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Biomedical subjects

H Devlin

Publications and source records attributed to H Devlin.

At least 37 records · Page 2Linked to original sources

Developmental basis of retinal-specific induction of cancer by RB mutation.

Understanding why children with RB mutations specifically develop retinoblastoma will contribute to the understanding of the fundamental principles of cancer. Only a subset of developing retinal cells are at risk for developing cancer when RB is mutant because rod photoreceptor and bipolar cells never normally express RB. Retinoblastomas are observed to arise commonly in the inner nuclear layer, where they can show features attributed to outer nuclear layer cells (photoreceptors). The best-studied function of RB is control of the cell cycle, and the usual tissue consequence of loss of RB is apoptosis. Perhaps the specificity of RB mutation for retinal cancer resides in the dependency of this tissue on programmed cell death to achieve a precise architecture of individual types of interconnecting neurons. The additional mutations that are present in all retinoblastoma, such as the i(6p) marker chromosome, may interrupt signals that normally would induce apoptosis when RB is absent. A combination of loss of cell cycle control and loss of signals that delete extra cells would result in retinoblastoma.

Animals↗

Expression of cartilage-derived retinoic acid-sensitive protein during healing of the rat tooth-extraction socket.

Cartilage-derived retinoic acid sensitive protein (CD-RAP) is a recently described, cartilage-specific protein. During early healing of the tooth-extraction socket, cells express both chondrogenic and osteogenic cell markers, but no cartilage is formed. Cartilaginous collagen type II protein, a major constituent of hyaline cartilage, has not been detected in the healing socket, although type IX collagen, which coats these fibres, has been detected transiently in early socket healing. This study investigated the spatial and temporal expression of CD-RAP and various osteoblast cell markers, i.e., alkaline phosphatase, osteopontin, osteonectin and osteocalcin, during healing. Immunolocalization of these proteins was determined in the rat tooth socket at 3, 4, 5, 6, 7, 8, 10 and 14 days after extraction. CD-RAP was expressed by preosteoblast cells maximally at 6, 7, and 8 days after extraction. Fully differentiated osteoblasts expressed osteocalcin, a specific osteoblast marker. Preosteoblasts and fibroblasts did not express osteocalcin. On double immunofluorescent staining, some preosteoblasts coexpressed CD-RAP (indicative of chondrogenic differentiation), and either alkaline phosphatase or osteopontin (markers of osteogenic stem-cell maturation). There was no colocalization between osteopontin and osteonectin. CD-RAP was unique amongst the cell markers used in that it was expressed by preosteoblasts, but not by osteoblasts lining the newly formed trabeculae. CD-RAP may have an important role in osteoblast cell differentiation during bone healing.

Alkaline Phosphatase↗

The reproducibility of the mandibular cortical index.

OBJECTIVES: To assess the reproducibility and diagnostic validity of Mandibular Cortical Index (MCI) when used by minimally trained observers. METHODS: Four 'experts' and 45 final-year dental students classified the appearance of the lower border of the mandibular cortex in 30 panoramic radiographs using the MCI. Experts viewed the original radiographs. The students received instruction in the MCI and viewed slides of the radiographs in a lecture theatre. RESULTS: For intra-observer agreement, the experts had significantly higher overall values of weighted kappa, indicating substantial agreement in MCI assessment, whereas the students showed moderate agreement. For inter-observer agreement, there was fair agreement between the experts and poor agreement between the students. Using the experts' MCI assessment as the 'gold standard', the mean sensitivity of the students in diagnosis of C3 was 0.71 (maximum 0.95, minimum 0.25) and mean specificity was 0.56 (maximum 0.9, minimum 0.20). CONCLUSIONS: The MCI has important limitations in terms of intra- and inter-observer agreement. Minimal training in its use, such as might be given in a lecture format to dentists, was ineffective and associated with poor inter-observer agreement and limited diagnostic validity in identifying signs of osteoporosis. More lengthy training and experience in using the MCI would be needed for it to be effective as a diagnostic tool in general dental practice.

Clinical Competence↗

Radiomorphometric indices of the mandible in a British female population.

