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J Sandy

Publications and source records attributed to J Sandy.

At least 19 recordsLinked to original sources

Orthodontics. Part 12: Combined orthodontic treatment.

Dentistry is becoming more sophisticated and capable of providing much higher treatment standards than ever before. Treatments previously considered impossible can now be achieved as a direct consequence of these advances. However, this increased complexity of treatment also means that the different branches of dentistry have, as a necessity, become more and more specialised. It is important that the specialities collaborate in a systematic focused way to ensure the optimal treatment outcome with the minimum burden of care for the patient.

Cuspid↗

Orthodontics. Part 11: orthodontic tooth movement.

Orthodontic tooth movement is dependent on efficient remodelling of bone. The cell-cell interactions are now more fully understood and the links between osteoblasts and osteoclasts appear to be governed by the production and responses of osteoprotegerin ligand. The theories of orthodontic tooth movement remain speculative but the histological documentation is unequivocal. A periodontal ligament placed under pressure will result in bone resorption whereas a periodontal ligament under tension results in bone formation. This phenomenon may be applicable to the generation of new bone in relation to limb lengthening and cranial-suture distraction. It must be remembered that orthodontic tooth movement will result in root resorption at the microscopic level in every case. Usually this repairs but some root characteristics apparent on radiographs before treatment begins may be indicative of likely root resorption. Some orthodontic procedures (such as fixed appliances) are also known to cause root resorption.

Biomechanical Phenomena↗

Orthodontics. Part 10: Impacted teeth.

This section deals with the important issue of impacted teeth. Impacted canines in Class I uncrowded cases can be improved by removal of the deciduous canines. There is some evidence that this is true for both buccal and palatal impactions. Treatment of impacted canines is lengthy and potentially hazardous. Interceptive measures are effective and preferred to active treatment. Supernumerary teeth may also cause impaction of permanent incisors, their early diagnosis and appropriate treatment is essential to optimise final outcomes. If there are any doubts about impacted teeth it is better to refer too early than too late, this latter option may unnecessarily extend the length of treatment as well as the treatment required.

Bicuspid↗

Orthodontics. Part 9: anchorage control and distal movement.

Anchorage is an important consideration when planning orthodontic tooth movement. Unwanted tooth movement known as loss of anchorage can have a detrimental effect on the treatment outcome. Anchorage can be sourced from the teeth, the oral mucosa and underlying bone, implants and extra orally. If extra-oral anchorage is used, particularly with a facebow then the use of at least two safety devices is mandatory.

Alveolar Process↗

Orthodontics. Part 8: Extractions in orthodontics.

Extractions in orthodontics remains a relatively controversial area. It is not possible to treat all malocclusions without taking out any teeth. The factors which affect the decision to extract include the patient's medical history, the attitude to treatment, oral hygiene, caries rates and the quality of teeth. Extractions of specific teeth are required in the various presentations of malocclusion. In some situations careful timing of extractions may result in spontaneous correction of the malocclusion.

Bicuspid↗

Orthodontics. Part 7: Fact and fantasy in orthodontics.

Clinical research has previously lacked good methodology and much opinion was based on anecdote which is widely regarded as the weakest form of clinical evidence. There are few randomised control trials in orthodontics which support or refute areas of dogma. The number of randomised control trials is increasing significantly. There is currently however no good evidence that orthodontics causes or cures temporomandibular joint dysfunction, that appropriate extractions in orthodontics ruin patients' profiles, or that the orthodontist is able to significantly influence facial growth with appliances.

Evidence-Based Medicine↗

Orthodontics. Part 6: Risks in orthodontic treatment.

Orthodontics has the potential to cause significant damage to hard and soft tissues. The most important aspect of orthodontic care is to have an extremely high standard of oral hygiene before and during orthodontic treatment. It is also essential that any carious lesions are dealt with before any active treatment starts. Root resorption is a common complication during orthodontic treatment but there is some evidence that once appliances are removed this resorption stops. Some of the risk pointers for root resorption are summarised. Soft tissue damage includes that caused by archwires but also the more harrowing potential for headgears to cause damage to eyes. It is essential that adequate safety measures are included with this type of treatment.

