Osseointegration depends on the activity of osteoblastic cells to form and maintain bone. Although changes in implant design, surgical technique, and restorative method may be improved with regard to osseous responses, the fundamental aspects of bone cell biology and osseous physiology must be considered as a source for additional clues of improving implant success. Particularly, molecular and cellular information concerning the process of osteogenesis at implant surfaces is presently required. The aim of this article is to identify molecular and cellular determinants of bone formation that may be used in clinical attempts to improve the application of endosseous implants for dental and craniofacial prosthetics. A review of bone biology, dental and orthopedic implant manuscripts was performed using published monographs and Medline. It is indicated that molecular and cellular approaches for formation of bone mass may be used to enhance or expand the application of dental implants. The regulation of cellular activity should be the guide to the development of novel strategies for improving tissue integration of dental prostheses.

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Morphological changes in the external nose after surgical anterior shift of the maxilla were evaluated. The absence of morphological change is desirable unless morphological modification is an objective of the surgery. Presently, however, the degree of postoperative morphological changes in the external nose is difficult to anticipate. Morphological changes are clinically encountered also during the period of postoperative orthodontic treatment. In this study,primarily postoperative morphological changes in the external nose and the course of such changes were evaluated. We examined 9 females who underwent surgical anterior shift of the maxilla at our university hospital school of dentistry, using standard lateral head X-ray films and front-view facial photographs in the natural position obtained before,1 month after, and 1 year after surgery. The apex of the nose was shifted anteriorly in all patients

<br>1 month after surgery but returned posteriorly in 8 of the 9 patients after 1 year. Vertically, upward shifts of the nasal apex were observed in 7 of the 9 patients, and downward shifts were observed in the remaining 2.Returns to the preoperative level were observed in 7 of the 9 patients including those that showed downward shifts. The distance between the wings of the nose was increased in all patients 1 month after surgery. It showed a return in 4 of them after 1 year but increased further in the remaining 5. The acceptable range of morphological changes of the external nose varies among individuals and is difficult to evaluate using a uniform scale, but none of the 9 patients in this study complained about the postoperative nasal morphology. However, morphological changes did occur, and further improvernents in preventive measures against them are anticipated. Also, considerations of the external nose morphology are thought to be necessary in planning occlusal reconstitution.

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This clinical study reviewed intravenous sedatior for 1313 cases in 634 patients at the Department of Dental Anesthesiology, Iwate Medical University, over a period of 10 years and 6 months from July 1989 to December 1999. Patients were classified retrospectively into one of the following four groups according to the reason for sedation:Group I, comparatively major invasive surgery, although not to an extent requiring general anesthesia(n=169);Group M, medically compromised dental patients(n=296);Group D, behaviour management for disabled patients(n= 624);and Group O, other difficulties associated with dental treatment(n=341). The Dental Center for Special Patients(dentistry for the handicapped)was requested to perform intravenous sedation in the largest number of cases(612 cases), with 326 from department of oral surgery, and 317 from other institutes. The number of cases from the departments of conservative dentistry, pedodontics and prosthodontics were notably few. Administration of midazolam as the sole sedative occurred in the vast majority of cases(1109 cases). Treatment was completed within 30 mi皿tes in 642 cases. Most(559 cases)were monitored for periods of between 31 and 60 minutes. Both mean treatment time and monitoring time for Group D were significantly shorter than for other groups. In the M/T value, a sigrlificant difference was found between Groups D and M. Systemic complications were preoperatively known in 226 cases of circulatory disorders.Electrocardiogram abnormalities were noted in 86 cases, rlervous system disorders in 71, respiratory disorders in 69, and metabolic or endocrinal disorders in 55. Intraoperative complications comprised 17 cases of reduced SpO2. Four cases of restriction of the respiratory tract due to depression of the base of the tongue were noted in Group D. Postoperative complications involved nausea in 6 cases. Vomiting was noted in 2 cases。 No serious intra-or postoperative complications were noted. Of the 1313 cases,149 were admitted as in-patients. To provide the most appropriate and safe form of dental treatment to larger numbers of patients in the future requires improved consultation between departments, which in turn relies upon the provision of detailed information to these departments, particularly to the departments of conservative dentistry and prosthodontics in our hospita]、 We further recommend that the use of intravenous sedation for dental treatment be extended to use in patients requiring less invasive treatments as well as to those in good health.

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