OBJECTIVES: To examine the radiomorphometric indices of the mandible on panoramic radiographs in a population of British female patients, to identify their normal ranges and to investigate their relationships with age, detentition and social class. METHODS: Five indices, cortical width at the gonion (GI) and below the mental foramen (MI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) and one new index (measurement of cortical width at the antegonion; AI), were measured bilaterally on 500 panoramic radiographs of females by one trained observer. The measurements were analysed for ease of application, repeatability, relationships with age, dentition and social class and interrelationships between the variables. RESULTS: All quantitative indices (GI, MI, PMI, AI), showed a significant, negative correlation with age. MCI showed an age-related distribution. Mandibular dentition exerted a significant influence on some indices, but social class had no influence. Intra-observer repeatability of MI, PMI and AI was fair (precision < 20%) but that for GI was poor. Intra-observer agreement in MCI assessments was excellent. CONCLUSIONS: The age-related changes in mandibular radiomorphometric indices and their variation within each age band lend support to their potential use in identification of skeletal osteopenia. However, problems with repeatability and measurement precision identified in the pilot study, notably with GI, may be a considerable obstacle to their use in general practice.

Adult↗

Osseointegration of titanium metal implants in erbium-YAG laser-prepared bone.

Titanium screws were implanted in rat calvarial defects of identical size using either a laser or bur. The aims of this study were to determine whether the screws were able to osseointegrate in a laser-prepared bone defect and to compare the pattern of bone healing around these screws. The optimal laser settings to produce a 0.7-mm-diameter hole in the rat calvaria were determined. A 0.7-mm-diameter hole was prepared on the left calvaria with the erbium-YAG laser to receive a 1-mm-diameter self-threading titanium screw. Each animal also received a 0.7-mm-diameter hole prepared on the right calvaria with a conventional metal bur, and a 1-mm-diameter self-threading screw implant was placed. Rats were killed humanely either 3 weeks or 3 months after surgery, and the skulls were processed in paraffin wax for histological analysis. Laser-prepared defects: At 3 weeks, the screw was surrounded by vital woven bone. The dura mater was perforated, and cystic change was present in the underlying brain tissue. There was active bone formation adjacent to the screw surface, deposited on a thin zone of necrotic bone. At 3 months, the screws were osseointegrated, and the brain tissue was healed by gliosis. Bur-prepared defects: At 3 weeks, there was extensive remodeling around the prepared defect. The dura mater was intact, and there was no damage to the underlying brain. At 3 months, the screws were successfully osseointegrated with bone adjacent to the screw. Osseointegration of titanium screws can be achieved using an erbium-YAG laser to prepare the implant bed.

Animals↗

Preventing failed appointments in general dental practice: a comparison of reminder methods.

OBJECTIVE: To test the effectiveness of different systems of reminding patients about their appointments in order to reduce the rate of failed attendance. The expense in implementing a reminder system for patients was also estimated. DESIGN: A clinical study in a single-handed dental practice. SUBJECTS: Patients were reminded about their appointment using either postal, manual telephone or automated telephone reminders (or all three combined). A control group received no reminders. 500 patient attendances were recorded in each group. RESULTS: Patients failed to attend for 130 of the 2500 appointments considered in the study. There was a significant reduction in the failed attendance rate from 9.4% (with no reminder) to a minimum of 3% when a reminder was given to the patient before the appointment. However, there was no significant difference among the four reminder test groups, indicating that the form of the reminder made no difference to the failure rate. CONCLUSIONS: Reminding patients using postal or manual telephone techniques is effective at improving attendance. All of the reminder methods, telephone and postal, provided net cost savings rather than additional costs.

Appointments and Schedules↗

Current perspectives in residual ridge remodeling and its clinical implications: a review.

PURPOSE: This article reviews the current understanding of the biology of tooth extraction wound healing and residual ridge remodeling. METHODS: The review of the biology of tooth extraction wound healing involves a discussion of the different cells populating the tooth extraction wound, the matrix formation, and the control of the repair process in the short-term. Defects in socket matrix formation or cellular activity will lead to stalled healing. The review of residual ridge remodeling describes the long-term result of tooth extraction and formation of residual ridges, in which the quantity of bone tissue continuously decreases. This may suggest that any potential regulatory factors of residual ridge resorption should have an adverse effect either on the increased catabolic activity by osteoclasts or on the decreased anabolic activity by osteoblasts. Both short-term tooth extraction healing and long-term residual ridge remodeling processes are interdependent. Furthermore, any potential genetic and environmental regulatory factors can affect the quality and quantity of bone by altering the gene expression events taking place in bone cells. RESULTS: The intent of this article was to review the current progresses of biologic research on residual ridge remodeling and to relate the changes at molecular, cellular, and tissue levels. The understanding of residual ridge remodeling may provide a sound scientific basis for improved restorative and therapeutic treatments of the edentulous population.

Alveolar Process↗

A comparison of maxillary and mandibular bone mineral densities.

