Still Scholarworks (A.T. Still University)
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Enhancing digital workflows for removable partial dentures: A novel diagnostic surveyor and designer
No full textRemovable partial dentures (RPDs) are a valuable treatment option in prosthodontics, often selected due to patient-specific limitations such as financial constraints, inadequate bone support, or medical contraindications to other prosthetic solutions. Despite the advantages of digital dentistry, such as the efficiency and accuracy of various workflows, the adoption of fully digital RPD workflows has lagged due to the absence of accessible diagnostic surveying and design tools for digital models. This article introduces the AiDENTAL RPD Surveyor and Designer, a lightweight, browser-based software solution that simplifies digital surveying, streamlines design, and facilitates the export of diagnostic scans. By addressing these needs in the current digital workflow, the system aims to enhance the efficiency, accuracy, and convenience of RPD fabrication. A step-by-step description of the process highlights its potential to improve clinical outcomes and reintegrate traditional framework-based RPDs into mainstream practice
Examining the effects of custom 3D-printed respirator frames on the seal of KN95 masks: A pilot study
No full textDuring most of the COVID-19 pandemic, N95 respirators were in short supply, creating a need for alternative solutions to protect healthcare workers and others from infection. The current pilot study was conducted to determine whether using a KN95 respirator with a custom respirator frame would be an effective alternative to an N95 respirator. Using the Bellus3D Dental Pro application on an iPhone, a 3D face scan was obtained for six adult volunteers (three women, three men), and a custom mask frame was 3D printed in gray resin. Next, a PortaCount Fit Tester was used to test the fit of a KN95 respirator, a KN95 respirator with the custom mask frame, and an N95 respirator. The three respirator configurations were compared for overall fit and fit during four day-to-day movements (bending over, talking, and moving the head side to side or up and down). Fit factor values could range from 1-200, and a value of 100 was considered the minimum to meet established safety specifications. The mean (SD) overall fit factor was 12.1 (1.8) for the KN95 respirator, 195.4 (11.2) for the KN95 respirator with the custom mask frame, and 170.0 (38.3) for the N95 respirator. Differences were found between the three configurations for all outcomes (all p \u3c.004). Post hoc comparisons indicated differences between the KN95 respirator and KN95 respirator with the custom mask frame for all outcomes (all p \u3c.02) and between the KN95 respirator with the custom mask frame and N95 respirator for moving the head side to side (p =.04). Results of the pilot current study suggested using a KN95 respirator with a custom mask frame significantly improved the fit factor to meet existing safety specifications. In the future, healthcare workers and organizations should consider this configuration as an effective alternative to N95 respirators
Skin Reactions and Other Underappreciated Dermatologic Side Effects of Cancer Therapies
No full textCutaneous adverse events (cAEs) are among the most common toxicities associated with modern cancer therapies, which are particularly heightened among immunotherapies and targeted agents. Despite being frequently immune-mediated, the majority of cAEs are mild to moderate and can be effectively managed without interruption of anticancer treatment. In immunotherapies-receiving patients, common phenotypes of cAEs include eczema-like, lichenoid, psoriasiform, vitiligo-like, and bullous eruptions. Targeted therapies including epidermal growth factor receptor inhibitors, BRAF inhibitors/MEK inhibitors, and phosphoinositide 3-kinase inhibitors are frequently associated with papulopustular eruptions, xerosis, paronychia, and photosensitivity. Mechanistically, cAEs may result from on-target immune activation, which correlates with treatment efficacy, or off-target hypersensitivity. Notably, certain phenotypes such as vitiligo, alopecia areata, and lichenoid reactions have been associated with improved survival in melanoma and non-small cell lung cancer. Management is guided based on the Common Terminology Criteria for Adverse Events grading, emphasizing the role of topical therapies for mild cases, systemic corticosteroids or immunosuppressants for moderate-to-severe reactions, and biologic or novel topical agents for steroid-refractory disease. By timely and appropriate intervention, most cAEs are manageable and may carry favorable prognostic significance. Early dermatologic collaboration is essential to reduce morbidity and ensure uninterrupted oncologic therapy
