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Risk of inferior alveolar nerve injury with coronectomy versus surgical extraction of mandibular third molars - A comparison of two techniques and review of the literature

AbstractBackgroundThe removal of mandibular third molar teeth is one of the most common oral surgical procedures. In a significant number of patients it carries a degree of associated morbidity, including damage to the inferior alveolar nerve (IAN). For this reason, practitioners desire the most up-to-date guidance on the most appropriate technique, informed by the best available evidence that will produce the lowest incidence of iatrogenic complications. ObjectivePerform a systematic review comparing the effect of coronectomy versus complete surgical extraction of mandibular third molar teeth on the risk of IAN injury and other complications in adults. Data SourcesStudies were identified through Embase (1980-2015) and Ovid MEDLINE (1946-2015) database searches. Search terms included coronectomy, partial root removal, deliberate vital root retention, odontectomy, surgical removal, surgical extraction, complete tooth extraction, and extract*. Limits included humans, English language, and…
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Torsional fatigue resistance of pathfinding instruments manufactured from several NiTi alloys

AbstractAimTo evaluate the torsional properties of pathfinding nickel-titanium (NiTi) rotary instruments manufactured from several NiTi alloys, ProGlider (M-wire), Hyflex GPF (conventional NiTi Wire and controlled memory wire), Logic (conventional NiTi wire and controlled memory wire) and Mtwo (conventional NiTi wire). MethodologyA total of 56 NiTi instruments from Glidepath rotary systems (n = 8) were used Logic (size 25, .01 taper), Logic CM (size 25, .01 taper), ProGlider (size 16, .02 taper), Hyflex GPF (size 15, .01 taper), Hyflex GPF CM (size 15, .02 taper; size 20, .02 taper) and Mtwo (size 10, .04 taper). The torsion tests were performed based on ISO 3630-1 (1992). Three millimetres of each instrument tip was clamped to a small load cell by a lever arm linked to the torsion axis. Data were analysed using a one way analysis of variance (ANOVA) and Tukey test with a significance level at a=5%. ResultsThe Logic size 25, .01 taper had significantly higher torsional strength values (…

A new dental option planned to help low-income residents

Increased access to dental care could be on the horizon for low-income residents of Pipestone County and surrounding counties who are insured through state health care programs such as MnCare and Medical Assistance. Caring Hands Dental Clinic, an Alexandria-based nonprofit organization that provides dental care to people with state insurance programs, plans to open an office in Pipestone within the next two years.

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AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma

AbstractThis article is a continuation of the "Do You Know Your Guidelines" series, initiated by the Education committee of the American Head and Neck Society. Treatment guidelines for advanced head and neck squamous cell carcinoma are reviewed here, including the critical roles of radiotherapy, chemotherapy, and the recent application of immunotherapy agents. We will be limiting this discussion to include cancers of the oral cavity, oropharynx, hypopharynx, and larynx. It should be noted that much of the article pertains to human papillomavirus (HPV)-negative oropharyngeal cancer where applicable, as HPV-positive oropharyngeal squamous cell carcinoma carries a different natural history, different prognosis, and now different staging criteria. Additionally, the article will not include information on nasopharyngeal or sinus cancers, as these latter topics are covered in separate "Do you know your guidelines?" installments and these diagnoses carry somewhat differen…

Meta-analysis of induction chemotherapy as selection marker for chemoradiation in the head and neck

ObjectiveMany trials incorporate induction chemotherapy (IC) in selecting for organ preservation in head and neck squamous cell carcinomas (HNSCC). However, few studies examine IC response in predicting for chemoradiation therapy (CRT) response. This meta-analysis aims to determine the predictive accuracy of IC for subsequent response to CRT and overall survival (OS). Data sourcesMedline, EMBASE, Cochrane register. MethodsA systematic search identified studies from database inception to October 2016 that used IC prior to CRT as definitive treatment for advanced HNSCC. The sensitivities and specificities of IC response predicting for complete CRT response were calculated, and the results were pooled in a summary receiver operating curve. One-, 2- and 5-year OS data were extracted. ResultsSeven studies (n = 423 patients) were analyzed for response and six (n = 439) for OS. Pooled median sensitivity and specificity of IC response predicting CRT response were 0.95 (95% confidence interval [C…

Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling

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The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test

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Potential treatment for vocal fold scar with pirfenidone

Objectives/HypothesisPirfenidone (PFD) is a strong antifibrotic agent that has been clinically approved in Japan for idiopathic pulmonary fibrosis. We examined the antifibrotic effects of PFD on fibroblasts isolated from scarred vocal folds (VFs) of ferrets in vitro. Study DesignProspective animal experiments with controls. MethodsScar fibroblasts (SFs) were isolated from scarred VFs that had been electrocauterized 2 weeks before harvesting (N = 4). Normal fibroblasts (NFs) were isolated from intact VFs (N = 4). SFs and NFs were incubated in the presence of 10 ng/mL transforming growth factor β1 (TGF-β1), with or without PFD. After the 48-hour incubation, mRNA expression levels of α smooth muscle actin (αSMA), TGF-β1, collagen type I, and hyaluronan synthase 2 (HAS2) were examined by real-time polymerase chain reaction. Immunohistochemistry with anti-αSMA anti-collagen type I and phosphorylated Smad (p-Smad)2/3 antibodies in SFs with or without PFD was performed. SFs and NFs were cultur…

Teaching frontal sinus anatomy using the frontal sinus masterclass 3- D conceptualization model

ObjectiveFrontal sinus anatomy is complex and often is a difficult subject to both teach and learn. The traditional surgical dogma of "see one, do one, teach one" is impractical and dangerous in the frontal sinus. Based on the building block three-dimensional conceptualization module, the Frontal Sinus Masterclass (FSMC) was created to teach this anatomy. MethodsStudy was performed at two academic centers among second- to fifth-year otolaryngology residents. A pretest assessed knowledge prior to the course. Computed tomography scans of the sinuses were evaluated in triplanar view, and participants attempted to reconstruct the anatomy. Subsequently, the course instructor explained the anatomy using the building block method and showed a short video of the surgical dissection, pointing out relevant anatomy. Cases progressed in anatomical difficulty and inflammatory load. A posttest determined knowledge after the course. ResultsThirty of 50 participating residents completed the p…

Does the diameter of the stapes prosthesis really matter? A prospective clinical study

Objectives/HypothesisTo evaluate the influence of the diameter of stapes prosthesis on functional outcomes in stapes surgery. Study DesignProspective cohort study. MethodsFifty consecutive small fenestra stapedotomies performed using a 0.4-mm-diameter prosthesis were compared with 50 consecutive small fenestra stapedotomies carried out using a 0.6-mm-diameter piston. Audiological assessment following the recommendations of the Committee on Hearing and Equilibrium was performed 1 month after surgery. Postoperative complications between the two groups were noted. ResultsThere were no statistically significant differences in demographic data between the two groups, and no differences in preoperative bone-conduction (BC) or air-conduction (AC) hearing thresholds for all frequencies (analysis of variance [ANOVA] and χ2 tests). No differences were found in the mean preoperative BC and AC pure-tone average and air-bone gap (ABG). In the postoperative evaluation, a statistically significant diff…

Long-term outcomes in unilateral vocal fold paralysis patients

Objectives/HypothesisAt presentation, unilateral vocal fold paralysis (UVFP) patients have different treatment options, including conservative management (CM), injection laryngoplasty (IL) with a temporary agent, or permanent medialization (PM). This study evaluates long-term outcomes for UVFP patients relative to intervention. Study DesignRetrospective chart review. MethodsA retrospective chart review was performed of UVFP patients who presented to the University of California San Francisco Voice and Swallowing Center. Videolaryngostroboscopy examinations were reviewed. Maximum glottic closure was quantified with the normalized glottic gap area (NGGA). Perceptual voice analysis was performed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) at corresponding time points. ResultsFifty-three patients met inclusion criteria. Six underwent CM only, 20 went on to require PM, 19 underwent IL only, and eight underwent IL and subsequent PM. NGGA at presentation was similar amo…

Investigation of the presence of HPV on KTP laser fibers following KTP laser treatment of papilloma

