Augmentation genioplasty using discarded bone fragments following proximal segment osteotomy of the ramus in intraoral vertical ramus osteotomy (IVRO).

BACKGROUND: Based on a three-dimensional (3D) orthognathic simulation, this technical report introduces a method for augmentation genioplasty using a proximal bone fragment of the mandible, which is typically discarded in intraoral vertical ramus osteotomy (IVRO). RESULTS: A 43-year-old female patient diagnosed with Class III malocclusion, presenting with a protruding mandible and long facial height, underwent surgical treatment. The surgical plan involved mandibular setback position using IVRO and augmentation genioplasty. The 3D orthognathic surgery including augmentation genioplasty simulation was performed. An excessively elongated proximal segment was sectioned following IVRO. The inferior part of the sectioned proximal bone fragment of the mandible was positioned to align with the requirements of advancement genioplasty. After ensuring that the placement of the fragment matched that of the simulated surgery, each bone fragment was fixed. At 1.5 years post-surgery, the grafted bone on the augmentation genioplasty was well maintained, with slight bone resorption. CONCLUSIONS: Augmentation genioplasty using the proximal bone fragment of the mandible, which is typically discarded in IVRO, reduces the surgical complications associated with chin osteotomy. When a secondary genioplasty is required, genioplasty with osteotomy, movement of the cut bone fragments, partial bone-shaving osteotomy, and additional bone grafting are viable options.

Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis Associated With Mediastinal and Ovarian Teratomas: A Case Report.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common type of autoimmune encephalitis. Approximately 80% of patients with anti-NMDAR encephalitis are women. Tumors are detected in approximately 50% of female patients with anti-NMDAR encephalitis, of which 96% are ovarian teratomas. We describe the case of a 28-year-old woman diagnosed with anti-NMDAR encephalitis with mediastinal and bilateral ovarian teratomas in July 2019. The patient recovered following surgical management of the mediastinal mass and both ovarian teratomas, and immunotherapy. This case shows that teratomas can be found at multiple sites other than ovaries. Therefore, detecting teratomas using whole-body evaluation may be helpful for diagnosis and treatment.

No Difference in Clinical Outcomes and Survivorship for Robotic, Navigational, and Conventional Primary Total Knee Arthroplasty with a Minimum Follow-up of 10 Years.

Background: Computer-assisted surgery, including robotic and navigational total knee arthroplasty (TKA), has been proposed as a technique used to improve alignment of implants. The purpose of this study was to compare the clinical and radiological outcomes during a minimum follow-up period of 10 years among robotic, navigational, and conventional TKA. Methods: A total of 855 knees (robotic group, 194; conventional group, 270; and navigational group, 391) were available for physical and radiological examinations over a mean follow-up period of 10 years. The survival rate was analyzed using the Kaplan-Meier method based on the survival endpoint. The Hospital for Special Surgery score, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Score, and range of motion were used for clinical evaluation. The hip-knee-ankle (HKA) axis angle, the coronal inclination of femoral and tibial components, and the presence of radiolucent lines were also assessed at the final follow-up. Results: All clinical assessments at the final follow-up revealed improvements in the three groups without any significant difference among the groups (p > 0.05). The cumulative 10-year survival rate was 97.4% in the robotic group, 96.6% in the conventional group, and 98.2% in the navigational group, with no significant difference (p = 0.447). The rates of complication-associated surgery were not significantly different among the groups (p = 0.907). Only the proportion of outliers in the HKA axis angle showed a significant difference (p = 0.001), but other radiological outcomes were not significantly different among the three groups. Conclusions: Our study demonstrated satisfactory survival rates for robotic, navigational, and conventional TKAs and similar clinical outcomes during the long-term follow-up. Larger studies with continuous serial data are needed to confirm these findings.

Development of Clinical Milestones in Parkinson's Disease After Bilateral Subthalamic Deep Brain Stimulation.

