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The Fragility of Statistical Findings in the Femoral Neck Fracture Literature: A Systematic Review of Randomized Controlled Trials
No full textOBJECTIVES:Randomized controlled trials (RCTs) in the femoral neck fracture literature frequently report P-values for outcomes, which have substantial implications in guiding surgical management. This study used the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the statistical stability of outcomes reported in RCTs evaluating the management and treatment of femoral neck fractures.METHODS:Data Sources:Design:PubMed, Embase, and MEDLINE were queried for RCTs (January 1, 2010 to February 28, 2023).Setting:RCTs that evaluated surgical management or treatment of femoral neck fractures were included.Study Selection Criteria:RCTs with 2 treatment arms reporting categorical dichotomous outcomes were included. Non-RCT studies, RCTs with greater than 2 treatment arms, and RCTs without a femoral neck fracture cohort were excluded.Data Extraction and Synthesis:Outcome Measures and Comparisons:The FI and rFI were calculated as the number of outcome event reversals required to alter statistical significance for significant (P \u3c 0.05) and nonsignificant (P ≥ 0.05) outcomes, respectively. The FQ was calculated by dividing the FI by the sample size for the study.RESULTS:Nine hundred eighty-five articles were screened, with 71 studies included for analysis. The median FI across a total of 197 outcomes was 4 [interquartile range (IQR) 2-5] with an associated FQ of 0.033 (IQR 0.017-0.060). Forty-seven outcomes were statistically significant with a median FI of 2 (IQR 1-4) and associated FQ of 0.02 (IQR 0.014-0.043). One hundred fifty outcomes were statistically nonsignificant with a median rFI of 4 (IQR 3-5) and associated FQ of 0.037 (IQR 0.019-0.065).CONCLUSIONS:Statistical findings in femoral neck fracture RCTs are fragile, with reversal of a median 4 outcomes altering significance of study findings. The authors thus recommend standardized reporting of P-values with FI and FQ metrics to aid in interpreting the robustness of outcomes in femoral neck fracture RCTs.LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence
Biomechanical and clinical considerations in deep bite treatment using temporary skeletal anchorage devices
No full textAbstract
Deep bite is usually treated by intrusion of the anterior teeth, extrusion of the posterior teeth, or a combination thereof. Various traditional methods have been used to correct deep bites, but they can cause negative side effects. Recently, temporary skeletal anchorage devices (TSADs) have been used to intrude the anterior teeth simply and efficiently without side effects. The amount of incisal exposure at rest should be considered as the first factor in determining which tooth segment should be intruded to correct a deep bite. The center of resistance of the anterior teeth should be considered to achieve the proper biomechanics when intruding them. The location of TSADs should be determined to ensure sufficient interradicular bone to achieve the desired tooth movement. Therefore, clinicians should understand the biomechanical and clinical considerations to correct a deep bite using TSADs
The Other Side of Endodontics: Vital Pulp Therapy on Mature Permanent Teeth
No full textABSTRACT
Vital pulp therapy (VPT) was once a treatment modality that was only considered for immature permanent teeth to allow for the continued development of the radicular system if the pulp was vital. With the advent of bioceramics and bioactive materials such as calcium silicate cements, the applications for VPT have greatly increased, giving dentists a treatment option other than nonsurgical root canal therapy (RCT) for mature teeth previously diagnosed to have an irreversible pulpitis. This approach can serve as a less invasive, simpler procedure than RCT while allowing for the preservation of natural tooth structure. It also may be a more amenable treatment alternative for patients than RCT. This article outlines and reviews the protocol for VPT with pulp exposure.
