Panoramic radiography: effects of head alignment on the vertical dimension of the mandibular ramus and condyle region.

The aim of this study was to assess whether it is possible to derive accurate vertical measurements of the mandibular ramus and condyle from panoramic radiographs. A human dry skull was positioned in a panoramic machine. The skull was displaced along the sagittal and transverse plane and rotated around the vertical and transverse axes. A set of 252 digital radiographs with defined positioning errors was compared with a set of 42 radiographs in the 'ideal' position. The distances between the metal markers that had been attached at the angle of the mandible at a distance of 60 mm in the condyle region to produce fixed reference points on the radiographs were measured. Statistical differences were investigated using Friedman repeated measures analysis of variance on ranks followed by the Dunnett's test for the comparison against the control group in the ideal position (α = 0.05). Vertical measurements were significantly affected when the skull was rotated around the vertical (P < 0.001) or shifted along the transverse axis (P < 0.001). Misalignment of the head affected the vertical measurement of the mandibular ramus and condyle. However, asymmetries of more than 6 per cent are probably not due to patient positioning in the panoramic machine.

Prescription Market Share and Treatment Patterns in Atopic Dermatitis: A Retrospective Observational Study Using US Insurance Claims.

INTRODUCTION: There is limited real-world evidence on the treatments for atopic dermatitis (AD) since dupilumab was approved in 2017. The objective of this study was to assess market share of drugs commonly prescribed for the treatment of AD and describe treatment patterns in patients diagnosed with AD. METHODS: This was a retrospective, observational study in adult patients with an ICD-10 diagnosis of AD between 2017 and 2019 using insurance claims data in the US population. RESULTS: Market share cohorts consisted of 75,794 (2017) and 89,618 (2018) patients. Treatment patterns cohort had 68,588 patients with 63.56% female, mean (SD) age 43.54 (15.96) years, and mean (SD) Quan CCI 0.31 (0.85). Topicals had two-thirds market share by prescription volume (2017 = 65.56%; 2018 = 63.63%). Corticosteroids were the most prescribed topical (2017 = 71.94%; 2018 = 72.04%) and systemic (2017 = 30.59%; 2018 = 30.23%) drug class. Dupilumab had the highest medication adherence (proportion of days covered [PDC] ≥ 80%; 60.74%) and persistence (17.39%), lowest discontinuation rate (23.32%), and longest mean (SD) days on therapy 148.20 (101.77). CONCLUSION: Topicals are the primary treatment for patients with AD, even though systemic users have higher medication adherence (PDC). Systemics provide a treatment alternative to topicals.

Detecting Data Quality Issues in Clinical Trials: Current Practices and Recommendations.

BACKGROUND: Data quality issues in clinical trials can be caused by a variety of behaviors including fraud, misconduct, intentional or unintentional noncompliance, and significant carelessness. Regardless of how these behaviors are defined, they may compromise the validity of the study results. Reliable study results and quality data are needed to evaluate products for marketing approval and for decisions that are made on the use of medicine. This article focuses on detecting data quality issues, irrespective of origin or motive. Early detection of data quality issues are important so that corrective actions taken can be implemented during the conduct of the trial, recurrence can be prevented, and data quality can be preserved. METHODS: A survey was distributed to TransCelerate member companies to assess current strategies for detecting and mitigating risks involving fraud and misconduct in clinical trials. A review of literature across many industries from 1985 to 2014 was conducted using multiple platforms. RESULTS: Eighteen TransCelerate member companies anonymously responded to the survey. All of the respondents had one or more existing strategies for fraud and misconduct detection. The literature search identified current practices and methodologies across many industries. CONCLUSIONS: TransCelerate recommends the creation of an integrated, multifaceted approach to proactively detect data quality issues. Detection methods should include a strategy tailored to the characteristics of the study. Some sponsors are taking advantage of more advanced methods and integrated processes and systems to proactively detect and address issues, relying on advances in technology to more efficiently review data in real time. Further research is underway to assess statistical data quality detection methodology in clinical trials.

Temporomandibular joint dysfunction in Marfan syndrome.

OBJECTIVE: The aim of this study was to examine the prevalence of signs and symptoms of temporomandibular joint (TMJ) dysfunction in persons with Marfan syndrome. STUDY DESIGN: A questionnaire was distributed to 350 patients with Marfan syndrome. Twenty-one patients were additionally subjected to a clinical examination and magnetic resonance imaging (MRI) of the TMJ. RESULTS: The prevalence of symptoms of TMJ dysfunction was 51.6% (n=145), with 24.2 % (n=68) indicating symptoms of subluxation, and 34.9% (n=98) of the patients already undergoing medical treatment for their TMJ problems. Anterior disc displacement with and without reduction was observed in 17 of the examined patients (81.0%), with 4 of these patients additionally showing osteoarthrosis of the affected temporomandibular joints. CONCLUSION: TMJ dysfunction appears to be an important aspect in Marfan syndrome.