OBJECTIVE: Deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson's disease (PD) patients does not halt disease progression, as these patients will progress and develop disabling non-levodopa responsive symptoms. These features may act as milestones that represent the overall functionality of patients after DBS. The objective of this study was to investigate the development of clinical milestones in advanced PD patients who underwent bilateral STN-DBS. METHODS: The study evaluated PD patients who underwent STN-DBS at baseline up to their last follow-up using the Unified Parkinson's Disease Rating Scale and Hoehn and Yahr scale. The symptoms of hallucinations, dysarthria, dysphagia, frequent falls, difficulty walking, cognitive impairment and the loss of autonomy were chosen as the clinical milestones. RESULTS: A total of 106 patients with a mean age of 47.21 ± 10.52 years at disease onset, a mean age of 58.72 ± 8.74 years at surgery and a mean disease duration of 11.51 ± 4.4 years before surgery were included. Initial improvement of motor symptoms was seen after the surgery with the appearance of clinical milestones over time. Using the moderately disabling criteria, 81 patients (76.41%) developed at least one clinical milestone, while 48 patients (45.28%) developed a milestone when using the severely disabling criteria. CONCLUSION: STN-DBS has a limited effect on axial and nonmotor symptoms of the PD patients, in contrast to the effect on motor symptoms. These symptoms may serve as clinical milestones that can convey the status of PD patients and its impact on the patients and their caregivers. Therefore, advanced PD patients, even those treated with bilateral STN-DBS, will still require assistance and cannot live independently in the long run.

High preoperative gait variability is a prognostic predictor of gait and balance in Parkinson disease patients with deep brain stimulation.

INTRODUCTION: The objective biomarker for prediction of gait and balance in the long-term follow-up of Parkinson's disease(PD) patients with subthalamic nucleus deep brain stimulation(STN-DBS) has not yet been elucidated. We investigated the value of pre-operative quantitative gait parameters for the prediction of long-term prognosis of gait in PD patients with DBS. METHODS: We retrospectively collected gait videos(both medication ON/OFF states) of PD patients recorded as preoperative evaluation before STN DBS. We enrolled patients who were followed-up for more than 5 years after the surgery from 2006 to 2014. We derived objective gait parameters from video-based gait analysis algorithm. We defined the clinical milestones of frequent falling, impaired walking, and loss of autonomy based on the Unified Parkinson's disease rating scale and Hoehn and Yahr stage, which were regularly followed up to 156 months after surgery. We calculated hazard ratios(HRs) of baseline gait parameters for predicting the clinical milestones. RESULTS: A total of 96 gait videos from 63 PD patients were analyzed. The mean follow-up duration(standard deviation) was 88.0(34.2) months after surgery. Relatively high (>mean + 1 standard deviation) variability for step length, step time and stride time (HR = 2.92[1.02-8.33], 3.91[1.38-11.11] and 7.16[2.09-24.52],respectively) in medication-ON state significantly predicted reaching any of the three clinical milestones of frequent falling, impaired walking and loss of autonomy. Gait parameters from the medication-OFF state did not predict any clinical milestone. CONCLUSIONS: High preoperative gait variability from the medication-ON state predicts long-term outcomes for gait and balance in PD patients with STN DBS.

Serum Inflammatory Markers and Progression of Nonmotor Symptoms in Early Parkinson's Disease.

BACKGROUND: The influence of peripheral inflammation on nonmotor symptoms (NMSs) in Parkinson's disease (PD) remains unclear. OBJECTIVE: The aim of this study was to explore whether serum inflammatory marker profiles are associated with the progression of NMSs in early PD. METHODS: We included 45 patients with early PD and 20 healthy control subjects. Six inflammatory markers, including interleukin (IL)-1ß, IL-2, IL-6, IL-10, tumor necrosis factor-α, and high-sensitivity C-reactive protein, were measured. NMSs were assessed using the Non-Motor Symptoms Scale, Montreal Cognitive Assessment, and Composite Autonomic Symptom Score-31 at baseline and after 3 years. RESULTS: Principal component (PC) analysis showed that only PC3 scores, mainly loaded by IL-2 and IL-6, were significantly elevated in the PD group compared with the control group. Higher PC3 scores in the PD group were associated with faster progression of Non-Motor Symptoms Scale total and mood/apathy domain scores. There were no significant associations of PC scores with Montreal Cognitive Assessment and Composite Autonomic Symptom Score-31 score changes. CONCLUSIONS: Peripheral inflammation may be related to the evolution of NMSs, particularly mood symptoms, in the early stages of PD. © 2022 International Parkinson and Movement Disorder Society.

Effect of Topical Anesthesia on Pain from Needle Insertion and Injection and Its Relationship with Anxiety in Patients Awaiting Apical Surgery: A Randomized Double-blind Clinical Trial.