STATEMENT OF PROBLEM: The success rate of implant osseointegration is dependent on many factors such as bone mineral density, volume and vascularity of bone, implant design, ridge shape, and patient selection criteria among others. PURPOSE: This study examined whether a technique to measure differences in bone mineral density in the maxilla and mandible might be useful to predict the likelihood of successful osseointegration. MATERIAL AND METHODS: Bone densitometry of the jaws was performed with a densitometer, and bone mineral density was calculated at three regions of the maxilla and one site in the mandibular body in 39 edentulous subjects. RESULTS: Significant differences were found between the mean bone mineral density of each site when compared with the three other locations. The mean bone mineral density for the mandible (mean = 1.11 g.cm-2), was twice that of the anterior maxilla (mean = 0.55 g.cm-2). Both were significantly greater than the bone mineral density of the posterior maxilla (mean = 0.31 g.cm-2; including the hard palate, mean = 0.45 g.cm-2). The bone mineral densities at the three maxillary sites were all highly correlated (r > or = 0.78, p < 0.001). CONCLUSION: The dissimilarity in bone mineral density at different mandibular and maxillary sites may partly explain some variation in previously reported osseointegration rates. The posterior maxilla had the lowest bone mineral density and in certain circumstances before implant insertion, bone augmentation, or guided tissue regeneration may be advisable to improve the rate of osseointegration. Because the radiation dose is low, dual energy x-ray absorptiometry may be a useful noninvasive technique for determining the bone mineral density before implant insertion.

Absorptiometry, Photon↗

The relationship between mandibular bone mineral density and panoramic radiographic measurements.

OBJECTIVES: To compare densitometric and linear measurements (mandibular cortical thickness, MCT; panoramic mandibular index, PMI) made from dental panoramic tomograms (DPTs) with bone mineral density (BMD) values obtained using dual energy X-ray absorptiometry (DXA) of the mandible and to determine whether measurements from DPTs have validity in predicting BMD. METHODS: Forty edentulous female patients were examined by a DPT incorporating a nickel step wedge and by DXA of the mandible. In each case the equivalent nickel thickness of sites in the mandibular body, MCT and PMI values were calculated and their relationship with DXA measurements assessed. RESULTS: Densitometric measurements of DPTs did not correlate with mandibular BMD. MCT significantly correlated with mandibular BMD (r = 0.50, P = 0.001 and r = 0.36, P = 0.021 for repeated measurements) as did PMI (r = 0.37, P = 0.019 and r = 0.38, P = 0.016 for repeated measurements). All three measurements from DPTs had limited repeatability. MCT and PMI had moderate sensitivity and specificity for diagnosis of low mandibular BMD. Using ROC analysis, MCT and PMI measurements of one observer were significantly more valid than densitometry for diagnosis of low mandibular BMD. CONCLUSIONS: It may be feasible to use MCT and PMI as diagnostic indicators of mandibular BMD, but further work is required to overcome problems with repeatability and to provide a larger patient sample.

Absorptiometry, Photon↗

The relationships between two indices of mandibular bone quality and bone mineral density measured by dual energy X-ray absorptiometry.

OBJECTIVES: To establish whether a relationship exists between the bone quality index (BQI), the mandibular cortical index (MCI) and bone mineral density (BMD) of the body of the mandible as measured by dual energy X-ray absorptiometry (DXA). METHODS: Mandibular DXA and panoramic radiography were performed on 40 edentulous female patients. Mandibular body BMD was calculated by manual analysis of DXA scans. Panoramic radiographic appearances of the mandibles were assessed according to the BQI and MCI. All assessments were performed by two observers. RESULTS: There were significant correlations between BQI and BMD (P < 0.01 for both observers) and between MCI and BMD (P < 0.005), but MCI was the more dominant of the two variables. Inter-observer agreement between BQI assessments was superior to that between MCI assessments. There were marked differences between intra-observer agreement for the two observers for both indices. CONCLUSIONS: Both BQI and MCI are significantly related to BMD. However, particularly in the case of MCI, there were problems in repeatability of assessments which might limit their use in clinical practice.

Absorptiometry, Photon↗

Bone mineral density and composition in rat pregnancy: effects of streptozotocin-induced diabetes mellitus and insulin replacement.

