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Biomedical subjects

K K Kapur

Publications and source records attributed to K K Kapur.

At least 19 recordsLinked to original sources
PubMed1991

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part III: Comparisons of masticatory scores between two treatment modalities.

Five Veterans Administration Medical Centers participated in a study to determine the comparative influence of fixed partial dentures (FDPs) supported by endosteal blade implants and removable partial dentures (RPDs) on masticatory performance. The study design, methodology, and success rates have been described in Parts I and II. A total of 232 patients received comprehensive dental care, including RPDs for 118 patients and FPDs for 114. Three standardized masticatory tests were made with peanuts and carrots before treatment. These tests were repeated at 16 weeks following RPD or implant insertion and thereafter at 6, 18, 36, and 60 months. At entry, there were no significant differences in performance scores and chewing time and strokes taken to reach the swallowing threshold between the RPD and FPD groups (p greater than 0.05). After treatment completion, FPDs and RPDs significantly improved the masticatory ability of patients with Kennedy class I or class II edentulous conditions (p less than 0.001). The improvements in performance scores for both test foods were slightly better in the RPD group than in the FPD group, although none of the 30 mean differences was significant (p greater than 0.05). After the baseline period to 60 months, only slight changes in performance scores were observed for both groups. RPDs and FPDs were comparable in improving the chewing efficiency of patients with Kennedy class I and class II partially edentulous conditions.

Adult↗
PubMed1991

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part IV: Comparisons of patient satisfaction between two treatment modalities.

This study compares treatment assessments made by two groups of patients with Kennedy class I or class II mandibular edentulous conditions, who received either a removable partial denture (RPD) (N = 115) or one or two fixed partial dentures (FPDs), each supported distally by a blade implant (N = 113). Two questionnaires were administered, one at 16 weeks after the implant or RPD insertion and at the 6-month interval and the other at 18, 36, and 60 months. Marked functional improvements were perceived by a large majority of patients in both groups after the insertion of prosthesis. At 6 months, a higher percent of patients with RPDs than those with FPDs found it easy to clean their RPDs and experienced chewing discomfort, restriction of food choices, feeling of insecurity with their RPDs, and difficulty with their pronunciation. The exclusion of assessments by 25 RPD patients, whose treatment was judged to be a failure functionally, made the mean differences between the two treatments statistically significant (p less than 0.05) only for ease of cleaning in favor of the RPD and fewer restrictions of food choices in favor of the FPD group. At 60 months, significant differences between the percents of patients with the most favorable responses occurred for perceptions of eating enjoyment, food particles seldom getting under the removable partial denture, and improvement in social life in favor of the FPD treatment and for the ease of cleaning the removable partial denture in favor of the RPD treatment. The results seem to support superiority of the FPD in terms of patient satisfaction, but not enough to favor this type of prosthesis over the RPD without consideration of other pertinent factors.

Adaptation, Psychological↗
PubMed1990

Effects of anaesthesia of human oral structures on masticatory performance and food particle size distribution.

Ten persons with intact dentitions performed a series of 6 masticatory tests, employing 5, 10, 20, 40, 80 and 160 strokes to chew standard quantities of peanuts on their preferred chewing side for each of three test conditions: (1) before anaesthesia: (2) after maxillary anaesthesia; and, (3) after maxillary and mandibular anaesthesia (unilateral). A seventh test employing 20 strokes was also repeated on the non-anaesthetized contralateral side. The chewed food was sieved through 5, 10, 20, 40, 80 and 100 mesh screens. The percentage of the ratio of the volume of peanuts that passed through the sieve and the total volume of recovered food provided the performance score for the given sieve. The performance scores increased significantly with the number of stokes and dropped markedly after anaesthesia. The maximum reduction of 19.6% in the mean masticatory performance and 46% in the mean masticatory efficiency occurred after unilateral anaesthesia at 10 mesh particle size in the 20-stroke test. An average of 40 strokes was required after unilateral anaesthesia to achieve almost the same performance achieved with 20 strokes before anaesthesia. The regression slopes, derived from the 5, 10 and 20 mesh particle distributions showed that coarse particles were ground more rapidly than fine particles before anaesthesia. This preferential comminution became less evident after maxillary anaesthesia and was least evident after unilateral anaesthesia. The regression slope for the control peaked at 10 strokes as compared to 20 strokes after unilateral anaesthesia. Thus peripheral sensory impairment affects masticatory efficiency in dentate persons.