Dental Caries↗

Orthodontics. Part 5: Appliance choices.

There are bewildering array of different orthodontic appliances. However, they fall into four main categories of removable, fixed, functional and extra-oral devices. The appliance has to be selected with care and used correctly as inappropriate use can make the malocclusion worse. Removable appliances are only capable of very simple movements whereas fixed appliances are sophisticated devices, which can precisely position the teeth. Functional appliances are useful in difficult cases and are primarily used for Class II Division I malocciusions. Extra-oral devices are used to re-enforce anchorage and can be an aid in both opening and closing spaces.

Humans↗

The use of osseointegrated implants in orthodontic patients: I. Implants and their use in children.

Implants have been used successfully for the rehabilitation of edentulous adults. However, their use in children is limited because of the special problems of implants relating to continuing growth and development. This, the first of two articles, provides a review of the use of osseointegrated implants in the context of facial growth, and the role of the orthodontist in the management of implant-supported prosthodontic structures. A second article will discuss the role of implants in orthodontics in providing what has been termed 'absolute anchorage'.

Anodontia↗

Orthodontics. Part 4: Treatment planning.

The treatment plan is an integral part of orthodontic management. It should be divided into both treatment aims (what do you want to do?) and plan (how are you going to do it?). The treatment aims will include, for example overjet reduction. The plan will consider how to create space in order to accomplish this as well as the appliance system that will be used.

Humans↗

Orthodontics. Part 2: Patient assessment and examination I.

The patient assessment forms the essential basis of orthodontic treatment. This is divided into an extra-oral and intra-oral examination. The extra-oral examination is carried out first as this can fundamentally influence the treatment options. The skeletal pattern, soft tissue form and the presence or absence of habits must all be taken into account.

Cephalometry↗

Arylamine N-acetyltransferases: a pharmacogenomic approach to drug metabolism and endogenous function.

The arylamine N-acetyltransferases (NATs) are a unique family of enzymes that catalyse the transfer of an acetyl group from acetyl-CoA to the terminal nitrogen of hydrazine and arylamine drugs and carcinogens. The NATs have been shown to be important in drug detoxification and carcinogen activation, with humans possessing two isoenzymes encoded by polymorphic genes. This polymorphism has pharmacogenetic implications, leading to different rates of inactivation of drugs, including the anti-tubercular agent isoniazid and the anti-hypertensive drug hydralazine. Mice provide a good model for human NAT, allowing genetic manipulation of expression to explore possible endogenous roles of these enzymes. The first three-dimensional NAT structure was resolved for NAT from Salmonella typhimurium, and subsequently the structure of NAT from Mycobacterium smegmatis has been elucidated. These identified a 'Cys-His-Asp' catalytic triad (conserved in all NATs), which is believed to be responsible for the activation of the active site cysteine residue. As more genomic data become available, NAT homologues continue to be found in prokaryotic species, many of which are pathogenic, including Mycobacterium tuberculosis. The discovery of NAT in M. tuberculosis is particularly significant, since this enzyme participates in inactivation of isoniazid in the bacterium, with implications for isoniazid resistance. Structural studies on NAT proteins and phenotypic analyses of organisms (both mice and prokaryotes) following genetic modifications of the nat genes are leading to an understanding of the potentially diverse roles of NAT in endogenous and xenobiotic metabolism. These studies have indicated that NAT, particularly in Mycobacteria, has the potential to be a drug target. Combinatorial chemical approaches, together with in silico structural studies, will allow for advances in the identification of NAT substrates and inhibitors, both as experimental tools and as potential drugs.

Animals↗

Arylamine N-acetyltransferases - of mice, men and microorganisms.