Mandibular instantaneous centers of rotation in patients with and without temporomandibular dysfunction.

PATIENTS AND METHODS: The free opening movement of the mandible was examined in 30 patients with and without dysfunctions, using the CADIAX electronic axiography system. All patients in the diseased group showed dysfunctions in the left temporomandibular joint. Half of the 20 asymptomatic patients were skeletal Class II, the other half skeletal Class III. Based on the data collected for the left temporomandibular joint, the movement of the mandible during the mouth-opening movement in the sagittal and vertical planes was described as the pathway over time of the various instantaneous centers of rotation (ICR), using physico-biomechanical factors. RESULTS AND CONCLUSION: It emerged that the ICR path in the patients with dysfunctions was irregular with erratic changes of direction. A harmonious ICR path beginning near the condyle was typical of the healthy group; as the mouth opened, the path moved toward downward backward and finally shifted toward forward and forward upward. Therefore, such an ICR path pattern can be used as an indicator in detecting dysfunctions.

The helical axis of the mandible during the opening and closing movement of the mouth.

BACKGROUND: The movement of a rigid body through space may be comprehensively described by constructing a "finite helical axis" (FHA). The rigid body carries out a rotation around this axis for discrete periods of time while at the same time moving along this axis. MATERIAL AND METHODS: The free opening and closing movement of the mouth was registered in eight asymptomatic test persons, using the CADIAX electronic axiography system (GAMMA-DENTAL, Klosterneuburg, Austria). Subsequently, the position of the FHA in space, the angle of rotation around this axis, and the amount of translation along the FHA were determined for each subject, using the coordinates of the measuring styluses. RESULTS: During the initial phase of the mouth-opening movement, the FHAs were near the condyle. Over the course of the opening movement, they moved toward downward backward, downward and downward forward, and finally to forward upward toward the condyle upon reaching maximum mouth opening. During the closing movement, the FHAs shifted back in the reverse direction. During both the opening and the closing movement, there was a slight translational movement along the FHAs, which provided an indication of mandibular deviation.

In vitro study on the fatigue limit of single-lap joints.

Lasting adhesion between attachment and tooth is an essential prerequisite for all adhesive techniques in dentistry. However, the maximum static fatigue load is only one material-related parameter for the quality of this adhesion. Another parameter is the dynamic loading capacity of a bonded joint, which was determined in the present study for Dual adhesive resin by means of fatigue testing. This revealed a significant correlation between the recorded static and dynamic fatigue load and the gap width, which varied between 0.01 mm, 0.15 mm and 0.5 mm in the experimental setup. At 18.8 MPa, the median gap width of 0.15 mm yielded the highest static resistance, with a dynamic resistance 15% below this figure. Both the smaller and the larger gap showed significantly lower static fracture strengths (0.01 mm: 13.6 MPa; 0.5 mm: 13.7 MPa), whereas a dynamic load on the 0.01 mm bond, in contrast to the 0.5 mm bond, led to only a 5% reduction in bonding strength.

Autotransplantation of immature third molars: influence of different splinting methods and fixation periods.

Different data were published documenting the influence of fixation methods and periods on the outcome of autotransplantations of teeth. Besides studies reporting increased ankylosis and disturbances of pulpal revascularization following rigid or extended fixation, there are studies revealing no connection in this matter. The clinical and radiological results of 76 transplanted germs of third molars were to be assessed after a rigid fixation for 4 weeks or after a suture splinting for 7 days and compared with each other. The choice of fixation method depended on the initial stability of the transplant. After a mean observation period of 3.4 years (range 1.0-6.1 years), 92.9% of the teeth stabilized with a suture, but only 73.5% fixed with an acid-etch composite and wire splint could be classified as successful (P = 0.029). The significant increases in ankylosis (P = 0.036) and pulp necrosis (P = 0.041) were the factors for the less favorable results of the rigidly fixed teeth. Our data support the results of other experimental and clinical studies with regard to the negative influences of an extended and rigid fixation on the success of tooth transplantation. However, apart from a correlation with the method and period of fixation, we also suspect the influence of an incongruity between the transplant and recipient site.