ObjectivesRecurrent respiratory papillomatosis is often treated with in-office laser procedures using a potassium titanyl phosphate (KTP) laser transmitted through a laser fiber. Although effective, this procedure has notable downsides, including the possibility of transmitting human papillomavirus (HPV) in the smoke plume and the high cost of these single-use fibers. The objective of this study is to determine if HPV can be detected on a laser fiber after use, with or without sterilization. MethodsTwelve patients with laryngeal papillomas were treated with KTP laser energy transmitted via a KTP fiber. Ten fibers were sterilized in CIDEX (ASP, Irvine, California), a glutaraldehyde disinfectant, for 12 minutes, whereas two fibers were left unsterilized. Human papillomavirus DNA amplification was done on all 12 fiber samples with real-time polymerase chain reaction (PCR) using general primer mediated 5+ and 6+. Human papillomavirus genotyping detection was done using type specific probes…

Relationship between degree of obstruction and airflow limitation in subglottic stenosis

ObjectivesSubglottic stenosis (SGS) is one of the most common airway disorders in pediatric patients. Currently, treatment decisions rely primarily on the Cotton-Myer scale, which classifies SGS severity based on percentage reduction in airspace cross-sectional area (CSA). However, the precise relationship between upper airway resistance and subglottic CSA is unknown. We hypothesize that airway resistance can be described by the Bernoulli Obstruction Theory, which predicts that airway resistance is inversely proportional to airspace CSA ( ) in cases of severe constriction. MethodsComputed tomography (CT) scans of six healthy subjects and five SGS patients were used to create three-dimensional models of the respiratory tract from nostrils to carina. Cylindrical segments of varying lengths and varying diameters were digitally inserted in the subglottis of the healthy subjects to create simulated SGS models. Computational fluid dynamics simulations were run, and airway resistance was comp…

Oral sampling methods are associated with differences in immune marker concentrations

ObjectiveTo determine whether the concentration and distribution of immune markers in paired oral samples were similar. Study TypeClinical research. Study DesignCross-sectional study. MethodsPaired saliva and oral secretions (OS) samples were collected. The concentration of immune markers was estimated using Luminex multiplex assay (Thermo Fisher Scientific, Waltham, MA). For each sample, the concentration of respective immune markers was normalized to total protein present and log-transformed. Median concentrations of immune markers were compared between both types of samples. Intermarker correlation in each sampling method and across sampling methods was evaluated. ResultsThere were 90 study participants. Concentrations of immune markers in saliva samples were significantly different from concentrations in OS samples. Oral secretions samples showed higher concentrations of immunoregulatory markers, whereas the saliva samples contained proinflammatory markers in higher concentration. Conc…

Epistaxis in children and adolescents with hereditary hemorrhagic telangiectasia

Objectives/HypothesisOur objective was to describe epistaxis onset and severity in pediatric hereditary hemorrhagic telangiectasia (HHT) patients and study the cumulative incidence of epistaxis by age of onset within each genetic subtype. Study DesignRetrospective cohort chart review. MethodsCharts were reviewed of patients age 0 to 18 years with a clinical or genetic diagnosis of HHT who were evaluated at a tertiary multidisciplinary HHT clinic from January 2010 to June 2016. The epistaxis severity score (ESS), a validated tool for assessing epistaxis severity, was used to assess epistaxis. Statistical analyses were conducted on the full HHT cohort as well as subgroups stratified by the HHT causative gene (HHT1 = ENG and HHT2 = ACVRL1). ResultsSixty-nine pediatric subjects were identified; 60 had HHT confirmed by genetic testing, and nine (from families with known mutations) met published clinical diagnostic criteria alone. Fifty-nine (85%) had onset of epistaxis. The median age of onse…

The Effect of Probiotics on Halitosis: a Systematic Review and Meta-analysis.