A bright future for the American Journal of Orthodontics & Dentofacial Orthopedics and the American Journal of Orthodontics & Dentofacial Orthopedics Clinical Companion
No full textNonextraction treatment of severe Class III malocclusion with anterior maxillary protrusion using temporary skeletal anchorage devices
No full textIn this case report, we describe the successful nonsurgical and nonextraction treatment of a patient with severe Class III malocclusion and upper lip protrusion. An 18-year-old female presented with protrusive upper and lower lips, skeletal Class III malocclusion (ANB, −0.3°; Wits, −7.0 mm), and maxillary anterior proclination (U1-FH, 123.1°). A ramal plate and modified C-palatal plate were introduced as treatment options for Class III malocclusion and maxillary molar distalization, respectively, followed by retraction of the upper lip protrusion. Using the ramal plate, the mandibular molars achieved 5.0 mm distalization, effectively correcting severe Class III malocclusion without surgical intervention. In addition, with a modified C-palatal plate, the maxillary molars achieved 2.0 mm distalization, and the anterior teeth were retracted without the need for premolar extractions
Maxillary skeletal expander with 6 miniscrews and tadlock: A case report
No full textMiniscrew-assisted rapid palatal expansion (MARPE) devices offer an alternative to orthognathic surgery for postpubertal patients, but a limitation of MARPE is the possible migration of miniscrews during maxillary expansion. This becomes critical when palatal bone is thin at the miniscrew insertion sites, potentially leading to miniscrew failure. In this article, a maxillary skeletal expander (MSE), a particular type of MARPE appliance, was adopted to skeletally expand the maxilla in a postpubertal patient with a thin palatal bone. To reinforce the skeletal anchorage, the MSE was modified by adding 2 lateral miniscrews in the palatal slope between the second premolar and first molar. A virtual model of the MSE with 4 miniscrews was imported into the merged model of the patient\u27s cone-beam computed tomography and maxillary dental arch. Then, a computer-aided design/manufacturing structure with appliance arms, 2 bushings for additional lateral miniscrews, and molar bands was 3-dimensionally designed and manufactured with selective laser melting technology and was laser welded to the MSE body to produce the modified MSE with 6 miniscrews. Because appliance arms tend to slide along the additional lateral miniscrews during maxillary expansion because of the lateral force vector, a steel ligature (the “tadlock”) is tied between the miniscrew head and the bushing pin present on the appliance arms to eliminate the problem. The digital workflow to fabricate the MSE with 6 miniscrews and the tadlock mechanism are presented along with the procedure to expand the maxilla in a postpubertal patient with a thin palatal bone
Fracture Resistance of Chairside CAD/CAM Lithium Disilicate Partial and Full Coverage Crowns and Veneers for Maxillary Canines
No full textOBJECTIVE: This study aimed to assess the fracture resistance of chairside computer assisted design and computer assisted manufacturing (CAD-CAM) lithium disilicate partial and full-coverage crowns and veneers for maxillary canines. METHODS AND MATERIALS: Forty-eight restorations for maxillary right canines (12 per group) were designed as follows: (1) partial crown with finish line in the upper middle third; (2) partial crown with finish line in the lower middle third; (3) traditional labial veneer; and (4) traditional full-coverage crown. Restorations were fabricated out of lithium disilicate (Amber Mill, Hassbio) using a chairside CAD-CAM system (Cerec Dentsply Sirona). Partial and full crowns and veneers were treated with a primer system (Monobond Plus, Ivoclar Vivadent) and cemented using dual-cure resin cement (Variolink Esthetic, Ivoclar Vivadent) and cemented to printed resin dies. Subsequently, the restorations were subjected to 10,000 thermocycles between 5°C and 55°C with a dwell time of 30 seconds. The restorations were then loaded axially on the incisal edge in compression to fracture with a flat indenter. RESULTS: Full-coverage crowns displayed the highest fracture resistance (809±28.57 N) followed by partial crowns with finish line in lower third (649±21.74 N) and crowns with finish line in upper third (421±17.46 N). Veneers displayed the lowest fracture resistance values (259±15.69 N). CONCLUSIONS: The fracture resistance of partial and full-coverage crowns and veneers was significantly influenced by the design. Full coverage crowns displayed the highest fracture resistance and partial crowns showed higher fracture resistance than traditional veneers
Core program elements for equitable, effective participation in a lifestyle medicine program for chronic musculoskeletal pain