When talking with restorative dentists and patients, endodontists may often hear statements such as, If I need a root canal, take the tooth out. Sometimes if the dentist wants to refer to the endodontist, the patient may not want to go to an endodontist and insist that the dentist either do the work necessary or take out the tooth. Patients also may consider root canals too costly, or that they do not work for various reasons. In some of these circumstances there may be another solution. Applying the principles and protocol used for successful vital pulp therapy (VPT) in immature permanent teeth to mature permanent teeth with irreversible pulpitis may be the answer to some of these predicaments
Autogenous Tooth Graft Biomaterial in Guided Bone Regeneration: A Comprehensive Review
No full textObjective: This review evaluated the use of autogenous tooth as a bone graft material in guided bone regeneration (GBR). Moreover, it compared the results of GBR using autogenous demineralized dentin, partially demineralized dentin, and mineralized dentin with or without membrane to verify its clinical advantage, effectiveness, and safety. Methods: A search was conducted in PubMed/MEDLINE, Lilacs, Embase, Cochrane, and Scopus databases. Specific criteria were established for the inclusion and exclusion of studies, including types of studies considered, target population (clinical studies: humans), evaluated intervention (studies assessing and comparing autologous demineralized dentin, partially demineralized dentin, and mineralized dentin in GBR with or without resorbable membrane), and language and publication period of articles (English and published in the last 11 years). A detailed assessment of the methodological quality of the selected studies was conducted using the JBI critical appraisal tool. Results: Based on the analysis conducted, out of 174 potentially relevant articles obtained, only 19 publications met the inclusion criteria, with three papers showing medium quality/moderate risk of bias and the rest with high quality/low risk of bias. Comparison between groups revealed stability of the newly formed bone, low marginal bone loss, clinically acceptable primary and secondary implant stability quotient (ISQ) values, and high implant survival rates after using autogenous tooth biomaterial. Conclusions: The results of this review on the use of autogenous teeth as a bone graft material in guided bone regeneration indicated that the technique has the potential to be an effective and safe treatment option. Analysis of selected studies showed favorable evidence for the use of autogenous teeth in bone regeneration, suggesting clinical benefits, most for socket preservation. These results are relevant for guiding clinical practice and assisting dental professionals in having options for biomaterials for bone regeneration
Clinical assessment of monolithic zirconia crowns fabricated using an intraoral scanner
No full textBackground. This in vivo study assessed the accuracy of single-tooth monolithic zirconia crowns made using an intraoral scanner (IOS) and computer-aided design/computer-aided manufacturing (CAD/CAM) technology. Methods. Thirty patients requiring single posterior crowns were selected. The teeth were prepared with a deep chamfer finish line with a 1-mm extension subgingivally and a 1-mm reduction in all surfaces by one prosthodontist. The gingival margins were retracted using a gingival retraction paste before making impressions using a Trios scanner. All the digital impression files were sent to one laboratory using the dental designer software (3Shape, Copenhagen, Denmark). After completing the milling and sintering processes, the crowns were dyed and glazed. After removing the temporary crown, the qualitative assessment of proximal contacts of definitive monolithic zirconia crowns was performed according to the CDA criteria. Data were analyzed with Friedman’s two-way analysis and independent t-test at α = 0.05. Results. The difference in axial and total gaps between premolar and molar teeth was not significant; however, the mean marginal gap of molars was higher than that of the premolars (P = 0.043). Furthermore, the comparison of the axial, total, and marginal gaps between the upper and lower jaws showed no significant difference (P \u3e 0.05). The distribution of occlusal and proximal contacts indicated 60% and 66.7% proper contacts and no contacts in 6.7% and 10% of cases, respectively. Conclusion. Using IOSs could result in accurate monolithic zirconia crowns in terms of adaptation. Also, most occlusal and proximal contacts did not need any adjustments
Evaluating and Comparing the Tensile Strength and Clinical Behavior of Monofilament Polyamide and Multifilament Silk Sutures: A Systematic Review