The Effect of Probiotics on Halitosis: a Systematic Review and Meta-analysis.Probiotics Antimicrob Proteins. 2017 Nov 22;:Authors: Yoo JI, Shin IS, Jeon JG, Yang YM, Kim JG, Lee DWAbstract
Although several studies have evaluated the inhibitory effect of probiotics on halitosis, findings are inconsistent. This systematic review and meta-analysis of randomized clinical trials (RCT) was conducted to summarize the evidence on the effect of probiotics on halitosis. RCT on any type of probiotic treatment with at least 2-week duration were identified through electronic databases (PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials) and hand searched between 1946 and January 17, 2017. Primary outcomes were organoleptic (OLT) scores and volatile sulfur compounds (VSC). Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. Meta-analysis was conducted to synthesize the evidence. Of the 153 articles identified, three met the inclu…

Das Ringerohr der etwas anderen Art

ZusammenfassungWir berichten über den Fall eines 19-jährigen Mannes mit rezidivierenden, kreisförmigen und groblamellär geschuppten Hautveränderungen. Anamnestisch war der Patient in seiner Freizeit als Ringer tätig. Nach zunächst frustraner antibiotischer Lokaltherapie konnte im Rahmen einer spezifischen dermatologischen Diagnostik eine Tinea corporis gladiatorum gesichert werden. Unter der leitliniengerechten Therapie für Dermatophytosen mittels systemischer Gabe von Fluconazol sowie einer Lokaltherapie mit Ciclopiroxolamin und Ketoconazol konnte eine schnelle Befundbesserung erwirkt werden.

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Triple negative breast cancer – prognostic role of immune-related factors: a systematic review

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Mortality and recurrence rates among systemically untreated high risk breast cancer patients included in the DBCG 77 trials

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Breast conserving surgery versus mastectomy: overall and relative survival—a population based study by the Danish Breast Cancer Cooperative Group (DBCG)

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Standardized assessment of tumor-infiltrating lymphocytes in breast cancer: an evaluation of inter-observer agreement between pathologists

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Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG)

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Gas hydrate saturations estimated from pore-and fracture-filling gas hydrate reservoirs in the Qilian Mountain permafrost, China

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Understanding heat patterns produced by vehicular flows in urban areas

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No evidence for social immunity in co-founding queen associations

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Can Niche Modeling and Geometric Morphometrics Document Competitive Exclusion in a Pair of Subterranean Rodents (Genus Ctenomys) with Tiny Parapatric Distributions?

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Internal fit of three-unit fixed dental prostheses produced by computer-aided design/computer-aided manufacturing and the lost-wax metal casting technique assessed using the triple-scan protocol

Suboptimal adaptation of fixed dental prostheses (FDPs) can lead to technical and biological complications. It is unclear if the computer-aided design/computer-aided manufacturing (CAD/CAM) technique improves adaptation of FDPs compared with FDPs made using the lost-wax and metal casting technique. Three-unit FDPs were manufactured by CAD/CAM based on digital impression of a typodont model. The FDPs were made from one of five materials: pre-sintered zirconium dioxide; hot isostatic pressed zirconium dioxide; lithium disilicate glass-ceramic; milled cobalt-chromium; and laser-sintered cobalt-chromium. The FDPs made using the lost-wax and metal casting technique were used as reference. The fit of the FDPs was analysed using the triple-scan method. The fit was evaluated for both single abutments and three-unit FDPs. The average cement space varied between 50 μm and 300 μm. Insignificant differences in internal fit were observed between the CAD/CAM-manufactured FDPs, and none of the FPDs …

Effect of temporomandibular joint articular disc repositioning on anterior open-bite malocclusion: An orthodontic-surgical approach

An anterior open bite is a challenge to orthodontic treatment; it has a multifactorial etiology and a wide range of intervention options. Temporomandibular joint (TMJ) disorders are a risk factor for the development of malocclusions such as the anterior open bite, especially in patients who have TMJ osteoarthritis with disc displacement. Articular disc repositioning surgery is an available option for treating this pathology, and it contributes to maintaining the condyles in a more stable position.

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Two-dimensional vs 3-dimensional comparison of alveolar bone over maxillary incisors with A-point as a reference

Our objectives were to compare, relative to A-point, (1) bone thickness over the most forward maxillary incisor (MFMI) in 2 dimensions vs 3 dimensions, and (2) bone thickness and inclination of each maxillary incisor in 3 dimensions.

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Short-term and long-term effectiveness of powered toothbrushes in promoting periodontal health during orthodontic treatment: A systematic review and meta-analysis

Although powered toothbrushes have been reported to reduce gingivitis more than manual toothbrushes in the general population, the evidence regarding orthodontic patients has been inconclusive. Thus, we aimed to compare their effectiveness in relation to any available parameter regarding oral health in orthodontic patients with fixed appliances.

