Dental implant retaining screws: the effect of using gold or titanium on preload

MDent, Faculty of Health Sciences, University of the WitwatersrandPURPOSE The purpose of this in vitro investigation was to determine the effect of using either gold or titanium retaining screws on preload in the dental implant body-abutment complex. This preload is of vital importance for the long term success of the dental implant complex. Inadequate preload results in either loosening or fracture of the retaining screw, and is the most commonly occurring mechanical complication in implant supported/retained prostheses. Similar complications occur when excessive preload is applied to the retaining screws. These complications can result in unscheduled visits with costly and time consuming repairs for the clinician and patient. Routine maintenance protocols for implant supported prostheses range from biannually to five year visits to the dentist. Maintenance visits involve removal of the prosthesis facilitating cleaning of both the implant and prosthesis and inspection of retaining screws . This study sought to gain insight into changes in preload generation after repeated torque application to gold and titanium screws and to observe whether gold or titanium generated better preload. A maintenance protocol would be suggested if any observable pattern was noted. MATERIALS AND METHODS The test setup consisted of an implant body, a cylindrical transmucosal abutment and the retaining screws (gold or titanium). The implant body was anchored using a load cell. Transmucosal abutments were attached to the implant body using either a gold or titanium v retaining screw. A torque gauge was used to apply torque of 20Ncm, 32Ncm and 40Ncm to the retaining screws. This was undertaken to investigate the effect of gold or titanium on preload generated. The effect of applying torque beyond manufacturers recommended 32Ncm was carried out to see if greater preloads could be achieved. All components were from the Southern Implant system. RESULTS Gold retaining screws were found to achieve consistently higher preload values than titanium retaining screws. Preload values were not significantly different from the first to the tenth torque cycle. Titanium screws showed more consistent preload values, albeit lower than those of gold retaining screws. However due to possible galling of the internal thread of the implant body by titanium screws, gold screws remain the retaining screw of choice. Maintenance protocols suggest replacing retaining screws every 20 years. After ten torque cycles were applied to each screw there was an insignificant change in preload generated in both titanium and gold screws. This study was therefore inconclusive with regards to maintenance protocols. CONCLUSION Within the limitations of this study, gold retaining screws generated better preload than titanium. Torque application beyond manufacturers’ recommendations resulted in a more stable implant complex. Further investigation into repeated torque application to retaining screws is required, to determine ideal maintenance protocols

Emotional intelligence and effective team functioning of MBA syndicate groups at the NMMU business school

A common issue in leadership development is the high flyers who reach a position where their lack of “soft” skills hampers their performance and proves a barrier to their continued progression to higher levels of responsibility (Newell, 2002: 288). Business Schools offering Masters in Business Administration (MBA) programmes assist in developing managers with not just managerial competence but also with “soft” skills. By delivering educated business managers, these managers through their intellectual skills and community sensitive values, will lead future transformational processes. It is useful and interesting to consider how important emotional intelligence is for effective performance at work. A considerable body of research suggests that an employee’s ability to perceive, identify, and manage emotion provides the basis for the kinds of social and emotional competencies that are important for success in almost any position. Furthermore, as the pace of change increases and the world of work make ever-greater demands on an employee’s cognitive, emotional, and physical resources, this particular set of abilities will become increasingly important (Cherniss, 2000). The primary objective of this study is to determine the perceptions of the Masters in Business Administration (MBA), B-Tech in Business Administration (BBA), Advanced Business Programme (ABP) programmes and the Business School Alumni to determine the overall emotional intelligence profile of students as well as the effective team functions of the syndicate groups. Based on the main findings of the survey, it was concluded that emotional intelligence is an important factor for the NMMU Business School, MBA Unit students. The skills attained through the course work will not only improve team effectiveness in the syndicate group functioning but also enhance their performance in the business environment. The MBA team learning experiences enhances workplace learning as the ability to work in a team and ability to think and act independently are highly desired skills and competencies for success in the workplace

The employment of individuals with hearing impairment in the KwaZulu-Natal private sector: current employers’ perceptions and experiences.

Masters Degrees (Audiology). University of KwaZulu-Natal. Westville, 2018.Background: Despite policies and legislation mandating the employment of persons with disabilities, individuals with hearing impairment continue to face barriers and challenges accessing the labour market and have typically experienced higher rates of unemployment or underemployment. In South Africa, the majority of individuals with disabilities remain dependent on social-welfare to meet basic needs and as a result, their potential remains grossly untapped. Misconceptions regarding the capabilities of hearing impaired individuals have resulted in the occupational marginalization of this population. Objective: This study aimed to investigate employers’ perceptions and experiences in recruiting and retaining individuals with hearing impairment in KwaZulu-Natal Provinces’ private sector. Method: A descriptive survey with quantitative methods of analysis was used to obtain information from employers, human resource personnel or management in various industries who have employed individuals with hearing loss. The Chronbach Alpha suggested that the self-administered questionnaire had good internal consistency (p = 0.858). A total of 30 responses were obtained from the 19 companies who agreed to participate. Results: Approximately 75% of participants indicated either a medium or low level of awareness regarding disability. Legislation such as the Employment Equity Act (EEA, no 55 of 1998) and the Skills Development Act (SDA, no 97 of 1998) were considered the most useful legislature, as indicated by 66.7% of participants. Those who indicated that external services or resources, such as the KZN Blind and Deaf Society and eDeaf were used during recruitment and retention were more likely to report to the benefits of employing hearing impaired individuals, this being statistically significant (p < 0.001). Less than half of the participants reported that reasonable accommodations were provided for their employees, and half indicated that they were willing to provide sign language interpreters. Most participants (70%) suggested that communication difficulties, particularly in meetings, contributed towards poor employment rates amongst individuals with hearing impairment. Communication difficulties were further endorsed by 73.3% of participants as a major challenge when recruiting and hiring persons with hearing impairment. Other concerns related to the safety of employees and attitudes of co-workers. Conclusion: The findings suggest that a lack of familiarity of disability and disability legislature can manifest in reliance on erroneous stereotypes that individuals with disabilities are poor job performers and incapable of working independently. However, with the use of reasonable accommodations which includes sign language interpreters and desensitization workshops, employers were able to successfully integrate hearing impaired employees into the workforce

