Steroid sex hormones have a significant effect on different organ systems. As far as gingiva are concerned, they can influence the cellular proliferation, differentiation and growth of keratinocytes and fibroblasts. Estrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In addition, some micro-organisms found in the human mouth synthesize enzymes needed for steroid synthesis and catabolism. In women, during puberty, ovulation and pregnancy, there is an increase in the production of sex steroid hormones which results in increased gingival inflammation, characterized by gingival enlargement, increased gingival bleeding and crevicular fluid flow and microbial changes.

The subclinical increase of IL-6 at progesterone peak is not accompanied by clinical changes in the periodontium.

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Considers the relationship between the types of targets or benchmarks used and reward structures adopted in two contrasting performance improvement strategies ± continuous improvement and radical change. Hypothesises that the process of target setting and the reward structures adopted will be different between the two strategies. The propositions are that organisations involved in continuous improvement of a process will base their performance targets on past performance and internal benchmarking, arrived at through consultation and with a mixture of financial and non-financial rewards for achieving targets. For processes involving radical change, targets will be based on external benchmarks imposed by senior management, with financial rewards for their achievement. The findings from a semi-structured questionnaire conducted in 40 UK service organisations reveal that most continuous improvement targets were based on past performance and that processes undergoing radical change made limited use of external benchmarks. In the majority of cases, targets were imposed by managers without consultation, with rewards linked to the achievement of those targets. Financial rewards, particularly financial bonuses, predominated in both improvement strategies. The implications are that the potential benefits of adopting process changes are being constrained. In continuous improvement the lack of participation in target setting could be undermining the team-based empowerment philosophy of the strategy. The aim of radical change is to achieve a paradigm shift involving revolutionary rather than evolutionary change which is less likely to be fulfilled with targets based on past performance.

Invasive cervical resorption (ICR) is a significant defect of the root surface where the hard dental tissues are undermined and become translucent due to the resorptive granulomatous tissue. It is mainly detected on radiographs. The radiographic appearance of ICR is asymmetrical radiolucency with irregular margins and an unchanged root canal. The purpose of this study is to present a comprehensive review together with the characteristics and the treatment of ICR through two cases which were followed-up for 36 months. In both cases the teeth were vital and the management consisted of raising a flap, granulomatous tissue removal, thorough debridement, restoration of the resorptive defect by placing a suitable filling material and follow-up examinations. Our results indicate that the specific treatment protocol has very positive outcomes. After 36 months pulpal vitality tests revealed a healthy pulp, and clinical and radiographic examination confirmed a stable periodontal condition.