Tooth Anatomy Inspector: A comprehensive assessment of an extended reality (XR) application designed for teaching and learning of root canal anatomy by students.

AIM: To develop and evaluate a suitable software application for mobile devices designed for teaching root canal anatomy to undergraduate students in an informative and engaging manner. METHODOLOGY: Extracted human teeth were scanned by µCT and digitized by converting into STL files. An extended reality (XR) application illustrating the root canal anatomy of the scanned teeth was developed. Prior to deployment, undergraduate dental students were voluntarily asked about their expectations regarding an educational application on tooth anatomy. After a testing phase of the application on a mobile device and within a virtual reality environment, a subsequent evaluation was conducted to assess their overall experience in relation to their initial expectations. Data were analysed using Kolmogorov-Smirnov test and Mann-Whitney U test. The level of significance was set to .05 (p = .05). RESULTS: The application was able to meet the expectations of the students in all categories (p < .466-.731). Furthermore, it was evaluated as user-friendly (98.2%) and highly motivating for the purpose of learning more on root canal anatomy (100%). CONCLUSION: Given the overwhelmingly positive reception from undergraduate dental students, the application emerges to be a promising supplementary teaching method for the endodontic curriculum.

A retrospective multicentric cohort study of checkpoint inhibitors-induced pruritus with focus on management.

BACKGROUND: Limited data on immune checkpoint inhibitor (ICI)-induced pruritus per se and efficacy of different therapeutic modalities in its management exist. OBJECTIVE: To study the quantitative and qualitative characteristics of ICI-induced pruritus per se and to assess the efficacy of the therapeutic modalities usually applied. METHODS: We retrospectively reviewed the records of 91 patients who were under treatment with ICIs for any kind of neoplasia and developed pruritus during treatment. RESULTS: Twenty out of 91 individuals (22.0%) with ICI-induced pruritus had pruritus as the only symptom, while 71/91 (78.0%) presented with pruritus coexisting with an additional cutaneous toxicity. Pruritus was treated with antihistamines (18/20, 90.0%) and/or topical regimens, as first-line choice. In resistant cases, as a second therapeutic intervention, narrow-band UVB (NBUVB), oral steroids and GABA analogs were added (70.0%). Statistical analysis revealed a significant difference in mean pruritus Numerical Rating Scale (NRS) scores between baseline and sequential visits. Moreover, subgroup analysis revealed a significant reduction in mean NRS scores in those treated with phototherapy. LIMITATIONS: Retrospective design, low number of patients and survivorship bias. CONCLUSION: Pruritus per se was present in a substantial portion of our cohort (22.0%). Our study confirms the efficacy of current treatment strategies and suggests NBUVB as a potential steroid-sparing therapeutic alternative.

Topical immunotherapy treatment of alopecia areata with diphenylcyclopropenone: Regulatory T cells as biomarkers for treatment response.

Treatment of alopecia areata is often challenging, especially for patients with extended disease. Contact immunotherapy with diphenylcyclopropenone (DPCP) has been reported as an effective topical treatment but the exact immunologic mechanism of diverting the immune response is still unknown. We investigated the efficacy of topical immunotherapy with DPCD in acute, intermediate, and chronic lesions of AA and the response rate was associated with perifollicular infiltrate of T regulatory cells. Approximately two-thirds of our patients (67.5%) had a response rate > 50% after 6 months of DPCP therapy. Patients with acute and intermediate onset of the disease were more likely to respond to the therapy. Although responders demonstrated FOXP3+ positive lymphocytes in immunohistochemistry, this association could not be confirmed by statistical significance (p = 0.052). In patients with multiple lesions, that had different chronological onset, the lesions with more recent onset responded faster than lesions of longer duration.

Challenges in sarcoidosis and sarcoid-like reactions associated to immune checkpoint inhibitors: A narrative review apropos of a case.

