Objective: To evaluate an innovative approach, Crown Margin Shifting (CMS), for its ability to re-establish the biological width (BW) or supracrestal tissue attachment.
Clinical considerations:Seven patients aged between 25-45 years old, presented with bilateral maxillary premolars with deep interproximal caries violating the BW were recruited for this study. Both study sites received monolithic zirconia crowns with heavy chamfer finish line. The heavy chamfer is thicker and with bevel on the deepest part of experiment site. Clinical parameters were evaluated at baseline, 6 and 12 months after. Radiographic evaluation using CBCT was done to measure marginal bone loss (MBL) and the established BW at the deep proximal finish line.Results revealed significant improvement in Modified Plaque Index (MBI) and Gingival Index (GI) parameters in both sites at the end of the study. The Periodontal Probing Depth (PPD) increased significantly in the first 6 months only for both. The marginal bone loss (MBL) was present in control site throughout the 12 months, whereas in CMS site, it took place only in the first 6 months.
Conclusions:The results support that CMS approach had less radiographic marginal bone loss without a negative influence on the clinical parameters up to one year follow-up.
A 3.5-year-old female from Palestine presented to Jordan Hospital with pharmaco-resistant epilepsy. She was diagnosed with tuberous sclerosis (TS) at six months of age. Onset of seizure activity, consisting of twitching and eye deviation, was noted at age one month. Her symptoms quickly progressed to infantile spasms. Various medications and dietary changes were implemented but without sustained seizure control. The patient underwent a vagal nerve stimulation procedure as a last resort to reduce seizure burden and frequency. Pharmaco-resistant epilepsy is defined as the failure of a patient's seizures to respond to at least two antiepileptic medications that are appropriately chosen and used for an adequate period. Our protocol for vagal nerve stimulation for this age is to start with a stimulus level at 0.25 milliampere and increase it gradually until we reach 2.5 milliampere within six months. Vagal nerve stimulation proved to be a relatively effective method at reducing the frequency and
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