Adult↗
PubMed1989

Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair?

Tricuspid regurgitation severity was assessed preoperatively with Doppler color flow mapping and these assessments were compared with surgical findings in 90 patients undergoing mitral or aortic valve replacement, or both. Group I (n = 52) required tricuspid valve annuloplasty because tricuspid regurgitation was judged intraoperatively to be severe; in Group II (n = 38), tricuspid valve annuloplasty was not performed because tricuspid regurgitation was judged intraoperatively not to be severe. With use of the apical four chamber and parasternal short-axis imaging planes, the severity of tricuspid regurgitation by Doppler color flow mapping was assessed by comparing the maximal area of tricuspid regurgitant signals with the right atrial area taken in the same frame in which the maximal tricuspid regurgitant signals were noted. This ratio was found to be greater than or equal to 34% (mean 50.2 +/- 11.8%) in 50 (96%) of 52 patients in Group I and less than 34% (mean 27.5 +/- 6.9%) in 36 (95%) of 38 patients in Group II (p less than 0.001). The maximal diastolic tricuspid anulus diameter measured with the same two-dimensional imaging planes was greater than or equal to mm/m2 body surface area (mean 26.7 +/- 5.2 mm/m2) in 46 patients (88%) in Group I and less than 21 mm/m2 (mean 17.8 +/- 2.5 mm/m2) in 36 patients (95%) in Group II (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1989

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part II: Comparisons of success rates and periodontal health between two treatment modalities.

Five Veterans Administration centers have participated in a study to determine whether fixed partial dentures (FPDs) supported by blade implants offer an acceptable substitute for mandibular unilateral or bilateral distal-base extension removable partial dentures (RPDs). The study design and methodology have been described in Part I. A total of 232 patients received comprehensive dental care including RPDs for 118 patients and FPDs for 114. Prespecified criteria determined treatment failures. During the 60-month period, treatment failures occurred in 19 FPD patients and 30 RPD patients. Ten FPD failures occurred before and nine after the FPD insertion. Five RPD failures were caused by abutment tooth loss and 25 for not using the RPD while eating. Life table analysis showed 5-year success rates of 84.2% for the FPD and 74% for the RPD. The 17.9% higher FPD success rate in Kennedy class II patients was both statistically and clinically significant. Excluding the 10 early failures, the 5-year FPD success rate was 91.5%. Of the 170 attempted implants, 26 failed, including 12 before the FPD fabrication. Radiographic assessments by a panel of three judges showed no bone deterioration during baseline to 60 months in 29.6%, slight in 25.4%, moderate in 15.9%, marked in 27%, and severe deterioration in 2.1% of the implant posts.

Blade Implantation↗
PubMed1989

Doppler color flow mapping in the evaluation of prosthetic mitral and aortic valve function.

Doppler color flow mapping and color-guided conventional Doppler studies were performed on 119 patients with 126 prosthetic valves (mitral alone in 60, aortic alone in 52 and both mitral and aortic in 7 patients) within 2 weeks of the catheterization study or surgery, or both. The mean pressure gradients derived by color-guided continuous wave Doppler ultrasound correlated well with those obtained at catheterization for both the tissue and mechanical mitral and aortic prostheses (r = 0.85 to 0.87). For the effective prosthetic orifice areas, better correlation with catheterization results were obtained with the tissue mitral (r = 0.94) and tissue aortic (r = 0.87) prostheses than with the mechanical mitral (r = 0.79) and mechanical aortic (r = 0.76) prostheses. The maximal width of the color flow signals at their origin from the tissue mitral prostheses also correlated well with the effective prosthetic orifice area at catheterization (r = 0.81). Doppler color flow mapping identified prosthetic valvular regurgitation with a sensitivity and specificity of 89% and 100%, respectively, for the mitral and 92% and 83% for the aortic prostheses. There was complete agreement between the Doppler color flow mapping and angiographic grading of the severity of prosthetic valvular regurgitation in 90% of mitral and 73.5% of the aortic regurgitant prostheses with under- or overestimation by greater than 1 grade in only two cases. Valvular and paravalvular regurgitation was correctly categorized by Doppler color flow mapping in relation to the surgical findings in 94% of the mitral and 80.5% of the aortic prostheses.