Sarcoidosis and sarcoid-like reactions (SLRs) may develop in association with various malignancies, as well as in association to certain oncologic drugs, including immune checkpoint inhibitors (ICIs). We aimed to perform a narrative review with regard to the development of ICIs-associated sarcoidosis or SLRs, and to discuss the corresponding diagnostic and therapeutic challenges raised in this scenario. Apropos of a melanoma patient developing SLRs while treated with ipilimumab and nivolumab, we searched for clinically evident, ICIs-associated sarcoidosis or SLRs in the English literature. We recorded the oncologic characteristics, including type of malignancy and type of ICI, the phenotypic characteristics of sarcoidosis/SLRs, as well as the impact on immunotherapy. Including our patient, we identified 80 ICIs-associated sarcoidosis or SLRs cases. Both sexes were equally affected (40 F/40 M) and the most common malignancy was melanoma (65/80, 81.3%). Concerning the oncologic treatment, there was a predilection for pembrolizumab (23/80, 28.7%), followed by the ipilimumab/nivolumab combination (21/80, 26.3%), ipilimumab (18/80, 22.5%), nivolumab (16/80, 20.0%). Although in the majority of the cases (52/80, 65.0%) there was no need for systemic prednisolone for the management of sarcoidosis, a significant proportion of patients finally discontinued ICIs treatment (44/80, 55.0%). Phenotypically, sarcoidosis and SLRs highly imitate oncologic progression posing diagnostic difficulties. A therapeutic dilemma is also raised when there is a need for systemic prednisolone, since the latter may jeopardize the therapeutic efficacy of immunotherapy. Sarcoidosis and SLRs, though rare, can present in oncologic patients treated with ICIs. Clinicians should be aware of this possibility and the related diagnostic and therapeutic challenges they have to face in this scenario.

The dermatoscopic spectrum of cutaneous lupus erythematosus: A retrospective analysis by clinical subtype with clinicopathological correlation.

The skin is the most common organ of involvement during the course of lupus erythematosus (LE). The literature data concerning the dermatoscopic patterns of the different clinical variants of cutaneous LE (CLE), namely chronic (CCLE), subacute (SCLE), and acute (ACLE), are scarce. To determine the dermatoscopic spectrum of CLE and to correlate the dermatoscopic features with the histological findings. This was a retrospective, observational, multicenter, cohort study. We evaluated the dermatoscopic features in a cohort of patients diagnosed with CLE. Furthermore, we investigated their frequency per clinical subtype and correlated them with the anatomic alterations. We included 79 patients. The most prevalent dermatoscopic features of CCLE included follicular plugs (86.4%, P < .01), patchy distribution (75%, P = .1) of mostly linear curved vessels (56.8%, P = .8), white scales (68.2%, P < .01), and structureless white color (68.2%, P < .01). The most common criteria of SCLE were patchy distribution (90%, P = .1) of mostly linear curved vessels (53.3%, P = .8) and fine white scales (60%, P < .01), while ACLE was characterized by erythema (100%, P < .05) and patchy distribution (100%, P = .1) of mostly dotted vessels (60%, P = .4). Follicular plugs/rosettes in dermatoscopy strongly correlated with follicular plugs in histology (rho = 0.919). Hyperkeratosis significantly correlated with white (rho = 0.644) and yellow/brown scales (rho = 0.225), telangiectasia with linear curved vessels (rho = 0.321) and white color with dermal fibrosis (rho = 0.623). Depending on CLE subtype, distinct dermatoscopic patterns are recognized. In CLE there is a high correlation between certain dermatoscopic criteria and the underneath anatomic alteration.

A detailed report on the measures taken in the Department of Conservative Dentistry and Periodontology in Munich at the beginning of the COVID-19 outbreak.