INTRODUCTION: We aimed to simultaneously investigate the effects of topical anesthesia on needle insertion and injection pain in the labial mucosa of the maxillary central incisors of patients awaiting apical surgery and to assess the relationship between patients' anxiety and pain scores. METHODS: Forty-four patients scheduled for apical surgery of the maxillary anterior incisor or canine were included, and all completed the Modified Dental Anxiety Scale (MDAS) questionnaire. One piece of Xylocaine (AstraZeneca, Sodertalje, Sweden) gauze was applied to the right or left side of the labial vestibule below the central incisor according to a randomization process, and 1 piece of water gauze was applied to the contralateral side of the labial vestibule. Each piece of gauze remained in place for 2 minutes. The subjects were asked to rate their pain according to the numeric rating scale immediately after needle insertion and anesthetic solution injection. RESULTS: Topical anesthetic application significantly reduced both insertion- and injection-related pain. Injection pain was significantly higher than insertion pain throughout the experiment. The difference in pain scores between the placebo and topical anesthetic groups was significantly greater for insertion pain than injection pain. The group with higher MDAS scores showed significantly higher pain scores, except for insertion pain reported by the topical anesthetic group, which did not show a significant difference between MDAS score groups. CONCLUSIONS: The topical anesthetic was highly effective for both insertion and injection pain during infiltration anesthesia in the maxillary central incisors. Highly anxious patients reported higher pain scores; however, topical anesthetics reduced the effect of anxiety on increasing pain.

Scanning electron microscopic examination of resected root apices obtained from endodontic microsurgery.

This study was designed to examine the morphological features of the resected root apices obtained from endodontic microsurgery using a scanning electron microscope (SEM) as well as their anatomical effect on the clinical outcome of the surgical treatment. One-hundred-six resected root apices from 91 patients/surgeries were obtained by endodontic microsurgery, and fixed immediately for storage. The resected apices were prepared for SEM to examine their morphological features, such as the number and size of the apical foramina. The patients were periodically checked up at least 1 year and the clinical outcome of the microsurgery was judged as a success or failure according to the Molven's criteria. The SEM findings and the clinical outcome of apical surgery were evaluated to see any potential correlation between them. The SEM examination revealed that 60.4% of specimens had more than two portals of exit on the resected root apices and the size of the major foramen was at least 386 micrometer and 334 micrometer from maxillary and mandibular molar, respectively. With a recall rate of 72.9%, 91.9% of the surgical cases were decided to have successful outcomes. Based on this SEM study, a relatively high frequency of multiple portals of exit was existed and the sizes of major foramina were bigger than that were reported in previous reports. The clinical outcomes of endodontic microsurgery were not correlated with the anatomical features of resected apical root apices. SCANNING 38:455-461, 2016. © 2016 Wiley Periodicals, Inc.

Prognostic factors for clinical outcomes in endodontic microsurgery: a retrospective study.

INTRODUCTION: This retrospective study examined the potential prognostic factors on the outcome after endodontic microsurgery and compared the predictors of isolated endodontic lesion with those of both isolated endodontic lesions and endodontic-periodontal lesions. METHODS: The data were collected from patients with a history of endodontic microsurgery performed between August 2004 and December 2008 and at least 1 year before being evaluated. Surgical procedures were performed by the endodontic faculty and residents. After surgery, an operation record form was made with the preoperative, intraoperative, and postoperative factors from the clinical and radiographic measures. For statistical analysis of the predisposing factors, the dependent variable was the dichotomous outcome (ie, success vs failure). RESULTS: Of 907 cases, 491 were retained at follow-up. At the 0.05 level of significance, age, sex (female), tooth position (anterior), root-filling length (inadequate), [corrected] lesion type (endodontic lesion), root-end filling material (mineral trioxide aggregate and Super EBA; Harry J. Bosworth, Skokie, IL), and restoration at follow-up appeared to have a positive effect on the outcome. On the other hand, with an isolated endodontic lesion, the tooth position (anterior), root-filling length (inadequate), [corrected] and restoration at follow-up were significant factors at the 95% confidence level. CONCLUSIONS: Under the control of the significant variables in logistic regression, the potential prognostic factors on the outcome were sex, tooth position, lesion type, and root-end filling material. On the other hand, the tooth position was a pure predictor of an endodontic lesion affecting the clinical outcome.

Comparison of the cleaning efficacy of a new apical negative pressure irrigating system with conventional irrigation needles in the root canals.