Contractile Effects of Radiofrequency Energized Helium Plasma on the Fibrous Septal Network

Body contouring with liposuction has evolved significantly from the early approach of simply debulking excess fatty tissue, to affecting the mechanical properties of different tissue types and layers. Operative paradigms have been expanded to apply energy-based technologies intraoperatively to provide more uniform aspiration, selective fatty tissue emulsification in soft and fibrous body areas, minimize trauma to nerves and vessels, expose the fibrous septal network, reduce operator fatigue and help deliver smooth shapes with less discomfort and bruising. Advanced refinements with the delivery of monopolar and bipolar radiofrequency energy for soft tissue heating have been shown to reduce the residual soft tissue laxity that often follows voluminous fat removal. The Renuvion® (Apyx™ Medical, Clearwater, FL) radiofrequency powered helium plasma technology introduces an emerging concept in which the delivery of subdermal thermal energy preferentially coagulates the fascia and fibrous septal network through a conductive helium plasma stream seeking the path of least resistance, which in turn results in collagen contraction and tissue shrinkage that permits re-draping of the skin and enhanced definition. The physics and mechanics of Renuvion® subdermal soft tissue coagulation will be presented, along with clinical applications that have provided the authors more contouring finesse and has augmented liposuction outcomes

Deciding on prosthodontic treatment in children with inherited dental abnormalities : should psychological or dental well-being take precedence?

Children with inherited dental anomalies have many complex problems that may interfere with their physical, mental and psychological well-being.1,2 The anomalies generally present early in life as isolated conditions, or associated with other defects, and may require immediate as well as prolonged multidisciplinary management.2 The spectrum of defects is diverse, as is the range of deformities that can manifest in the head and neck region.1 Common to all is their potential to have “profound negative consequences for the individual and their families, ranging from aesthetic concerns that impact on their self-esteem, to masticatory difficulties, tooth sensitivity, financial burdens, and protracted dental treatment.”http://www.sada.co.zaam2019Prosthodontic

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

The Changes of Skin Temperature on Hands and Feet During and after T3 Sympathicotomy for Palmar Hyperhidrosis

Unilateral thoracic sympathectomy in patients with palmar hyperhidrosis causes a skin temperature drop in the contralateral hand. A cross-inhibitory effect by the post-ganglionic neurons innervating hands is postulated as a mechanism of contralateral vasoconstriction. The purpose of our study was to evaluate whether this cross-inhibitory effect also occurs in the feet. Twenty patients scheduled for thoracoscopic sympathicotomy due to palmar hyperhidosis were studied. Right T3 sympathicotomy was performed first, followed by left T3 sympathicotomy. The thenar skin temperatures of both hands and feet were continuously monitored using a thermometer and recorded before induction of anesthesia, during the operation, 4 hr after and 1 week later. Following right T3 sympathicotomy, the skin temperature of the ipsilateral hand gradually increased, however the skin temperature of the contralateral hand gradually decreased. Immediately after bilateral sympathicotomy, the skin temperature differences between hands and feet increased, but these differences decreased 1 week later. Our results show that cross-inhibitory control may exist in feet as well as in the contralateral hand. Thus, the release of cross-inhibitory control following T3 sympathicotomy results in vasoconstriction and decrease of skin temperature on the contralateral hand and feet. One week later, however, the temperature balance on hands and feet recovers

Assessing the clinical severity of the Omicron variant in the Western Cape Province, South Africa, using the diagnostic PCR proxy marker of RdRp target delay to distinguish between Omicron and Delta infections - a survival analysis

BACKGROUND: The extent to which the reduced risk of severe disease seen with SARS-CoV-2 Omicron is due to a decrease in variant virulence, or higher levels of population immunity, is currently not clear. METHODS: RdRp target delay (RTD) in the Seegene AllplexTM 2019-nCoV PCR assay is a proxy marker for the Delta variant. The absence of this proxy marker in the transition period was used to identify suspected Omicron infections. Cox regression was performed for the outcome of hospital admission in those who tested positive for SARS-CoV-2 on the Seegene AllplexTM assay from 1 November to 14 December 2021 in the Western Cape Province, South Africa, public sector. Vaccination status and prior diagnosed infection, were adjusted for. RESULTS: 150 cases with RTD and 1486 cases without RTD were included. Cases without RTD had a lower hazard of admission (adjusted Hazard Ratio [aHR] of 0.56, 95%CI 0.34-0.91). Complete vaccination was protective of admission with an aHR of 0.45 (95%CI 0.26-0.77). CONCLUSION: Omicron has resulted in a lower risk of hospital admission, compared to contemporaneous Delta infection, when using the proxy marker of RTD. Under-ascertainment of reinfections with an immune escape variant remains a challenge to accurately assessing variant virulence