Adult↗
PubMed1988

Color-guided Doppler echocardiographic assessment of aortic valve stenosis.

The severity of valvular aortic stenosis was assessed by Doppler color flow mapping in 100 consecutive patients who underwent successful cardiac catheterization within 2 weeks of the Doppler study. The maximal width of the aortic stenosis jet seen in 61 of these patients (Group A) was measured at the aortic valve. Color-guided continuous wave Doppler examination was used to measure the mean transaortic pressure gradient, and the aortic valve area was estimated using the simplified continuity equation. The aortic stenosis jet was not seen in 39 patients (Group B), and the mean pressure gradient and aortic valve area in these patients were assessed by conventional Doppler echocardiography alone. The mean pressure gradient obtained by continuous wave Doppler study and cardiac catheterization in the 61 Group A patients correlated well (r = 0.90); the correlation was lower in the 39 Group B patients (r = 0.70). The overall correlation for the combined Groups A and B was good (r = 0.82). The aortic valve area estimated by continuous wave Doppler study and cardiac catheterization in 54 Group A patients correlated well (r = 0.92); the correlation in 22 Group B patients was lower (r = 0.71). The correlation for all 76 patients (Groups A and B) was good (r = 0.80). The maximal aortic stenosis jet width also correlated well with the aortic valve area estimated at catheterization in 54 patients (r = 0.90). Group C represented an additional 14 patients in whom the left ventricle could not be entered during cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Requirements for clinical trials.

Significant progress and valuable contributions have been made by pioneers in the field of dental implantology during the past 20 years. The feasibility of clinical application of dental implants for specific prosthodontic conditions has been demonstrated by several reports based upon retrospective data or surveys of clinical experiences. However, there is a lack of reliable scientific information to determine the clinical efficacy of implant-supported prostheses or the physiological merits of the two types of implant-bone interface. Similarly, there are no known studies that have tested the relative efficacy of different implant systems. The claims of success rates for different implants can only be substantiated when controlled, independent studies are made, following research protocols that meet the requirements of clinical trials in terms of delineation of hypothesis, definition of treatment, entry and treatment allocations, exclusions and withdrawals, sample size, and a coordinated plan for the statistical analysis of data and interpretation of results. The study design of the VA Cooperative Study has followed the essential requirements of clinical trials in comparing the efficacies of the two treatment modalities--traditional removable partial dentures versus fixed partial dentures supported by implants.

Blade Implantation↗
PubMed1987

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part I: Methodology and comparisons between treatment groups at baseline.

