Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Thursday, March 31, 2022

At least 3 years of self-responsibility for periodontal care after 2 years of supportive periodontal therapy

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Abstract

Objectives

This study aimed to investigate the periodontal condition when patients became self-responsible for the continuation of periodontal care, after non-surgical periodontal therapy and 2 years of Supportive Periodontal Therapy (SPT).

Materials and methods

Fifty-seven patients completed a previous 2-year SPT study and were afterward advised to seek for dental assistance for maintenance care. After 4.2 ± 0.45 years of self-responsibility for periodontal care (SRPC), 27 patients could be re-examined of which 9 patients had followed the advice to turn to a dental professional for SPT care. Visible Plaque (VPI), Gingival Bleeding (GBI), Periodontal Probing Depth (PPD), Bleeding on probing (BOP), and Clinical Attachment Loss (CAL) were obtained from SPT study: before and after non-surgical treatment, and after 2 years of SPT. The same parameters were reassessed for the present study. General linear models for repeated measures were used for data analysis.

Results

At the end of the SRPC period, mean GBI, BOP, and PPD values (43.5%, 55.7%, 2.76 mm, respectively) were back to pre-treatment, whereas VPI (64.3%) and CAL (3.76 mm) became significantly higher. The percentage of sites with PPD ≥5 mm as well as sites with CAL ≥4 or ≥5 mm also returned to pre-treatment values. However, the percentage of sites with PPD ≥4 mm was still significantly lower compared to pre-treatment values but higher than after 2 years of SPT.

Conclusions

Self-responsibility for the continuation of periodontal care after professional treatment should be avoided.

Clinical relevance

Clinicians and specialists must be conscious of making all efforts to maintain the patient's frequent recalls.

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Descriptive analysis of recurrences of nasal intestinal‐type adenocarcinomas after radiotherapy

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Abstract

Background

Despite adjuvant radiotherapy, rates of recurrences of endoscopically operated nasal intestinal-type adenocarcinomas (ITAC) have not been improved in successive series. To better understand how to improve local control, we aimed to investigate the site of local recurrences of ITACs.

Methods

Retrospective study in a reference center in sinonasal malignancies. For all patients with a local recurrence, radiotherapy plans were retrieved and compared to the delineation of local recurrences.

Results

Of 63 patients, 54 underwent adjuvant radiotherapy of which 14 (25.9%) had a local recurrence. Eleven of them had their onset in an optimally irradiated area. Difficulty to dissect the cribriform plate and/or the lateral lamina was reported for 11 patients with local recurrences in the operative reports (p <0.0001).

Conclusions

Most of recurrences arose in an optimally irradiated area. A close cooperation between surgeons and radiotherapists is required to define areas at risk and adapt treatment.

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A Mass in the Infratemporal Fossa

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A 51-year-old woman presented with headache, jaw pain, paresthesia, trismus, and a history of anxiety, depression, emphysema, hyperlipidemia, migraines, pseudoseizures, and no pertinent surgery nor head trauma. What is your diagnosis?
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Key Issues in Use of Prophylactic Steroids to Prevent Hypocalcemia and Voice Dysfunction After Thyroidectomy—Reply

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In Reply We thank Ms Kane and colleagues for their feedback on our article.
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Disability After Computerized Vestibular Retraining for Stable Unilateral Vestibular Deficit

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This cohort study evaluates whether vestibular retraining using computerized dynamic posturography is associated with reduced participant-reported disability for patients with an objectively assessed unilateral peripheral vestibular deficit.
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Vestibular Rehabilitation for Unilateral Peripheral Vestibular Deficits

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In the 1940s, Cawthorne and Cooksey noted that patients with unilateral vestibular dysfunctions who exercised coped better with their symptoms and made a faster recovery than patients who did not exercise. These original exercise protocols were developed to treat patients with labyrinth injury resulting from head injury or surgery. Vestibular rehabilitation can be defined as a set of exercises designed to facilitate central nervous system plasticity through adaptation or by generating substitute mechanisms among patients with balance disorders, thus improving their overall stability and helping them resume their daily activities. Vestibular rehabilitation has been practiced for almost 70 years and evidence related to its efficacy and effectiveness has increased over the last 15 to 20 years. According to the Cochrane systematic review by McDonnell and Hillier, there is moderate to strong evidence that vestibular rehabilitation (movement, exercise based) is a safe and effective approach for unilateral peripheral vestibular disorders.
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Evaluation of digital construction, production and intraoral position accuracy of novel 3D CAD/CAM titanium retainers

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Abstract

Objectives

New opportunities have arisen to manufacture three-dimensional computer-aided design/computer-aided manufacturing (3D CAD/CAM) retainers from titanium blocks by digital cutting technology. These novel technologies need to fulfill requirements regarding digital planning and position accuracy. The aim of the present study was to investigate the digital construction, the CAD/CAM production and the intraoral positioning accuracy of custom-manufactured novel 3D CAD/CAM titanium retainers.

