How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones?

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on patient decision making remains uncertain. This study aimed to investigate the effect of the pandemic on treatment preferences of patients with proximal ureteral stones. Materials and methods: Retrospective data regarding treatment preferences of patients diagnosed with symptomatic proximal ureteral stones between July 2018 and November 2021 at a single center were analyzed. Data from 493 patients were analyzed according to 2 groups, including patients diagnosed during the COVID-19 pandemic and those diagnosed during an equivalent period of time before the pandemic. Results: Preference for conservative treatment increased during the COVID-19 pandemic (p = 0.009). In patients who had previously undergone shock wave lithotripsy (SWL), the preference for SWL decreased and the preference for conservative treatment increased during the COVID-19 pandemic (p = 0.042). Multiple logistic regression analysis revealed a significant correlation between a preference for conservative treatment during the pandemic and no prior spontaneous stone passage (p = 0.003; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.45-4.23), no hydronephrosis (p = 0.035; OR, 3.57; 95% CI, 1.34-9.49), and a visual analog scale score of 4 or less (p = 0.018; OR, 1.97; 95% CI, 1.15-3.38). Conclusions: A significant increase in the preference for conservative treatment was observed among patients diagnosed during the pandemic, and patients with a history of SWL demonstrated a preference shift from SWL to conservative treatment.

Thromboprophylaxis in pediatric patients with earthquake-related crush syndrome: a single centre experience.

PURPOSE: Injuries increase the risk of venous thromboembolism (VTE). However, the literature on the management of anticoagulant therapy in pediatric patients with crush injury is limited. In this study, we aimed to share our experience about anticoagulant thromboprophylaxis in pediatric patients with earthquake-related crush syndrome. METHODS: This study included patients who were evaluated for VTE risk after the Turkey-Syria earthquake in 2023. Since there is no specific pediatric guideline for the prevention of VTE in trauma patients, risk assessment for VTE and decision for thromboprophylaxis was made by adapting the guideline for the prevention of perioperative VTE in adolescent patients. RESULTS: Forty-nine patients [25 males and 24 females] with earthquake-related crush syndrome had participated in the study. The median age of the patients was 13.5 (8.8-15.5) years. Seven patients (14.6%) who had no risk factors for thrombosis were considered to be at low risk and did not receive thromboprophylaxis. Thirteen patients (27.1%) with one risk factor for thrombosis were considered to be at moderate risk and 28 patients (58.3%) with two or more risk factors for thrombosis were considered to be at high risk. Moderate-risk patients (n = 8) and high-risk patients aged < 13 years (n = 11) received prophylactic enoxaparin if they could not be mobilized early, while all high-risk patients aged ≥ 13 years (n = 13) received prophylactic enoxaparin. CONCLUSION: With the decision-making algorithm for thyromboprophylaxis we used, we observed a VTE rate of 2.1% in pediatric patients with earthquake-related crush syndrome.

Effects of various cone-beam computed tomography settings on the detection of recurrent caries under restorations in extracted primary teeth.

PURPOSE: The aim of this study was to assess the ex vivo diagnostic ability of 9 different cone-beam computed tomography (CBCT) settings in the detection of recurrent caries under amalgam restorations in primary teeth. MATERIALS AND METHODS: Fifty-two primary teeth were used. Twenty-six teeth had dentine caries and 26 teeth did not have dentine caries. Black class II cavities were prepared and restored with amalgam. In the 26 carious teeth, recurrent caries were left under restorations. The other 26 intact teeth that did not have caries served as controls. Teeth were imaged using a 100×90-mm field of view and a 0.2-mm voxel size with 9 different CBCT settings. Four observers assessed the images using a 5-point scale. Kappa values were calculated to assess observer agreement. CBCT settings were compared with the gold standard using a receiver operating characteristic analysis. The area under the curve (AUC) values for each setting were compared using the chi-square test, with a significance level of α=.05. RESULTS: Intraobserver kappa values ranged from 0.366 to 0.664 for observer 1, from 0.311 to 0.447 for observer 2, from 0.597 to 1.000 for observer 3, and from 0.869 to 1 for observer 4. Furthermore, interobserver kappa values among the observers ranged from 0.133 to 0.814 for the first reading and from 0.197 to 0.805 for the second reading. The highest AUC values were found for setting 5 (0.5916) and setting 3 (0.5886), and were not found to be statistically significant (P>.05). CONCLUSION: Variations in tube voltage and tube current did not affect the detection of recurrent caries under amalgam restorations in primary teeth.