A disturbed calcium homeostasis characterizes diabetic pregnancy. This study documents changes in bone mineral composition in diabetic pregnant rats and examines the effect of insulin replacement. Control pregnant (CP), diabetic pregnant (DP) and insulin-treated DP (DPi) rats were assessed for femoral calcium and magnesium content, bone mineral density (BMD) and the ratio of hypertrophic to maturing and proliferative cells in the femoral growth plate. DP rats showed a significantly (P < 0.01) lower body weight, femoral weight and length than CP rats. Femoral calcium and magnesium content was also significantly (P < 0.05) lower in DP rats, as was ash weight. When calcium and magnesium were normalized for ash weight no significant differences were apparent. A significantly (P < 0.05) lower total BMD at the distal femur was seen in DP rats. This comprised a significantly (P < 0.01) lower trabecular BMD with no significant change in cortical BMD. A significantly (P < 0.05) higher ratio of hypertrophic to maturing and proliferative cells of the femoral growth plate was evident in DP animals. DPi rats showed normal blood glucose concentrations and femoral growth plate histology. DPi rats also showed normal femoral weight and length but only partially restored femoral ash weight and mineral content. Insulin failed to normalize total or trabecular BMD. Diabetes mellitus clearly has a marked effect on bone growth and mineral content in pregnancy which may be relevant to overall calcium homeostasis. The lower bone growth, bone calcium content and trabecular BMD may be unfortunate consequences of the marked hypercalciuria reported elsewhere in diabetes and may serve to maintain normocalcaemia in the disease.

Animals↗

The prevention of failed appointments in general dental practice.

AIM: To identify those patients most likely to fail to attend dental appointments. DESIGN: Retrospective analysis of the attendance pattern of patients. SETTING: A National Health Service practice in Kent. SUBJECTS AND METHODS: Dental records of 1000 patients. MAIN OUTCOME MEASURES: Data (age, gender, plaque score, treatment planned, whether the patient was exempt from charges, distance between their home and the practice) were related to attendance history. RESULTS: 34.8% of patients receiving income support and 24.8% of children failed to attend compared with 18.6% of non-exempt adults. Differences between non-exempt adults and children [per cent difference 6.2%, CI = (0.6%, 11.8%)] and for those receiving income support [per cent difference 16.2%, CI = (6.2%, 26.2%)] were significant (P < 0.05). A significant improvement in the appointment failure rate was achieved using telephone reminders. CONCLUSIONS: Patients exempt from dental charges (mainly children and those receiving income support) were more likely to have failed to attend for their appointment. Whereas the attendance of children may be outside their control in some cases, we hypothesise that factors such as poverty in the group receiving income support may be an important influence in whether these patients feel able to attend for their appointments.

Adolescent↗

Pattern of healing of calvarial bone in the rat following application of the erbium-YAG laser.

BACKGROUND AND OBJECTIVE: The aim of this study was to examine the pattern of healing in rat calvarial defects prepared with the erbium-YAG laser, using the "guided tissue regeneration" technique [Dahlin et al., Scand J Plast Reconstr Hand Surg 1990;24: 13-19]. STUDY DESIGN/MATERIALS AND METHODS: PTFE membranes were placed over the lased skull defects and the skin wounds sutured. Rats were killed humanely at intervals after surgery and the skulls processed for paraffin wax histology. A further group of mature rats was killed humanely and the calvariae removed. Slots were prepared using the erbium-YAG laser and immediately examined under the environmental scanning electron microscope (ESEM) in hydrated conditions, which avoided drying artefact. RESULTS: An amorphous, mineral-rich carbon layer surrounds the lased bone defect, which in the in vivo experiments was seen as a basophilic zone that was resistant to resorption. CONCLUSION: Bone infilling of the lased defect was retarded by delayed resorption of the amorphous, mineral-rich carbon layer.

Animals↗

Panoramic mandibular index as a radiomorphometric tool: an assessment of precision.

OBJECTIVES: To evaluate the intra-observer repeatability and inter-observer reproducibility of the measurements used in deriving the Panoramic Mandibular Index (PMI). METHODS: Two observers measured 21 dental panoramic radiographs independently of each other, both repeating the measurements after a period of 1 week. The measurements were then evaluated using a number of statistical methods. RESULTS: All sets of compared measurements, both within and between observers, demonstrated significant positive correlations, with no significant difference between measurements Precision, however, was poor and variable. CONCLUSION: The main difficulties in obtaining consistency in repeated measurements were related to individual morphology and radiodensity. In order to improve the validity of the PMI as a measure of local bone loss, repeatability of the measurements should be improved. Suggestions as to how this, might be achieved are discussed.

Absorptiometry, Photon↗

Trabecular bone formation in the healing of the rodent molar tooth extraction socket.