No full textObjective: This systematic review was carried out with the primary objective of verifying which suture (polyamide or silk) of two non-resorbable suture materials with different structures had better/greater tensile strength/resistance to tension, thereby presenting better mechanical behavior. The secondary objective was to verify which one had better performance. The null hypothesis was that both types of sutures had the same behavior. Methods: This systematic study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The focused clinical question was: “In patients that underwent oral surgery treatment (P), is there significantly higher tensile strength/resistance for silk sutures (I) or for polyamide sutures (C) when comparing the outcomes (O)?”. The bibliographic search was conducted on ScienceDirect, B-On, and PubMed/MedLine between March and May 2023. The following MeSH terms were defined: sutures, breaking strength, tensile strength, oral surgery, and dentistry, which were articulated and combined using Boolean operators. There were restrictions, such as articles published in Portuguese, Spanish, or English between 1 January 2018 and 3 April 2023. The quality assessment involved the use of the Joanna Briggs Institute (JBI) checklist for RCTs and the QUIN tool (Quality Assessment Tool For In Vitro Studies) for in vitro assays. Results: Ten articles were included in this review (eight in vitro studies and two RCTs). For the RCTs, there were moderate and high levels of bias, whereas in the in vitro studies, three were classified as having a high risk of bias and five as moderate risk. The results proved that suture thread with a monofilament polyamide physical structure causes a less inflammatory reaction owing to less bacterial retention and capillarity, while multifilament sutures, such as silk, have superior mechanical characteristics. Regarding hydration, the evidence demonstrated that the preservation and stability of mechanical properties lacked uniformity. Otherwise, hyaluronic acid (HA) presents a promising solution with the same characteristics and antibacterial capabilities. Conclusion: It was possible to reject the null hypothesis that both types of sutures had the same behavior and result. It was proven by the results above that sutures with a monofilament polyamide physical structure cause a less inflammatory reaction owing to less bacterial retention and capillarity. In contrast, multifilament sutures (silk) have superior mechanical characteristics. Regarding hydration using chlorohexidine in surgical sites, the evidence demonstrated in the preservation and stability of mechanical properties lacks uniformity and congruence. However, HA seems to present a promising option with the same characteristics and antibacterial capabilities
Comparing Polymerization Shrinkage Measurement Methods for Universal Shade Flowable Resin-Based Composites
No full textUniversal shade flowable composites have been introduced to mimic tooth structure with reduced color mismatch and reduced chair time and cost. However, the polymerization shrinkage of resin material may lead to sensitivity and restoration failure. The purpose of this study was to compare the polymerization shrinkage of recently introduced universal shade flowable resin-based composites using both wet and dry density methods. Using two measurement methods, ISO 17304 (wet method) and a gas displacement pycnometry system (dry method), the density of the unpolymerized and the polymerized RBCs were measured, and the polymerization shrinkage was calculated from the density difference. Scanning electron microscopy was used to visualize filler particles. The polymerization shrinkage showed significant differences between many materials. In particular, Bulk Base HARD II Medium Flow showed significantly lower polymerization shrinkage than all the other materials. Shrinkages measured by different methods were significantly different in all cases. The wet method measured a smaller shrinkage than the dry method in most cases, but the shrinkage measured for Gracefil LoFlow was larger with the wet method. Shrinkage between universal shade flowable resin-based composites significantly varied based on both material and measurement method. The polymerization shrinkage of resin-based composites is an important factor in biomimetic clinical dentistry, and work must be conducted to measure it accurately and with more standardization
Accuracy of artificial intelligence-assisted growth prediction in skeletal Class I preadolescent patients using serial lateral cephalograms for a 2-year growth interval