OBJECTIVES: This study evaluated the efficacy of EndoVac system in comparison with that of a conventional needle irrigation method when the root canals were enlarged to various sizes. STUDY DESIGN: Sixty-nine single-rooted teeth were divided into 3 groups according to the root canal irrigation system (24G and 30G needle and EndoVac). Each group was divided into 3 subgroups according to the MAF size (#25, #40, and #60). Four-micron-thick serial sections were prepared at 1.5 and 3.5 mm from the apical level and photographs were taken for the analysis. The influence of the irrigation system and apical size was evaluated using a 1-way ANOVA test and Tukey's test (P < .05). RESULTS: At both levels, significant differences were detected between EndoVac system and conventional needle irrigation in removing debris (P < .05). The relationship between the MAF size and irrigation efficacy was found to have a positive relationship (P < .05). CONCLUSIONS: EndoVac left significantly less debris behind than the conventional needle irrigation methods. Although all 3 irrigation methods resulted in clean root canals because the percentage occupied by remaining debris was very low in our specimens, larger apical instrumentation seemed to improve apical root canal debridement.

An in vivo comparison of working length determination by only root-ZX apex locator versus combining root-ZX apex locator with radiographs using a new impression technique.

OBJECTIVE: The objective of this study was to compare, in vivo, the accuracy of working length determination using only the Root-ZX electronic apex locator versus adjusting Root-ZX measurements after obtaining a working length radiograph. STUDY DESIGN: The working length was determined in 25 premolar root canals using Root-ZX and K-files were fixed at these positions. Radiographs were acquired and interpreted, and the recorded working length measurement was adjusted, if necessary, for a combined measurement. The teeth were then extracted in an effort to determine the position of the file tip to the root canal constriction. On the basis of the position of the file tip to the apical foramen, polyvinylsiloxane impressions of the root apex were taken, or the root was imbedded in acrylic resin and ground in order to measure the position of the file tip to the apical constriction. RESULTS: The Root-ZX alone detected the apical constriction within +/- 0.5 mm in 84% of the samples (21 of 25 canals). However, 96% (24 of 25 canals) were within this range when the combination of Root-ZX and radiographs was used. We noted no statistical significance between these 2 methods (P > .05). CONCLUSION: Using a Root ZX Electronic Apex Locator combined with radiographs is recommended for the determination of working length, although there was no statistical significance between those 2 groups in this study.

Differences in prevalence of selected bacterial species in primary endodontic infections from two distinct geographic locations.

OBJECTIVE: This study intended to compare the prevalence of 7 putative endodontic pathogens in samples of primary endodontic infections taken from patients of 2 distant geographic locations. STUDY DESIGN: Samples from infected root canals associated with asymptomatic periradicular lesions or from pus aspirated from acute periradicular abscesses were collected from patients in Rio de Janeiro, Brazil, and Seoul, South Korea. South Korean samples were frozen and delivered to Brazil, where all steps in the molecular analysis were performed. DNA was extracted and a species-specific nested polymerase chain reaction assay was used to detect 7 target bacterial species. RESULTS: The most prevalent species detected in Brazilian samples were Porphyromonas endodontalis (79% of the cases) , Treponema denticola (79%), and Dialister pneumosintes (76%). The most prevalent species found in South Korean samples were Fusobacterium nucleatum (38% of the cases) , Tannerella forsythia (26%), and Treponema maltophilum (24%). Overall, P endodontalis, D pneumosintes, Filifactor alocis, T denticola, and T forsythia were significantly more detected in Brazilian samples than in South Korean samples ( P < .05). CONCLUSIONS: Findings indicated that the prevalence of some species in infections of endodontic origin may significantly differ from one geographic location to another.

Effect of different temperatures and penetration depths of a System B plugger in the filling of artificially created oval canals.

OBJECTIVES: The purpose of this study was to compare the gutta-percha-filled area in oval canals while varying the temperature and penetration depth of the System B plugger. STUDY DESIGN: Seventy-five resin blocks, with artificially created oval canals, were obturated by using a continuous wave technique. In groups 1, 2, and 3, the plugger was introduced to a depth of 4 mm from the apex at set temperatures of 100, 200, and 350 degrees C, respectively. In group 4, the plugger was inserted to a depth of 2 mm from the apex at a set temperature of 200 degrees C. Group 5 was obturated in the same way as group 2, and then an additional cold plugging was performed to a depth of 3 mm from the apex. The cross sections of the obturated canals were photographed, and the percentage of the gutta-percha-filled area (PGP) was measured. RESULTS: No significant differences were found between the 3 different temperature settings (P >.05). At 1 mm from the apex, group 4 showed the highest PGP (95.57% +/- 6.86), followed by group 5 (84.72% +/- 12.19), and group 2 (67.33 +/- 13.03) (P <.05). CONCLUSION: In artificially created oval canals, plugger temperature within the range used in this study did not affect the PGP. However, the penetration depth of the plugger was significantly related to PGP.