A comparison of 9-min colonoscopy withdrawal time and 6-min colonoscopy withdrawal time: A systematic review and meta-analysis.

INTRODUCTION: The optimal colonoscopy withdrawal time is still a controversial topic. While several studies demonstrate that longer withdrawal time improves adenoma detection rate, others have contradicted these findings. METHODS: Three independent reviewers performed a comprehensive review of all original articles published from inception to January 2021 and included studies reporting comparison of the two cohorts-(i) ≥ 6 but less than 9 min of colonoscopy withdrawal time (CWT) and (ii) ≥ 9 min of CWT. The outcome measures were the following: (i) adenoma detection rate (ADR), (ii) advanced ADR, and (iii) sessile serrated adenoma detection rate (SDR). The meta-analysis was performed, and the statistics were two-tailed. RESULTS: A total of seven studies met the inclusion criteria after a thorough search of the literature was completed. The analysis revealed that ≥ 9 min of CWT had significantly higher odds of adenoma detection as compared with 6-9 min of CWT (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.30-1.82; I2  = 93.7). Additionally, a significantly higher odds of sessile serrated adenoma detection (OR 1.68, 95% CI 1.28-2.22; I2  = 0) and a trend towards higher odds of advanced adenoma detection (OR 1.38, 95% CI 0.98-1.95, I2  = 90) were seen with CWT of at least 9 min when compared with 6-9 min of CWT. CONCLUSION: This systematic review and meta-analysis analysis provides further evidence that at least 9 min of CWT cohort had significantly higher ADR and SDR as compared with the at least 6 min but less than 9 min of cohort.

Assessment of undergraduate students in tooth extraction competence- A cohort study.

AIM: The aim of the study was to determine the value of the number of patient encounters and tooth extractions on the competence of final-year Bachelor of Dental Surgery (BDS) students. METHODS: Following ethics approval, the study employed purposive sampling to enrol final-year BDS students and assess their competence longitudinally over a full academic year. Students were assessed periodically on four separate occasions after they had gained experience in performing 15, 40, 70 and 100 patient encounters involving tooth extractions. RESULTS: There were 177 students with complete profiles completing the tooth extraction assessments including 31 males (18%) and 146 females (82%). The age range of participants was 22 to 24 years (mean = 21.92; median = 22). The total number of assessment data points available for the four assessments was 1062. A chi-squared test was carried out to test the hypothesis that competence in tooth extraction increases with increasing exposure to patients. Students in Group 100 were most likely to pass the competency, whilst students in Group 15 were most likely to fail. There was a statistically significant variation in the proportion of "Below Standard," "Meets Standard" and "Exceeds Standard" judgements awarded to students with differing levels of prior experience (p < .001). Therefore, the hypothesis was accepted. Analysis of assessment results for differential performance of students by gender did not show significant differences. CONCLUSIONS: The results of this study show a positive relationship between the number of tooth extractions performed and competence of final-year dental students. Over 90% students achieved competence after performing 100 patient encounters. Although competence in tooth extractions showed a linear relationship with experience of the participants in this study, the data were collected from a single cohort of students at one institution. Further multi-institution studies involving several cohorts are required to further explore the value of increased experience.

Modified maxillary protraction headgear for the correction of class III skeletal malocclusion with anterior open bite.

This is a case report of a 10-year-old girl with a hyper divergent class III skeletal malocclusion caused primarily due to maxillary retrognathism. Treatment involved the use of a modified maxillary protraction face mask that carries the point of force application extra orally to pass through the centre of resistance of the maxillary dentoalveolar complex. After 8 months, the maxilla was displaced anteriorly without rotation. Maxillary occlusal plane showed a clockwise rotation. Maxillary incisors were extruded and retroclined. Mandible was displaced downward and backward. Another 18 months were required for fixed orthodontic treatment to achieve perfect interdigitation.