OBJECTIVES: The corona disease (COVID-19) is developing into one of the greatest challenges for healthcare professionals around the world. In this article, we report the detailed actions taken in the Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany, during the early phase of the COVID-19 pandemic. MATERIAL AND METHODS: After a joint on-site inspection of the dental clinic with the Department of Clinical Microbiology and Hospital Hygiene, existing clinical and hygiene protocols were adapted for COVID-19 patients. RESULTS: A comprehensive summary of the preparation of the facilities as well as pre- treatment, treatment and posttreatment protocols are described and arising problems are being discussed. CONCLUSIONS: The importance of rigorous hygiene and treatment protocols as well as a sufficient supply of PPE for dental offices and hospitals is highlighted. The measures reported may be subject to change due to the dynamics of the pandemic. CLINICAL RELEVANCE: The modes of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (e.g., droplets, aerosols, and fomites) can pose a risk for dental healthcare professionals and patients alike. The presented measures may guide dental faculties and dental practices during the early stage of the COVID-19 crisis.

Temperature changes on the root surface during application of warm vertical compaction using three different obturation units.

This study aimed to determine the temperature increase on the root surface during warm vertical compaction using three different obturation systems. Forty-five human single-rooted premolars were randomly assigned to one of three experimental groups of 15 teeth each for obturation with a System B unit, an Elements Obturation Unit, or a B&L SuperEndo Alpha II unit. All teeth were filled using the continuous wave of condensation technique with a set temperature of 200 °C. The temperature measurements were made with an infrared camera at 3 s (T0) and 1 min (T1) following activation of the heat plugger. T0 ranged between 48.1 and 84 °C depending on the obturation system. The mean value for T0 showed significant differences between various obturation systems (p = 0.001). The temperature increase on the root surface during the application of vertical compaction shows considerable variability depending on the obturation system.

Use of Dermoscopy among Greek Dermatologists in Everyday Clinical Practice: A National Questionnaire-Based Study.

Background: Dermatoscopy has been established as an important diagnostic tool for a wide range of skin diseases. This study aims to evaluate the use of dermatoscopy in clinical practice among Greek dermatologists. Methods: A nationwide questionnaire-based survey was conducted collecting data on the frequency of dermatoscopic examinations, the types of lesions examined, training and educational resources, as well as factors influencing the choice to incorporate dermatoscopy into daily clinical routines. Results: A total of 366 Greek dermatologists participated in the survey. Most of the respondents reported the daily use of dermatoscopy in their practice. Pigmented and non-pigmented lesions, inflammatory diseases, cutaneous infectious, hair disorders, and nail lesions were the most common indications for dermatoscopy. Factors influencing the utilization of dermatoscopy included increased diagnostic accuracy, enhanced patient care, better patient communication and general compliance, and improved satisfaction among dermatologists. Conclusions: This national questionnaire-based study demonstrates that dermatoscopy has become an integral part of daily dermatological practice in Greece. The findings highlight the significance of structured training and education to promote dermoscopy's effective and routine use. Incorporating dermatoscopy into clinical practice not only improves diagnostic precision but also enhances patient care, contributing to the overall quality of dermatological services in Greece.

Congenital nevus of the nail apparatus--diagnostic approach of a case through dermoscopy.

Melanonychia striata in childhood is primarily due to congenital nevi, but melanoma should be excluded. We report a case in which dermoscopy was used in an attempt to avoid incisional biopsy.

Eccrine Poroma: Pathogenesis, New Diagnostic Tools and Association with Porocarcinoma-A Review.

Eccrine poroma (EP) is a relatively rare benign adnexal neoplasm that usually affects elderly patients. Its pathogenesis is still under investigation, but recent gene studies have revealed gene fusions as key incidences resulting in oncogenetic pathways. It often presents as a solitary, firm papule, mostly asymptomatic, located on the soles or palms. Due to its clinical and dermoscopic variability, it is characterized as the great imitator. We performed a literature review, aiming to summarize current data on the pathogenetic mechanisms, new dermoscopic features, and novel diagnostic tools that may aid in early diagnosis and proper management of this rare adnexal tumor. Furthermore, we reviewed the possible pathogenetic associations between EP and its malignant counterpart, namely eccrine porocarcinoma. This systematic approach may aid in understanding the pathogenetic mechanisms and how to use novel histopathologic markers and imaging methods to overcome the diagnostic dilemma of this rare tumor.