Materials and methods

A total of 37 prime4me® RETAIN3R (Dentaurum, Ispringen, Germany) retainers were inserted to stabilize the upper anterior front teeth. Following insertion, an intraoral scan was used to record the position. The intraoral position was compared to the virtual setup using 3D superimposition software. Measurement points were evaluated in all three dimensions (horizontal, sagittal and vertical planes). Data were analyzed using Kruskal–Wallis test followed by Dunn's multiple comparison test.

Results

A total of 185 measurements were performed. The horizontal plane and the sagittal plane demonstrated a high level of positioning accuracy between the planned and the intraoral position. Statistically significant deviations between the preceding virtual setup and the intraoral situation were observed in the vertical dimension. Within the retainer, the intraoral positioning accuracy decreased for the measurement points in the direction of the distal retainer segment.

Conclusion

Based on the results, the present study shows a high level of congruence between the 3D virtually planning and the final intraoral position of the fabricated novel 3D CAD/CAM titanium retainers.

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Expert consensus on dental caries management

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International Journal of Oral Science, Published online: 31 March 2022; doi:10.1038/s41368-022-00167-3

Expert consensus on dental caries management
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Wednesday, March 30, 2022

Air polishing or hand and/or power-driven instruments in supportive periodontal therapy

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This review of air polishing devices (APDs) in comparison with hand instruments and/or power-driven instruments in supportive periodontal treatment and implant maintenance included 6 RCTs. 4 of the 6 included studies were considered to be at high risk of bias so the findings should be interpreted cautiously.

The post Air polishing or hand and/or power-driven instruments in supportive periodontal therapy appeared first on National Elf Service.

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Comparison of stress distribution between zirconia/alloy endocrown and CAD/CAM multi-piece zirconia post-crown: three-dimensional finite element analysis

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Abstract

Objectives

This study aimed to evaluate a digital multi-piece zirconia post-crown to restore a mandibular second molar with extensive coronal loss and limited restoration space, and to compare the stress distribution between endocrowns made of zirconia or alloy and CAD/CAM multi-piece zirconia post-crowns.

Material and methods

Four three-dimensional finite element analysis models of a mandibular second molar with extensive coronal loss and limited restoration space were created as follows: (A) intact molar; (B) zirconia endocrown restored molar; (C) multi-piece post-crown restored-molar with tapered nail; (D) multi-piece post-crown restored molar with T-shaped nail. Models C and D were divided into two subgroups according to the material type: C1/D1, zirconia; C2/D2, NiCr alloy. The maximum modified von Mises failure criterion (mvM) stresses were calculated, and the stress distribution was recorded to analyze the effects of the restoration and material types on the biomechanical properties of dentin and prosthesis.

Results

The maximum mvM stress of dentin in model B (33.80 MPa) was lower compared with models C (C1, 37.81 MPa; C2, 36.36 MPa) and D (D1, 36.34 MPa; D2, 34.97 MPa) under vertical load, but the opposite was observed under oblique load. The highest mvM stress was concentrated in the nail region located in the root canal, and the T-shaped nail values were greater than the tapered nail, whereas model D with T-shaped nail showed a lower mvM stress level in dentin compared with Model C with tapered nail.

Conclusions

The digital multi-piece zirconia post-crown is a potential approach to restore mandibular second molars with extensive coronal loss and limited restoration space.

Clinical relevance

The digital multi-piece zirconia post-crown has potential to restore mandibular second molars with extensive coronal loss and limited restoration space using an innovative approach.

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The implicated clinical factors for outcomes in 304 patients with salivary duct carcinoma: Multi‐institutional retrospective analysis in Japan

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Abstract

Background

Salivary duct carcinoma (SDC) is a high-grade salivary malignancy that frequently occurs as the carcinomatous component of carcinoma ex pleomorphic adenoma. We herein examined the clinical factors affecting outcomes in a large cohort of SDC.

Methods

We selected 304 SDC cases and investigated clinical characteristics and the factors affecting outcomes.

Results

The median age of the cases examined was 68 years, the most common primary site was the parotid gland (238 cases), and there was a male predominance (M/F = 5:1). Outcomes were significantly worse when the primary tumor site was the minor salivary glands (SG) than when it was the major SG. Outcomes were also significantly worse in pN(+) cases (161 cases) than in pN0 cases, particularly those with a metastatic lymph node number ≥11. The cumulative incidence of relapse and distant metastases was significantly higher in stage IV cases than in stage 0–III cases.

Conclusions

The absolute number of lymph node metastases, higher stages, and the minor SG as the primary tumor site were identified as factors affecting the outcome of SDC.

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Subclonal heterogeneity sheds light on the transformation trajectory in IGLV3-21R110 chronic lymphocytic leukemia

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