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Differences in distances between maxillary posterior root apices and the sinus floor according to skeletal pattern

The aim of this study was to evaluate the distances from the maxillary posterior root apices to the inferior wall of the maxillary sinus using cone-beam computed tomography images and the relationships between roots and maxillary sinus according to age, sex, and skeletal pattern.

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Malocclusion and health care

In an editorial in the June 2017 issue, Dr Nadia Laniado wrote the following: "A fundamental issue distinguishes the specialty of orthodontics from the rest of dentistry: malocclusion is not a disease, but it is a variation from ideal. Therefore, while the rest of dentistry is primarily concerned with the sequelae of chronic conditions, including dental caries and periodontal disease, orthodontists are treating something for which there is no bacterial etiology and no potential cure" (Laniado N.

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Erratum

Erratum to: Eliades T. Bisphenol A and orthodontics: An update of evidence-based measures to minimize exposure for the orthodontic team and patients. Am J Orthod Dentofacial Orthop 2017;152:435-41.

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Computer-aided design and manufacture of hyrax devices: Can we really go digital?

The aim of this pilot study was to illustrate the feasibility of a new digital procedure to fabricate metallic orthodontic appliances. Hyrax appliances for rapid palatal expansion were produced for 3 patients using a CAD/CAM procedure without physical impressions or printed models. The work flow consisted of intraoral scanning, digital design with incorporation of a scanned prefabricated expansion screw, direct 3-dimensional metal printing via laser melting, welding of an expansion screw, insertion, and finally activation in the patients' mouths.

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Erratum

Erratum to: Favero CS, English JD, Cozad BE, Wirthlin JO, Short MM, Kasper FK. Effect of print layer height and printer type on the accuracy of 3-dimensional printed orthodontic models. Am J Orthod Dentofacial Orthop. 2017;152(4):557-65.

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Possible alternative treatment for mandibular asymmetry by local unilateral IGF-1 injection into the mandibular condylar cavity: Experimental study in mice

The purpose of this study was to investigate whether a local unilateral IGF-1 injection into the mandibular condylar cavity can induce unilateral endochondral mandibular growth without any systemic adverse effects.

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Residents' journal review

Reduced frictional resistance during tooth movement is believed to increase the efficiency of the orthodontic force system. The method of ligation contributes to the amount of frictional force between the archwire and bracket. Studies have shown that elastomeric ligatures tied in a figure-8 pattern had significantly more friction than conventional elastomeric or stainless steel ligation. The authors tested whether figure-8 elastomeric modules affect the rate of mandibular incisor alignment and whether there was a difference in the number of bracket failures between figure-8 and conventional groups.

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Effect of malocclusion on adults seeking orthodontic treatment

Our objective was to examine the Teen Oral Health-related Quality of Life (TOQOL) questionnaire for use in adults receiving orthodontic treatment and assess validity and reliability by age group.

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Mixed messages

The sole concern of your new patient, Jim, is his rotated maxillary right lateral incisor. He is otherwise content with his occlusal status. You suggest addressing this objective with a few aligners. He readily agrees, but advises you that his general dentist had delivered a maxillary full coverage night guard 2 months ago to address his bruxing habit, and he doesn't want to pay for a replacement. "No problem," you say. "Once we correct the tooth, we'll modify the night guard to accommodate the new position of the tooth so you can wear that night guard." You advise him to bring the night guard to the aligner delivery appointment so you can look at it.

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When things don't “ad” up

So, a patient comes to you needing whatever. He expects his insurance to cover the treatment, and so does your office. Therefore, you go ahead and treat him. Not too far down the road, everybody realizes that the insurance company will not cover the services rendered. You refuse to give the patient any more appointments until he pays the fee due for services already rendered. He disappears and ultimately reappears after an extended period of time, having dutifully worn whatever you gave him. Bad things have happened because of the unmonitored and unsupervised appliance wear.

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International Items of Interest

As I begin this editorial, I will admit that most of what I will tell you is not original. I will simply use this opportunity to inform you of a new section of the Journal, and I will explain from whence it came. For the most part, the title is derived from the activities of Rodrigues Ottolengui. His accomplishments are fairly well known in orthodontics, but for those not aware, I will make a few informational comments.1

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