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Background: Refractory (intractable/pharmaco-resistant) epilepsy in children is considered if disabling seizures continue despite appropriate trials of two anti-seizure drugs, either alone or in combination. Ketogenic diets are used as a treatment option in many countries for children with refractory seizures; however, few patients have tried it in Saudi Arabia. Therefore, we examined the relationship between the exposure to a ketogenic diet and its effect in decreasing seizure frequency in infants and children up to 14 years who had refractory epilepsy and assessed factors that could improve the outcome of seizures. Methods: This cross-sectional study was conducted at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected by reviewing medical records of eligible children (infants and children up to 14 years old) with refractory epilepsy who were on ketogenic diets. Socioeconomic data of the parents (guardians) were collected via phone interviews after verbal consent from the parents (guardians). Results: We recruited 95 children (aged 10 months to 14 years) with refractory epilepsy and on Ketogenic diets. Up to 44% of patients on 3:1 and 4.5:1 ratio ketogenic diets had decreased seizure frequency while patients on 1:1 and 2:1 ratio ketogenic diets showed no decrease in seizures. Patients with generalized epilepsy who were on ketogenic diets had the most improvement in seizure outcomes (56.1%) and patients on ketogenic diets who were ambulatory indoors and outdoors (66.7%) showed a high level of improvement in seizure outcomes compared to patients with who were non-ambulatory (21.9%). Lower improvements in seizure frequency in epileptic patients on ketogenic diets were associated with low education levels of parents (33.3% high school vs. 50% undergraduate school), low incomes [<11,400±7,560.864 Saudi riyal (SR)], and diagnosis of seizures in patients >8 years old. Conclusions: Ketogenic diets are a promising approach for treatment of refractory epilepsy among children. The improvement in seizure outcomes was associated with higher ratios of ketogenic diets (3:1 and 4.5:1), and higher physical activity. Sociodemographic factors, including parents' (guardians') education levels and income influenced the improvement of seizures.
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OBJECTIVES: Aramany's classification of postsurgical maxillectomy defects was introduced for partially edentulous situations, and has been widely used for education and effective communication among practitioners. Numerous classifications of maxillofacial defects, based on surgical procedure, resultant defects, or prosthodontist's perspective after rehabilitation, exist in the literature. However, no single classification has incorporated all these factors. The purpose of this review was to highlight the classification systems and describe a pragmatic classification series for edentulous maxillary arch defects (maxillectomy) by applying the Aramany classification criteria, to enhance treatment outcomes and communication among practitioners. MATERIAL AND METHODS: An electronic search of the literature published in English was conducted using the PubMed/MEDLINE and Google Scholar database. Keywords used were "maxillectomy classification" AND "surgical resection," "maxillectomy classification" AND "complete edentulous." In addition, a manual search was also performed followed the same criteria in the following journals: Journal of Prosthetic Dentistry and Journal of Prosthodontics. RESULTS: Several classification systems for partial dentition were found in terms of size, location, dentition, and extension of the defect (isolated or communication defects). The findings revealed a variety of maxillectomy defect classifications for partially dentate, considering surgical factors and rehabilitation. However, no study or classification system exist for the edentulous arch defects. CONCLUSIONS: Different classification systems for maxillectomy defects exist in the literature, only for partially dentate patients. To the authors best knowledge, no classification system for completely edentulous maxillary arch defects have been proposed till date. A simple classification system with clear characteristics for edentulous maxillectomy dental arch defects has been proposed. This classification was modeled after Aramany classification for easier memorization and application.
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Maxila , Prostodontia , Humanos , Maxila/cirurgia , AlgoritmosRESUMO
BACKGROUND: The purpose was to compare the fracture resistance and the mode of failure of different contemporary restorative materials to restore implant supported, cement-retained mandibular molars. METHODS: Two 5 × 10 mm titanium dental implants were mounted in resin blocks and prefabricated titanium and zirconia abutments were connected to each implant. Each implant received forty crowns resembling mandibular first molars. The specimens were divided into four groups (n = 10/group) for each abutment according to the type of material; Group A: porcelain fused to metal crowns; Group B: monolithic zirconia crowns; Group C: zirconia coping with ceramic veneer; Group D: all ceramic lithium disilicate crowns. Specimens were cemented to the abutments, mounted into a universal testing machine, and vertical static load was applied at a speed of 1 mm/min. The test stopped at signs of visual/audible fracture/chipping. Fracture resistance values were analyzed using ANOVA and Tukey's tests (α ≤ 0.05). The modes of failure were visually observed. RESULTS: A statistically significant difference (p < 0.001) of the fracture resistance values among tested groups was found. The group that showed the highest fracture resistance was Group A for both the titanium and the zirconia abutments (3.029 + 0.248 and 2.59 ± 0.39, respectively) while Group D for both abutments (1.134 + 0.289 and 1.68 ± 0.13) exhibited the least resistance. CONCLUSIONS: Fracture resistance and fracture mode varied depending on type of restorative material. For both titanium and zirconia abutments, porcelain fused to metal showed the highest fracture resistance values followed by monolithic zirconia.