Clinical and Dermoscopic Characteristics of Cutaneous Sarcomas: A Literature Review.

Under the umbrella of cutaneous sarcomas (CS) we include a heterogeneous group of rare, malignant, mesenchymal neoplasia, such as dermatofibrosarcoma protuberans, atypical fibroxanthoma, cutaneous undifferentiated pleomorphic sarcoma, cutaneous angiosarcoma and leiomyosarcoma. Clinical presentation and histopathological examination are the cornerstone of CS diagnosis and classification. There are scarce data in the literature in regards to the clinical and dermatoscopic characteristics of CS and the role of dermatoscopy in their early identification. We performed a literature review, aiming to summarize current data on the clinical and dermatoscopic presentation of the most common types of cutaneous sarcomas that may facilitate early diagnosis and prompt management. Based on the available published data, CS are characterized by mostly unspecific dermatoscopic patterns. Dermatofibrosarcoma protuberans, Kaposi's sarcoma, and in a lesser degree, cutaneous angiosarcoma, may display distinct dermatoscopic features, facilitating their early clinical recognition. In conclusion, dermatoscopy, in conjunction with the overall clinical context, may aid towards suspicion of CS.

Persistent erythematous lesion of the vulva: a diagnostic and treatment challenge.

The painful, erythematous and eroded vulva often proves to be a diagnostic problem both clinically and histologically. Its differential diagnosis includes both non-neoplastic and neoplastic diseases like Bowen's disease and squamous cell carcinoma (SCC). We report the case of a 62-year-old woman diagnosed, after considerable delay, with Bowen's disease of the vulva that eventually progressed to invasive SCC, despite the treatment with imiquimod 5% cream. Our case indicates, on one hand, that dermoscopy could contribute to the accuracy of the pre-operative clinical diagnosis. On the other hand it confirms the fact that treatment of Bowen's disease of the vulva could be rather intriguing. Although imiquimod 5% cream is an effective, non-invasive treatment option for large lesions or poor healing sites, it should be administered with great consideration in carefully selected cases.

Longevity of gold restorations in posterior teeth: A retrospective study up to 10-years.

OBJECTIVE: In this retrospective clinical study, we investigated the long-term survival and success of indirect gold restorations, placed by undergraduate students. MATERIAL AND METHODS: The study included 72 gold restorations in 45 patients, placed in a five-year period between 2009 and 2013. Two experienced dentists performed the evaluation following the FDI criteria after 5 to 10 years. Kaplan-Meier test was used for longevity analysis of success and survival. Data were tested for normality with Shapiro-Wilk test. Cox regression analysis, with significance level appointed at p ≤ .05, was performed using success and survival of restorations as dependent variables. Annual failure rates (AFRs) were calculated. RESULTS: Overall, 72 indirect gold restorations prepared in posterior teeth were assessed, with an observation time from 63 months to 117 months. The mean service time was 88.1 months and the median 87 months. No failures, but 2 repairs, were observed during the first five years. From 5 to 10 years 1 replacement and 1 more repair occurred. The survival and success rates of gold restorations were calculated at 9 years with 98.6% and 91%, respectively. Restorations placed on premolars had higher survival and success rates compared to molars. Three cases were categorized as repairs: in two cases, a root canal treatment was needed and, in one other, an occlusal perforation of the restoration was observed. CONCLUSIONS: Posterior indirect gold restorations placed by dental undergraduate students showed a highly predictable clinical performance in terms of success and survival. These results are comparable with survival rates reported in literature for restorations cemented in general dental practices. CLINICAL SIGNIFICANCE: Casted gold restorations placed from dental students in an undergraduate setting show high survival rates, similar to professional dentists.

Fungal Infections and Nail Psoriasis: An Update.