Multiple idiopathic external and internal resorption: Case report with cone-beam computed tomography findings.

Root resorption is loss of dental hard tissue as a result of clastic activities. The dental hard tissue of permanent teeth does not normally undergo resorption, except in cases of inflammation or trauma. However, there are rare cases of tooth resorption of an unknown cause, known as "idiopathic root resorption." This report would discuss a rare case of multiple idiopathic resorption in the permanent maxillary and mandibular teeth of an otherwise healthy 36-year-old male patient. In addition to a clinical examination, the patient was imaged using conventional radiography and cone-beam computed tomography (CBCT). The examinations revealed multiple external and internal resorption of the teeth in all four quadrants of the jaws with an unknown cause. Multiple root resorption is a rare clinical phenomenon that should be examined using different radiographic modalities. Cross-sectional CBCT is useful in the diagnosis and examination of such lesions.

Evaluation of the superior semicircular canal morphology using cone beam computed tomography: a possible correlation for temporomandibular joint symptoms.

OBJECTIVE: This study aimed to assess the superior semicircular canal (SSCC) morphology and to determine whether superior semicircular canal dehiscence (SSCD) correlates with temporomandibular joint (TMJ) symptoms. STUDY DESIGN: Clinical data and cone beam computed tomography (CBCT) scans of 175 patients were retrospectively examined by 2 observers. Distribution and thickness measurements of the different types of bone cover of the SSCC were performed. RESULTS: Five radiologic SSCC patterns were identified from CBCT data: 147 cases (42%) were defined as normal (0.6-1.7 mm thickness); 62 cases (17.71%) had a papyraceous pattern (<0.5 mm); 77 cases (22%) showed a thick pattern (>1.8 mm); and 42 cases (12%) had a pneumatized pattern. Observer 1 and 2 diagnosed SSCD in 22 of 350 (6.28%) temporal bones individually and had no discordances between the 2 reviews. All patients with SSCD were identified as having TMJ signs and symptoms (P < .05). CONCLUSIONS: Maxillofacial radiologists should be informed about these structures, which can be helpful for the interpretation of CBCT scans.

Evaluation of foramen tympanicum using cone-beam computed tomography in orthodontic malocclusions.

The foramen tympanicum is a persistent anatomic formation of the temporal bone due to a defect in ossification normal bone physiology in neonatal or postnatal period. This study determined the occurrence and location of the foramen tympanicum in a Turkish sample using cone-beam computed tomography. Scans of 370 sites in 185 patients were retrospectively analyzed to determine foramen tympanicum occurrence, sizes, and locations according to their orthodontic malocclusions. Measurements were done on axial and sagittal sections to identify the dimensions. Differences in foramen tympanicum incidence by measurements, sex, side, malocclusions, and location were statistically evaluated. Foramen tympanicum was determined in 42 (22.7%) of 185 patients. No statistical difference was found considering location and sex (P > 0.05), but it was found more bilaterally in female patients within significance level at P = 0.024. Mean sizes did not differ significantly by sex but were found to be greater in females. In axial diameter, the average measurement was found wider on the right side of all patients (P = 0.017). The findings showed a greater foramen tympanicum dimension among class II than among class I and III subjects (P < 0.05). Knowledge about these structures is helpful for the interpretation of imaging (especially cone-beam computed tomography) and provides valuable information especially before orthognathic surgery to avoid intraoperative reconstruction and complications.