The aim of this study was to investigate the nature of the template structure on which trabecular bone formation occurs during healing of the rodent tooth extraction socket, a well studied bone healing system. The presence of collagen type II mRNA has previously been described in the healing socket, although the formation of the protein or cartilage has not been observed. However, recent evidence from developmental and other bone healing studies indicates that collagen type III may be important in forming the preliminary scaffold on which bone trabeculae are formed. The maxillary right molar teeth were removed from rats under general anaesthesia and the animals killed at various times afterward. The tissues were examined using histological, in situ hybridization, and immunohistochemical staining techniques. It was concluded that collagen type IIA mRNA was produced by osteoblast cells of the socket, but that collagen type II, if present, would account for less than 0.01% of the total proteins extracted. During bone formation, Sharpey's fibers were seen radiating from the peripheral bone toward the center of the socket. These optically active collagen fibers were inserted into the forming bone trabeculae and were recognized by antibodies raised against collagen type III. The arrangement and composition of these fibers therefore suggest that they form a preliminary framework on which deposition of woven bone trabeculae occurs.

Animals↗

Healing of tooth extraction sockets in experimental diabetes mellitus.

PURPOSE: This study was undertaken to examine the healing of molar tooth extraction sockets in the streptozotocin-treated, diabetic rat. MATERIALS AND METHODS: Insulin-dependent diabetes mellitus was induced in a group of mature Sprague-Dawley rats by injecting streptozotocin. Control animals were injected with citrate buffer only. A third group of rats were also injected with streptozotocin, but the diabetes was controlled by daily injections of insulin. After 2 weeks, all of the rats underwent extraction of the right maxillary molar teeth under general anesthesia. The rats were killed at varying intervals and the maxilla and calvaria recovered in continuity. Tissue sections were stained with hematoxylin-eosin and periodic acid-Schiff (PAS), the latter to identify diabetic microangiopathy. RESULTS: At 10 days after tooth extraction in the control and insulin-streptozotocin-treated rats, thick collagen fibers formed a pretrabecular scaffold that dictated the direction of the forming trabeculae. The collagen fibers in the diabetic socket were thin and scanty, and formed a narrow layer in the apical part. There was no evidence of diabetic microangiopathy in the extraction sockets of diabetic, insulin-treated diabetic, or normal rats. CONCLUSION: These histologic observations suggest that in uncontrolled, insulin-dependent diabetes, the formation of the collagenous framework in the tooth extraction socket is inhibited, resulting in delayed healing and increased alveolar destruction.

Alveolar Bone Loss↗

Mandibular bone mineral density as a predictor of skeletal osteoporosis.

A considerable amount of work has been performed on methods of detecting individuals with low bone mass at an early stage. Some researchers have considered if dental radiographs could have a role in the detection of individuals with osteoporosis. A basic requirement for this would be that bone mass in the jaw relates significantly to that of other skeletal sites in which osteoporosis is a significant problem. The first aim of this study was to investigate the relationship between mandibular bone mineral density (BMD) and that of other skeletal sites commonly used for bone densitometry in the detection of osteoporosis. The second aim was to assess the validity of mandibular BMD as a predictor of BMD in these other sites. 40 edentulous females underwent dual energy X-ray absorptiometry (DXA) of the lumbar spine (L2-L4), DXA of the right femoral neck, single photon absorptiometry (SPA) of the proximal and distal forearm and DXA of the mandible. Significant correlations were observed between BMD in the mandibular body, ramus and symphysis and all other skeletal sites (p < 0.02). Five patients (12.5%) had age matched Z-scores of -1.0 or lower in all three non-mandibular sites (lumbar spine, femoral neck and forearm). Using these patients as the proportion of the population with a positive finding of "low bone mass", the sensitivity and specificity of mandibular BMD in predicting low bone mass for these patients was determined. Where a diagnostic threshold for low mandibular BMD was set at one standard deviation below the mean, the mandibular body BMD measurement gave high sensitivity (0.8) and specificity (0.97), the symphysis BMD low sensitivity (0.4) but a high specificity (0.77), while the ramus BMD had a moderate level of sensitivity (0.6) and high specificity (0.91). It is concluded that mandibular BMD assessed by DXA correlates significantly with BMD measurements of other important skeletal sites. The higher correlation coefficients and the greater sensitivity and specificity for the body of mandible suggest that this site should be used for any potential clinical application of dental radiographs in detection of osteoporosis.

Absorptiometry, Photon↗

Immediate addition to acrylic partial dentures.

The conventional method of adding teeth to an existing prosthesis has the disadvantage that patients must be without their dentures while the teeth are added. Whilst a new immediate denture avoids this, it means that the patient will have to grow accustomed to the shape of a new polished surface. The method described in this paper eliminates these problems by making an immediate addition to the existing partial denture. Additionally, the technique has been found to be beneficial to those patients who are unable to tolerate conventional impression taking procedures.

Acrylic Resins↗