differences among the groups. Teeth bonded with composite resin showed a 35% reduction in mean lesion depth when fluoride varnish was applied. Teeth bonded with RMGI cement showed no significant differences in lesion depth between varnish and nonvarnish groups. Both RMGI groups had 50% smaller mean lesion depths when compared with the composite resin group without fluoride varnish. Samples bonded with RMGI cement illustrated a wedge effect, with lesion depth shallower near the bracket. A chi-square test showed that the fluoride varnish was lost significantly faster in samples bonded with Fuji Ortho LC (P =.013). Although the fluoride varnish could not prevent demineralization, it appears to be beneficial in reducing lesion formation. Clinicians should consider applying fluoride varnish on areas of enamel that exhibit demineralization or are at risk of demineralization in patients with poor oral hygiene. (Am J Orthod Dentofacial Orthop 2002;122:125-34)

Amyotrophie et déminéralisation chez les amputés de membre inférieur

Objective To evaluate the degree of both muscular atrophy and demineralization in patients that underwent a lower limb amputation due to vascular disease. Material and method All patients were fitted with a prosthesis, CAT-CAM sockets for Above-Knee(AK) (33 patients) and KBM for Below-Knee (BK) (14 patients), and dynamic feet. CT-Scan of lower limb muscles and Dual Photonic Absorptiometry (DPA) of Ward's triangle, femoral neck, and big trocanter, were performed in both types of amputees. DPA of the tibial plateau was restricted to the BK subset of patients. Values of the involved limb were compared to those of the contralateral one. Muscular atrophy degrees between both subsets (AK and BK) of amputated extremities were also compared. Results The following muscles showed a statistically significant higher degree of atrophy in the injured extremity when compared to the uninjured one: gluteus maximus, gluteus médius, gluteus minimus, rectus femoris, tensor fascia latae and sartorius in AK amputees, and in gluteus maximus, gluteus medius and rectus femoris in BK amputees. In both AK and BK amputees, we objectivized a statistically significant loss of bone mineral density of the injured extremity at all sites. We could not find any correlation between the loss of muscular density and time elapsed from the amputation to definitive fitting for a prosthesis except for AK amputees, where loss of mineral density was related to time elapsed from amputation. When comparing muscles only of the amputated extremity, there were no differences in the muscular density between AK and BK amputees, except for the rectus femoris ( P < 0.05) and tensor fascia latae ( P < 0.05). Conclusions Our results suggest that quadrilateral and CAT-CAM sockets in AK amputees, as well as PTB, PTS and KBM in BK amputees, may increase the risk of muscular atrophy and bone demineralization. In contrast, the use of total contact sockets, practice of routine osteomioplasty and closing bone marrow cavity may decrease the demineralization process.

Degree and course of skeletal demineralization in patients with chronic renal insufficiency.

To Study the degree and course of skeletal demineralization in patients with chronic renal failure gamma-ray bone densitometry of the radius was performed (1) in a cross-sectional study of 88 uremic patients and (2) in a longitudinal study over 13.5 months in 26 of these patients. The results were compared to measurements of bone mineral content/width (BMC/W) in 191 normal adults. Furthermore to evaluate the importance of calcium-metabolic changes in skeletal demineralization of uremic patients measurements of serum ionized calcium (Ca++), phosphate, alkaline phosphatase, immunoreactive parathyroid hormone (i-PTH), intestinal calcium absorption, skeletal X-ray and 99mTechnetium-polyphosphate bone scintigraphy were performed in the majority of the patients. An accelerated bone loss (mean 3.1% per year) was demonstrated in uremic patients together with a significant reduction in BMC/W. The duration of uremia was correlated with the BMC/W values, whereas dialysis treatment as such did not affect BMC/W. The most rapid demineralization occurred in patients with severe hypocalcemia and increased levels of alkaline phosphatase and i-PTH. The presence of bone pain and generalized scintigraphic bone changes of renal osteodystrophy were correlated with BMC/W while radiographic bone changes were not correlated with the degree of skeletal demineralization. It is concluded that osteopenia develops and deteriorates during the course of chronic renal failure. The most severe bone loss is predominantly found in uremic patients with clinical symptoms, generalized scintigraphic bone changes and major disturbances in calcium metabolism.