No full textBackground: Despite growing interest in using lifestyle medicine to address chronic musculoskeletal pain, challenges remain in equitably and effectively delivering lifestyle-related interventions to this population. Objective: To identify program elements that affect engagement with, and effective delivery of, a lifestyle medicine program for patients with chronic musculoskeletal pain and metabolic comorbidities. It was hypothesized that patients with more social disadvantage engage with proportionately greater group (vs. individual) and telehealth (vs. in-person) programming. Design: Mixed methods study. Setting: Lifestyle medicine program within a tertiary care academic center. Participants: Adults with chronic musculoskeletal pain and obesity-related metabolic comorbidities who presented to a musculoskeletal-oriented lifestyle medicine program. Interventions: Not applicable. Main outcome measures: Logistic regression tested whether patients\u27 level of social disadvantage (operationalized as national Area Deprivation Index [ADI] percentile) is associated with their proportion of program engagement via group (compared to individual) and telehealth (compared to in-person) visits. Semistructured interviews among a subgroup of 38 patients explored other program elements that patients perceived to affect equitable and effective program implementation. Results: Among 205 patients (median [interquartile range] age 60 [50–67] years, 169 [82%] female, 145 [71%] White race), worse social disadvantage was associated with an increased proportion of engagement via group (compared to individual) visits (odds ratio [OR], 1.13 per 10-unit increase in national ADI percentile [95% confidence interval (CI), 1.07–1.20], p \u3c.001) and via telehealth (compared to in-person) visits (OR, 1.13 [1.07–1.20], p \u3c.001). Patient-perceived keys for effective participation included the program\u27s holistic, interprofessional, goal-oriented approach and genuine kindness and care by knowledgeable program clinicians. Some patients requested long-term periodic program check-ins to facilitate maintenance of lifestyle changes. Improved insurance coverage, clinic expansion to multiple sites, and after-hours programming would improve access for some patients. Conclusions: Group visits (using shared medical appointments) and telehealth visits improve equitable access to lifestyle medicine interventions
Teaching repair versus replacement of direct composite resin restorations: A cross-sectional study across dental schools in Malaysia
No full textObjective: To investigate the teaching of repair versus the replacement of defective direct composite resin restorations in undergraduate curricula in Malaysian dental schools. Methods: A 24-item validated questionnaire, including closed and open questions regarding the teaching of repair versus the replacement of direct composite resin restorations (DCRs) was emailed to faculty members in all 13 dental schools in Malaysia. Responses were compiled in Excel and analysed. The questionnaire asked about the inclusion of DCR repair in the curriculum, the underlying reasons for its inclusion, the methods employed for teaching, the indications for repair, the operative techniques and materials used, the acceptability of repairs to patients, the anticipated longevity of repairs, and recall arrangements. Results: All 13 dental schools completed and returned the questionnaire, reporting that composite repairs were taught as an alternative to the replacement of defective DCRs. All schools imparted theoretical and practical knowledge of repair within a clinical context. Twelve dental schools (92 %) agreed that the primary objective of teaching repair is the preservation of tooth structure. The principal reasons for repair were marginal defects (84 %), followed by marginal discoloration and partial loss of restoration (61 %). All 13 schools reported a high level of patient acceptance, which they regarded as a strong indicator. Eleven dental schools (84 %) reported recall arrangements to review repairs of DCRs. Conclusion: All undergraduate dental students in Malaysia are taught the use of repairs as an alternative to the replacement of defective DCRs. The advantages of this approach are considered in Malaysian dental schools to include, minimum intervention and preservation of tooth structure, with opportunity for time and cost savings. Further research should include the development of consensus criteria for the repair rather than replacement of defective DCRs and long-term clinical trials to further investigate the benefits of repair over the replacement of defective DCRs. Clinical significance: With all undergraduate dental students being taught the use of DCR repairs, the percentage of defective DCRs in Malaysia managed by means of a repair may be anticipated to increase in years to come. The cumulative effects of this increase may contribute to the conservation of teeth, with opportunity for cost savings