This study was conducted to determine whether fixed partial dentures supported by dental implants provide an acceptable alternative to conventional removable partial dentures in patients with Kennedy class I or class II edentulous conditions. The acceptability of the new treatment will be based on success rates, impact on the health of the remaining dentition, masticatory performance, patient satisfaction, and maintenance care and cost. The study was planned also to provide comparisons between two designs commonly used by dentists for fabricating removable partial dentures. The designs differed only in terms of the type of the retainer (clasp type) and tooth support (rest location). A total of 272 patients with Kennedy class I and class II edentulous conditions were assigned on a random basis to one of the treatment groups, 134 to receive a removable partial denture and 138 a fixed partial denture supported by a blade-vent implant. All of the patients were medically screened and met prespecified criteria for oral hygiene, bone support for abutment teeth, and size of the residual ridge. Thirty-four patients were eliminated from the study before completion of their treatment. An additional six patients with early implant failures were reentered in the study and followed up as a separate group. The remaining 232 patients received comprehensive dental care, including removable partial dentures for 118 and fixed partial dentures for 114 patients. A series of examinations, radiographs, masticatory performance tests, patient satisfaction, food selection questionnaires, and dietary history were completed before initiation of the treatment, 16 weeks after the insertion of an RPD or an implant, and thereafter at 6-, 18-, 36-, and 60-month intervals. In addition, patients were seen at 6-month intervals for a recall dental examination, oral prophylaxis, plaque instructions, radiographic survey of the implant, and any needed dental treatment. The randomization stratification approach produced two treatment groups with comparable age, number of remaining maxillary and mandibular teeth, type of opposing dentition, and percent of patients with Kennedy class I and class II edentulous conditions. The mean scores of bone support, tooth mobility, and sulcular depths of abutment teeth were also similar. Significant but comparable improvements in oral hygiene and sulcular depth occurred in the two groups after treatment. The periodontal health scores at the 16-week interval serve as the baseline to measure subsequent changes in periodontal health.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Replicability of electromyographic recordings of the masseter muscle during mastication.

This study evaluates the reliability of a method to duplicate the location of surface electrodes for recording the electromyographic activity of masseter muscles during mastication and quantifying the activity by a microcomputer system. A plastic framework consisting of a bite fork and electrode positioners was used to place the electrodes by relating the positioners to an occlusal index and keeping this relationship constant at subsequent sittings. EMG recordings were repeated on two different days for each of 10 subjects while they performed standardized masticatory performance tests with peanuts and carrots. The muscle activity recorded with hardware integrators was an average of 26.7% of the computerized software integrations but measures derived from the two methods of integration were highly correlated (r = 0.965) and yielded similar results. Significant correlations were found between test sessions for each measure of masticatory performance and integrated EMG activity for ipsilateral and contralateral muscles. For each subject, no significant differences were found between sessions for any masticatory performance or EMG variable. The results indicate that reliable inter session EMG recordings during mastication can be made by using the template for positioning of the electrodes. In addition, the microcomputer data acquisition system provides results comparable to those obtained with conventional hardware integrators, with the added benefit of providing information on each individual stroke and its various components.

Adolescent↗
PubMed1986

Clinical efficacy of dental radiography in the detection of dental caries and periodontal diseases.

This article reports the ability of dental radiographs to correctly detect evidence of dental caries and periodontal disease (sensitivity) and to correctly establish the absence of these diseases (specificity). The analysis used a unique data set that was collected as part of the Veterans Administration Dental Longitudinal Study in Boston. Periapical, panoramic, and posterior bitewing radiographs were independently compared with a consensus radiographic standard of all three radiographs read simultaneously. Findings showed that the sensitivities of all three radiographs to detect dental caries were lower than expected, at approximately 60%, whereas the sensitivities to detect evidence of periodontal disease averaged approximately 85%. Panoramic radiographs were substantially less sensitive for detecting dental caries than periapical and posterior bitewing radiographs, but no difference between these modalities was observed in the analysis of sensitivity to periodontal disease. The proportion of false-negative and false-positive readings from dental radiographs was substantial and requires further investigation.

Adult↗
PubMed1985

Studies of biologic parameters for denture design. Part III: Effects of occlusal adjustment, base retention, and fit on masseter muscle activity and masticatory performance.

EMG recordings of ipsilateral and contralateral masseter muscles and standardized masticatory performance tests were made in 20 denture wearers before and after modifications were made to their clinically unsatisfactory dentures. The improvement of retention and stability by correction of gross occlusal prematurities and by the use of a denture adhesive or base reline with a soft tissue-conditioning material did not significantly alter the chewing performance or muscle activity during mastication in denture wearers. The results support our previous findings that the influence of denture factors on chewing ability of denture wearers is limited. To avoid variations in EMG activity caused by changes in electrode positions, all tests for a given subject were made at the same sitting. Thus the study design did not provide time to denture wearers for their neuromuscular mechanism to adapt to the modifications prior to testing masticatory function. A replication of this study that permits sufficient adaptation time after each modification is suggested to validate the findings.

Adhesives↗