The impact of gender of the examiner on orofacial pain perception and pain reporting among healthy volunteers.

OBJECTIVES: Pain on palpation of jaw muscles is a commonly used diagnostic criterion when examining patients with orofacial pain. It is not known, however, if pain reports are affected by the gender of the examiner. Our aim was to investigate if pressure pain threshold (PPT), pressure pain tolerance (PTol), and pain intensity assessed over the masseter muscles in healthy individuals are affected by the gender of the examiner. MATERIALS AND METHODS: Healthy, pain-free individuals were recruited on a voluntary basis. PPT and PTol were assessed using pressure algometry. At the PTol level, participants also rated pain intensity on a 0-10 numeric rating scale. Assessments of PPT and PTol were conducted with six repeated measurements performed twice, separately by one female and one male examiner, on each participant. RESULTS: In total, 84 participants (43 women; median age 24, IQR 6) were included. With a female examiner, women reported higher pain intensity than men (Mann Whitney U, p = 0.005). In the multivariable analysis, significantly higher PTol was predicted by male examiner. Also, a higher ratio between PTol and reported pain intensity was predicted by male examiner. CONCLUSIONS: The gender of the examiner influences pain reporting and perception in an experimental setting. This effect on pain perception related to gender of the examiner is probably related to normative gender behaviors rather than to biological alterations within the examined individual. CLINICAL RELEVANCE: In clinical and experimental settings, gender of the examiner may affect not only pain perception but also pain reporting, with potential implications for diagnostics in patients with pain.

Influence of repeated implant-abutment manipulation on the prevalence of peri-implant diseases in complete arch restorations. A retrospective analysis.

PURPOSE: To evaluate the effects of repeated abutment manipulation on the prevalence of peri-implant diseases. MATERIALS AND METHODS: A total of 27 edentulous patients (n = 108 implants) immediately restored with double-crown retained implant-supported prostheses were identified for this retrospective study. The test included the one-abutment, one-time care concept (n = 18 patients, n = 72 implants, OAOT) and the control abutment replacement (n = 9 patients, n = 36 implants, AR). A mixed effects model regression was conducted for the variable diagnosis (healthy, peri-implant mucositis, and peri-implantitis) with predictors abutment replacement (presence/absence), number of abutment replacement, category of keratinized mucosa (KM) (2 < KM ≥2 mm), and radiographic bone loss (BL). RESULTS: After 3-15 years (mean 10.2 ± 2.8 years), the prevalence of peri-implant mucositis and peri-implantitis in patients in the AR group was 11.1% and 88.9%, corresponding to 22.2% and 55.6% at the implant level, respectively. In OAOT group, none of the implants showed peri-implant mucositis, whereas the prevalence for peri-implantitis at patient and implant level amounted to 5.6% and 5.6%, respectively. The increased number of abutment replacements was significantly associated with the increased probability to diagnose peri-implant mucositis and peri-implantitis (OR: 6.13; 95% CI [2.61, 14.39]) (p < 0.001), whereas the presence of keratinized mucosa was not founded as a significant cofounder. The estimated mean BL in AR group was 1.38 mm larger than in OAOT group (p = 0.0190). CONCLUSIONS: The OAOT concept was associated with a lower prevalence of peri-implant diseases.

Clinical performance of immediately placed and restored progressive-type implants in the esthetic zone: a prospective observational study.

PURPOSE: To assess implant success and survival of immediately placed and restored progressive-type implants in the esthetic zone. MATERIAL AND METHODS: A total of n = 21 patients (21 implants) had received an immediate placement of a tapered, two-part implant with a progressive thread design (PL) for a single tooth replacement in the anterior maxilla. An immediate 'non full-functional loaded' restoration was provided upon adequate primary stability on a final patient-specific abutment (one abutment-one time concept). The final restoration was provided at 12 weeks (baseline). Implant survival and success (e.g. bleeding on probing-BOP, probing pocket depth-PD, mucosal recession-MR, pink esthetic score-PES) as well as patient- reported outcomes (PROM`S) were recorded at 6 and 12 months. RESULTS: An adequate primary implant stability (i.e. insertion torque > 35 Ncm) was obtained at all but one sites. At 12 months, implant survival (n = 20 patients) amounted to 100%. Non-significant changes to baseline were noted for mean BOP (2.5 ± 28.2%), PD (- 0.26 ± 0.73 mm), and MR (0.0 ± 0.4 mm) values. PES values amounted to 12.9 ± 1.14 and 13.2 ± 0.84 at 6 and 12 months. Technical and mechanical complications were not observed. Patients expressed an overall high satisfaction. CONCLUSIONS: The presented immediacy protocol was associated with high survival and success rates on the short-term.

Ancillary findings assessed by ventilation/perfusion tomography. Impact and clinical outcome in patients with suspected pulmonary embolism.

UNLABELLED: Ventilation/perfusion tomography (V/P SPECT) is a recommended method for diagnosing and follow-up of pulmonary embolism (PE). Moreover, it is possible to recognize other pathologies in addition to PE, such as pneumonia, COPD and left heart failure (LHF). The objective of this prospective study was to identify frequency of ancillary findings among patients with suspected PE. Patients, material, method: 331 consecutive patients with suspected PE were examined and classified with V/P SPECT. Patients were followed up clinically and by means of other laboratory tests. RESULTS: 80 patients had a normal V/P SPECT and no clinical consequences in the follow-up. PE had 104 patients: 23 of them had also additional findings. Among the remaining 147 patients, pneumonias were shown in 82, acute in 75 patients and 7 had chronic post inflammatory state. COPD was present in 42 patients, in 3 combined with pneumonia. Sign of LHF was observed in 10: in 7 the acute LHF diagnosis was established, 3 were classified as having a chronic cardiopulmonary disease. Furthermore, in 16 patients, the V/P pattern was suggestive of a tumour. The clinical outcomes were 6 lung tumours, 3 empyema, one sarcoidosis, 2 were unclarified and 4 were lost in the follow-up. CONCLUSION: V/P SPECT identifies a high prevalence of other cardiopulmonary diseases among patients with a clinical suspicion of PE. Ancillary findings with V/P SPECT clarified patients' symptoms and had an impact on the treatment. These findings were verified by a clinical outcome by the follow-up over three months.

The deep inferior epigastric perforator flap for breast reconstruction, the learning curve explored.

The deep inferior epigastric perforator (DIEP) flap has been used as the principle tool for secondary breast reconstruction in our department. This article details our experience in learning and improving the technique with the help of an external team of experienced surgeons. In our initial 65 DIEP flap breast reconstructions our total flap loss rate was reduced from 9.5 to 0%, partial flap loss rate from 31 to 0%, and fat necrosis rate from 17 to 4.3%. We illustrate how a surgical team, which might initially have considered the complication rate from DIEP flap breast reconstruction too high, can benefit from a staged approach to this complex, but useful, reconstruction technique.