The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the compact nail plate acts as a barrier, preventing any infection. In psoriatic nails, the nail plate involvement, together with abnormalities in the blood capillaries, may lead to decreased natural defenses against microorganisms. Moreover, onycholysis (detachment of the nail plate) induces a humid environment that may favor fungal proliferation. Treatment with immunosuppressive drugs may additionally enhance onychomycosis. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails.

The potential role of microorganisms in the development of rosacea.

Rosacea is a chronic cutaneous disorder characterized by centrofacial persisting erythema, telangiectases, papules, pustules, edema, phymas and ocular involvement. Despite being one of the most common skin disorders, its pathogenesis remains unclear and controversial. Although the disease triggering factors are well recognized, the underlying causes of rosacea have not yet been identified. Several different postulates about its pathogenesis can be found in the medical literature. Abnormalities of the pilosebaceous unit, as well as genetic, vascular, inflammatory, environmental and microbial factors have been described. The microorganisms that have been associated include Helicobacter pylori, Demodex folliculorum, Staphylococcus epidermidis, and Chlamydia pneumonia; all the studies have been inconclusive. We review currently available scientific data on the potential pathogenetic role of microorganisms in the development of rosacea.

Basosquamous Carcinoma: A Commentary.

Basosquamous carcinoma is a rare, aggressive non-melanoma skin cancer with features that lie between those of basal cell carcinoma and squamous cell carcinoma. A lot of controversy has been raised around the classification, pathogenesis, histologic morphology, biologic behavior, prognosis and management of this tumor. This is a narrative review based on an electronic search of articles published in PubMed in English language which had in their title the terms "basosquamous carcinoma" and/or "metatypical carcinoma of the skin". The aim of this review was to summarize and evaluate current data regarding epidemiology, clinical presentation, dermoscopic and histopathologic characteristics, as well as the genetics and management of BSC, in order to shed some more light onto this intriguing entity. As a conclusion, dermoscopy, deep incisional biopsies and immunohistologic techniques (Ber-EP4) should be applied in clinically suspicious lesions in order to achieve an early diagnosis and better prognosis of this tumor. Surgical treatments, including wide excision and Mohs' micrographic surgery, remain the treatment of choice. Finally, vismodegib, a Hedgehog pathway inhibitor, must be thoroughly investigated, with large controlled trials, since it may offer an alternative solution to irresectable or difficult-to-treat, locally advanced cases of basosquamous carcinoma.

Longevity of lithium disilicate indirect restorations in posterior teeth prepared by undergraduate students: A retrospective study up to 8.5 years.

OBJECTIVES: To analyze retrospectively the clinical performance and survival of lithium disilicate inlays, partial crowns and crowns placed by undergraduate students. METHODS: 250 lithium disilicate posterior restorations (IPS™Emax Press) were evaluated. Mean service time was 6.6 years (79 months) with a maximum observation time of 8.5 years (102 months). Clinical performance was assessed using FDI Criteria. Descriptive statistics were used to display the distribution of the criteria. Success and survival of the restorations were calculated with the Kaplan Meier method. A Cox regression analysis was performed to detect influencing parameters for the survival or the success of the restorations. RESULTS: Survival and success rates of lithium disilicate indirect restorations were calculated at 6.6 years with 96.3 % and 93.8 %, respectively. After 8.5 years the survival rate was calculated with 94 % and the success rate with 83.8 %. 10 out of 250 restorations (4%) failed, while the main reasons for failure were fracture of material, debonding/loss of restoration, endodontic complications as well as recurrence of caries. A Cox regression analysis failed to show a correlation between restoration failure and the experience level of the students, an existing root canal treatment, type of tooth, bruxism or the use of rubber dam. CONCLUSIONS: Lithium disilicate indirect posterior restorations demonstrate a high success and survival rate after a mean service of 6.6 years when placed by undergraduate students with different levels of experience. Co-factors influencing the survival or success rate of these restorations could not be identified. CLINICAL SIGNIFICANCE: Lithium disilicate restorations show a good clinical performance up to 8.5 years when prepared by undergraduate students.