Marginal bone resorption around dental implants placed in grafted sinuses; an up-to-30-month clinical and radiological follow-up.

OBJECTIVE: To determine the relative success of two different bone grafting material - putty and powder forms of De-mineralised Bone Matrix (DBM) - used in sinus lift procedure. METHODS: The retrospective study was conducted at the Department of Oral and Maxillofacial Surgery, Ankara University, Ankara, Turkey, and comprised data related to the patients referred for bilateral maxillary sinus augmentation between 2007 and 2010. During the period, 48 endoosseous implants were placed concurrently with the sinus augmentation in 12 patients. Marginal bone loss around the implants was measured at the time of loading, 12 and 30 months after the treatment. SPSS 11.5 was used for data analysis. RESULTS: Of the 12 patients, 8 (66.6%) were females and 4 (33.3%) were males. All implants osseointegrated in both the putty and powder groups well without any significant clinical finding. The average volume of marginal bone resorption at implants for the putty side was 0.43 +/- 0.22 mm, 0.8 +/- 0.33 mm and 1.12 +/- 0.49 mm at prosthetic loading, 12-month and 30-month follow-up, respectively. For the powder side, the corresponding numbers were 0.48 +/- 0.32 mm, 0.82 +/- 0.46 mm and 1.24 +/- 0.57 mm. No statistically significant difference in bone loss between the two groups was observed (p > 0.05). CONCLUSION: Both putty and powder forms of de-mineralised Bone Matrix showed satisfactory results and there was no significant difference in marginal bone loss around dental implants and survival rates.

Comparative assessment of subjective image quality of cross-sectional cone-beam computed tomography scans.

Since the introduction of cone-beam computed tomography (CBCT), several novel systems with different technical specifications and settings have become commercially available. Therefore, it is essential to evaluate CBCT systems for differences in the subjective quality of images obtained for various dental procedures. We evaluated the subjective image quality of cross-sectional scans obtained from various CBCT systems. Images of three cadaver mandibles were obtained from four different CBCT units: 1) Veraviewepocs 3D 40 × 40 mm field of view (FOV) (voxel size: 0.125 × 0.125 × 0.125 mm), 2) Iluma, low-resolution (voxel size: 0.3 × 0.3 × 0.3 mm), 3) Kodak, 50 × 3.7 cm FOV (voxel size: 0.076 × 0.076 × 0.076 mm), and 4) Vatech 12 × 8.5cm FOV (voxel size: 0.160 × 0.160 × 0.160 mm). We assessed subjective image quality and the visibility of 10 specific features, namely, caries, amalgam restoration, final implant drill, root canal filling, metal crown, mandibular canal, mental foramen, tooth (periodontal ligament space and lamina dura), trabecular pattern, and soft tissue. Images were viewed and scored by five calibrated observers, and image quality was ranked from best to worst. The Veraviewepocs 3D had the highest quality images for most of the assessed features, whereas the Iluma low-resolution scans were rated as the lowest quality images.

Occlusal caries depth measurements obtained by five different imaging modalities.

The study aimed to assess the accuracy and reproducibility of occlusal caries depth measurements obtained from different imaging modalities. The study comprised 21 human mandibular molar teeth with occlusal caries. Teeth were imaged using film, CCD, two different cone-beam computerized tomography (CBCT) units and a microcomputer tomography (micro-CT). Thereafter, each tooth was serially sectioned, and the section with the deepest carious lesion was scanned using a high-resolution scanner. Each image set was separately viewed by three oral radiologists. Images were viewed randomly, and each set was viewed twice. Lesion depth was measured on film images using a digital caliper, on CCD and CBCT images using built-in measurement tools, on micro-CT images using the Mimics software program, and on histological images using AxioVision Rel. 4.7. Intra- and inter-rater reliabilities were assessed according to the Bland/Altman method by calculating Intraclass Correlation Coefficients (ICCs). Mean/median values obtained with intraoral systems were lower than those obtained with 3-D and histological images for all observers and both readings. Intra-observer ICC values for all observers were highest for histology and micro-CT. In addition, intra-observer ICC values were higher for histology and CBCT than for histology and intra-oral methods. Inter-observer ICC values for first and second readings were high for all observers. No differences in repeatability were found between Accuitomo and Iluma CBCT images or between intra-oral film and CCD images. Micro-CT was found to be the best imaging method for the ex vivo measurement of occlusal caries depth. In addition, both CBCT units performed similarly and better than intra-oral modalities.