No full textObjective: To investigate the accuracy of artificial intelligence-assisted growth prediction using a convolutional neural network (CNN) algorithm and longitudinal lateral cephalograms (Lat-cephs). Materials and Methods: A total of 198 Japanese preadolescent children, who had skeletal Class I malocclusion and whose Lat-cephs were available at age 8 years (T0) and 10 years (T1), were allocated into the training, validation, and test phases (n = 161, n = 17, n = 20). Orthodontists and the CNN model identified 28 hard-tissue landmarks (HTL) and 19 soft-tissue landmarks (STL). The mean prediction error values were defined as ‘excellent,’ ‘very good,’ ‘good,’ ‘acceptable,’ and ‘unsatisfactory’ (criteria: 0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm, respectively). The degree of accurate prediction percentage (APP) was defined as ‘very high,’ ‘high,’ ‘medium,’ and ‘low’ (criteria: 90%, 70%, and 50%, respectively) according to the percentage of subjects that showed the error range within 1.5 mm. Results: All HTLs showed acceptable-to-excellent mean PE values, while the STLs Pog’, Gn’, and Me’ showed unsatisfactory values, and the rest showed good-to-acceptable values. Regarding the degree of APP, HTLs Ba, ramus posterior, Pm, Pog, B-point, Me, and mandibular first molar root apex exhibited low APPs. The STLs labrale superius, lower embrasure, lower lip, point of lower profile, B′, Pog,’ Gn’ and Me’ also exhibited low APPs. The remainder of HTLs and STLs showed medium-to-very high APPs. Conclusion: Despite the possibility of using the CNN model to predict growth, further studies are needed to improve the prediction accuracy in HTLs and STLs of the chin area
Analysis of Variation in the Origin of the Obturator Artery in Midwestern American Donor Bodies
No full textAbstract
The obturator artery (OA) is typically a branch of the anterior division of the internal iliac artery. However, an aberrant obturator artery origin may lead to clinical complications. Because of its location in the pelvic cavity, the OA is at high risk of injury or laceration during a variety of pelvic surgeries. Regarding this, variations in the origins of the OA may result in bleeding that can often be overlooked, rendering treatment ineffective. Our study aimed to assess the origins and course of the OA in Midwestern American donor bodies. Sixty-two donor bodies were obtained from the Gift of Body Donation Program at A.T. Still University\u27s Kirksville College of Osteopathic Medicine. The origin of each OA was documented and photographed. The OA was identified by observing the vessel\u27s passage through the obturator foramen. Of 132 OAs studied, 72 (54.5%) had an aberrant OA. Further, 22 (16.7%) had an aberrant OA origin from the inferior epigastric artery, 20 (15.2%) had an aberrant OA origin from the posterior division of the internal iliac artery, 22 (16.7%) had an aberrant OA origin from dual origins of the anterior division of the internal iliac artery and the inferior epigastric artery, and eight (6.1%) had other aberrant OA origins. Overall, our results indicated anatomical variations are common in the origins and course of the OA. These data highlight the importance of considering variations in the OA and the prevalence of those variations during vascular and orthopedic procedures
Female-To-Male Transgenders Patients’ Perceived Disparities in Cancer Screening Adherence: A Phenomenological Study
No full textAbstract
Members of the transgender community may have a higher risk for cancer due to certain factors like smoking, alcohol and drug use, obesity, and significantly higher rates of HIV. However, transgender persons are less likely to adhere to life-saving cancer screening exams than cisgender individuals. Although quantitative data exist showing the lower percentage of transgender vs. heterosexual cancer screening adherence rates, qualitative research from a transgender person\u27s point of view is needed to understand the barriers to why fewer transgender individuals adhere to cancer screening guidelines. This qualitative, phenomenological study aims to explore female-to-male transgender individuals’ perceived experiences with cancer screening exams. A convenience sample of seven female-to-male transgender individuals was recruited from LGBTQ social media support websites. Qualitative data were collected through in-depth Zoom interviews using open-ended questions regarding the participant’s level of knowledge of routine cancer screening exams and the barriers preventing them from seeking these exams. Results from data analysis showed that overall, participants were unfamiliar with routine cancer screening recommendations. To determine barriers, thematic analysis of the interview data generated four main themes. These included: social stigma (discrimination), financial/insurance difficulty, emotional stress, and previous traumatic experiences. Understanding why this underserved population does not adhere to cancer screening exams will help identify specific barriers that can be addressed through interventions and education. If improvements can be made in health care so that the percentage of trans-patients who commit to routine cancer screening increases, diagnosis and treatment will improve, and lives will be saved