Arylamine N-acetyltransferases (NATs) catalyse the transfer of an acetyl group from acetyl CoA to the terminal nitrogen of hydrazine and arylamine drugs and carcinogens. These enzymes are polymorphic and have an important place in the history of pharmacogenetics, being first identified as responsible for the polymorphic inactivation of the anti-tubercular drug isoniazid. NAT has recently been identified within Mycobacterium tuberculosis itself and is an important candidate for modulating the response of mycobacteria to isoniazid. The first three-dimensional structure of the unique NAT family shows the active-site cysteine to be aligned with conserved histidine and aspartate residues to form a catalytic triad, thus providing an activation mechanism for transfer of the acetyl group from acetyl CoA to cysteine. The unique fold could allow different members of the NAT family to play a variety of roles in endogenous and xenobiotic metabolism.

Alleles↗

Arylamine N-acetyltransferase of Mycobacterium tuberculosis is a polymorphic enzyme and a site of isoniazid metabolism.

Arylamine N-acetyltransferases (NATs; E.C 2.3.1.5) N-acetylate arylhydralazine and arylamine substrates using acetyl coenzyme A. Human NAT2 acetylates and inactivates the antituberculosis drug, isoniazid (INH), and is polymorphic. We previously demonstrated that there is a homologue of human NAT2 in Mycobacterium tuberculosis, whose product N-acetylates INH in vitro. We now demonstrate that the nat gene is expressed in M. tuberculosis and M. bovis Bacille Calmette-Guerin (BCG), using reverse transcription-polymerase chain reaction and Western blotting. The NAT protein is active in M. bovis BCG in vivo, as detected by the presence of N-acetyl INH in M. bovis BCG lysates grown in INH. Sequence analysis of the M. tuberculosis nat coding region reveals a single nucleotide polymorphism in 18% of a random cohort of M. tuberculosis clinical isolates, conferring a G to R change. The recombinant mutant protein appears less stable than the wild type, and has an apparent affinity for INH of 10-fold less than the wild type. Modelling the change in M. tuberculosis NAT shows that the G to R change is close to the active site, and supports the experimental findings. Minimum inhibitory concentration data suggest that this polymorphism in nat is linked to low-level changes in the INH susceptibility of M. tuberculosis clinical isolates.

Acetylation↗

Structure of arylamine N-acetyltransferase reveals a catalytic triad.

Enzymes of the arylamine N-acetyltransferase (NAT) family are found in species ranging from Escherichia coli to humans. In humans they are known to be responsible for the acetylation of a number of arylamine and hydrazine drugs, and they are strongly linked to the carcinogenic potentiation of certain foreign substances. In prokaryotes their substrate specificities may vary and members of the gene family have been linked to pathways including amide synthesis during rifamycin production. Here we report the crystal structure at 2.8 A resolution of a representative member of this family from Salmonella typhimurium in the presence and absence of a covalently bound product analog. The structure reveals surprising mechanistic information including the presence of a Cys-His-Asp catalytic triad. The fold can be described in terms of three domains of roughly equal length with the second and third domains linked by an interdomain helix. The first two domains, a helical bundle and a beta-barrel, make up the catalytic triad using a structural motif identical to that of the cysteine protease superfamily.

Acetanilides↗

Initial cleft size does not correlate with outcome in unilateral cleft lip and palate.

Clinical outcomes in children born with a cleft lip and palate (CLP) have been an area of interest for orthodontists for a number of years. Whilst tools for measurement of these outcomes are available, there is no widely accepted measure of initial cleft severity and no known quantitative indices. Therefore, the potential influence of initial severity remains unmeasured and largely ignored. The aim of this investigation was to determine the importance of initial cleft severity in determining patient outcome. The longitudinal records of 49 children born with a unilateral cleft lip and palate (UCLP), and treated in a single centre were examined. An index of initial cleft severity was developed that categorizes the cleft area as a percentage of the total palate area. The dental arch relationships of the same patients at 6 years of age were also determined. The nature of the association between these was investigated for agreement and correlation by calculation of weighted Kappa and Spearman's correlation coefficient, respectively. No evidence was found in this sample that the initial cleft area had any bearing on the quality of outcome at 6 years of age.

Adolescent↗