Accuracy of CBCT measurements of a human skull.

The purpose of this study is to assess the accuracy and reproducibility of cone-beam computed tomography (CBCT) measurements of a human dry skull by comparing them to direct digital caliper measurements. Heated gutta-percha was used to mark 13 specific distances on a human skull, and the distances were directly measured using a digital caliper and on CBCT images obtained with Iluma (3M Imtec, OK, USA) and 3D Accuitomo 170 (3D Accuitomo; J Morita Mfg. Corp., Kyoto, Japan) CBCT imaging systems. Iluma images were obtained at 120 kVp and 3.8 mA and reconstructed using voxel sizes of 0.2 and 0.3 mm(3). Accuitomo images were obtained at 60 kVp and 2 mA and a voxel size of 0.250 mm(3). In addition, 3-D reconstructions were produced from images obtained from both systems. All measurements were made independently by three trained observers and were repeated after an interval of 1 week. Agreement between observers and image type was assessed by calculating Pearson correlation coefficients, with a level of significance set at p < 0.05. Pearson correlation coefficients between readings ranged from 0.995 to 1 for all image types. Correlations among observers were also very high, ranging from 0.992 to 1 for the first reading and from 0.992 to 1 for the second reading for the different image types. All CBCT image measurements were identical and highly correlated with digital caliper measurements. Accuracy of measurements of various distances on a human skull obtained from different CBCT units and image types is comparable to that of digital caliper measurements.

[The mid-term results of proximal row carpectomy in the treatment of degenerative wrist joint derangements]. / Dejeneratif el bilegi eklemi patolojilerinin tedavisinde proksimal sira rezeksiyon artroplastisinin orta dönem sonuçlari.

OBJECTIVES: We evaluated the mid-term results of proximal row carpectomy (PRC) in patients who underwent treatment for wrist joint derangements. METHODS: Nine patients (4 men, 5 women; mean age 38 years; range 23 to 66 years) underwent PRC to relive pain in the wrist joint and to improve motion and grip strength. Indications for surgery were acute transscaphoid-perilunate fracture dislocation in one patient, formerly unreduced perilunate fracture dislocation in one patient, Kienbock's disease in four patients, and scaphoid nonunion associated with scapholunate advanced collapse (SLAC) in three patients. The duration of the symptoms ranged from eight months to 10 years. The results were assessed with the use of pre- and postoperative clinical and radiographic studies, and measurements of active and passive motion, grip strength, and pulp and key pinch strengths. The mean follow-up was 35.4 months (range 13.5 to 72 months). RESULTS: Postoperatively, pain relief was achieved in all the patients and no complications were encountered in the early period. One patient with acute transscaphoid-perilunate fracture dislocation developed radiocapitate joint degeneration three years after surgery and underwent total wrist arthrodesis. Compared to the uninvolved side, wrist functions were found adequate with painless motion, except for passive radial deviation which exhibited a significant decrease (p<0.05). Age, sex, and the duration of symptoms did not influence postoperative results. CONCLUSION: In selected patients with wrist joint derangement, PRC enables painless and adequate motion and grip strength for daily activities. However, radial styloidectomy seems to be necessary to prevent restriction in radial deviation.