A comparison of toothpaste tablets and a sodium fluoride dentifrice for the control of supragingival plaque and gingivitis: A 2-week randomized controlled trial.

PURPOSE: To compare toothpaste tablets containing 0.243% sodium fluoride and a conventional sodium fluoride dentifrice for gingivitis and plaque control over a 2-week period. METHODS: Forty adult participants were randomized into two groups: Toothpaste tablets (Colgate Anywhere Travel Toothpaste Tablets) and conventional dentifrice (Colgate Cavity Protection). A blinded examiner measured the gingival and plaque index at baseline and after 2 weeks. A questionnaire was distributed at the end to determine overall satisfaction of the product used. Statistical analyses were performed separately for the gingival index and plaque index scores. Comparisons of the two treatment groups with respect to baseline and 2-week gingival index and plaque index scores were performed using Mann-Whitney U-test. Within-treatment comparisons of the gingival index and plaque index scores obtained at the 2-week examinations versus baseline were performed using Wilcoxon test. RESULTS: Both groups had statistically significant improvements in plaque control at the 2-week visit (P< 0.05). There was no statistically significant difference between groups for gingival and plaque index at the 2-week visit (P> 0.05). Overall satisfaction for both products were positive while perception on "texture/foaminess" was more negative for toothpaste tablets (P= 0.001). The results showed that toothpaste tablets' short-term performance on gingivitis and plaque control was equivalent to conventional dentifrice while the " texture/foaminess" of toothpaste tablets was found to be less appealing. CLINICAL SIGNIFICANCE: Toothpaste tablets are a relatively new form of toothpaste that can be a viable alternative to conventional dentifrice with the added benefit of an eco-friendly way of maintaining oral hygiene.

Effect of toothpaste tablets on gloss and surface roughness of resin-based composite materials.

PURPOSE: To evaluate the effects of toothpaste tablets on the gloss and surface roughness of resin-based composite materials and determine the relationship between gloss and roughness. METHODS: Rectangular jigs were designed and printed. Wells (2 mm deep x 7 mm diameter) were filled with Filtek Supreme Ultra A2B, light-cured and polished. A small-area glossmeter was used for gloss (GU) measurements and a profilometer for roughness measurements (Ra) at baseline and after challenge with each toothpaste. An automated tooth-brushing machine was set at 120 strokes/minute for a total of 10,000 strokes to evaluate four test groups with 16 specimens in each group. NC: Brushing with distilled water; TABS: Colgate Anywhere Travel Tooth Tabs; CP: Colgate Cavity Protection Toothpaste and AW: Colgate Whitening Advanced Toothpaste. Kruskal-Wallis test was used to test the difference in gloss and surface roughness among the groups and Pearson correlation was used to compare the relationship between gloss and roughness. RESULTS: There was no statistically significant difference in gloss and roughness among the four groups at baseline. At post-brushing, there was a statistically significant difference among the groups (P< 0.001) with increased roughness and decreased gloss for CP and AW when compared to TABS. There was a statistically significant correlation between post-brushing roughness and post-brushing gloss (P< 0.001, rho: -0.815). Thus, the higher the surface roughness the lower the gloss. CLINICAL SIGNIFICANCE: Toothpaste tablets retain better gloss and roughness of resin-based composite materials when compared to conventional toothpastes.

Assessing Adherence to Provider's Recommendations in Caries Risk Assessment and Management: A Retrospective Data Review.

AIM: To evaluate the distribution of caries risk category of patients at a dental institution and determine adherence to providers' recommendations. MATERIALS AND METHODS: A cross-sectional retrospective review of 1,235 patients records that included data collection on demographics, the sum of the number of decayed, missing due to caries, and filled teeth in the permanent teeth (DMFT), presence of frequent snacking, stimulated salivary flow rate, stimulated saliva pH, saliva buffering capacity, biofilm activity, caries risk category, anti-caries prescription accept/decline, and change in the caries risk category. Statistical analysis was carried out through Pearson's Chi-squared test and linear model ANOVA with a significance level of 0.05. RESULTS: Pearson's Chi-squared test showed a statistically significant difference in frequency by risk category (p < 0.001) indicating that patients were skewed toward high and extreme caries risk. Linear model ANOVA showed that higher risk categories were associated with lower salivary flow rates (p = 0.010) and higher biofilm activity (p < 0.001). About, 1 out of 3 patients were reported to have frequent snacking (N = 391, 32%). Frequent snacking patients were more likely to present with higher caries risk assessment (p < 0.001), younger age (p < 0.001), and female (p < 0.001). Despite recommendations from the dental student provider, only 27% accepted the anti-cavity prescriptions while 61% declined the recommendation. CONCLUSION: Distribution of caries risk category is not evenly distributed, but rather skewed toward high and extreme caries risk levels. Despite the identified risks, there is low adherence to the recommendations provided by healthcare providers. The results underscore the necessity for targeted interventions and initiatives aimed at fostering behavioral changes to enhance oral health outcomes. CLINICAL SIGNIFICANCE: There is a high need for targeted interventions and initiatives that promote behavioral changes to enhance oral health outcomes.

Impact of Dental Institutions' Values on Students' Intent to Practice in Underserved Communities: A Cross-sectional Study.

AIM: To evaluate how an institution's values can impact students' intent to practice in underserved areas. MATERIALS AND METHODS: The values of 71 accredited dental schools in the United States were searched and tabulated. The American Dental Education Association (ADEA) survey results were used to tabulate the desire to serve the underserved population before entering dental school and upon graduation. Additionally, responses on the total amount of educational debt on graduation was compiled for LLUSD and all other dental schools. Fisher's exact test was performed to compare the difference between the two cohorts and Wilcoxon test was used to assess difference within the groups. Tests were conducted at an alpha level of 0.05 with SAS v 9.1.3 (SAS Institute, Cary, NC, USA). RESULTS: The top five values of US dental institutions based on frequency were excellence, diversity/inclusion, integrity, innovation, and respect. There was no statistically significant difference between LLUSD and all other dental schools in their desire to serve the underserved community upon graduation (p > 0.05, in all instances). Overall, there was a trend that upon graduation, the desire to serve the underserved had less impact on students' decision-making on their career choices. This drop in the desire to serve the underserved was statistically significant within both cohorts in the year 2021 (p < 0.001). CONCLUSIONS: Dental institutions should focus on better understanding of how their values impact their students' career choices so that they can develop strategies to better align their values with the mission of addressing the dentist shortage in underserved areas. CLINICAL SIGNIFICANCE: Dental institutions' values play a major role in impacting students' career choices upon graduation and should be assessed using metrics that are measurable.

Evaluation of microbial air quality and aerosol distribution in a large dental clinic.

PURPOSE: To evaluate the microbial air quality during dental clinical procedures in a large clinical setting with increasing patient capacity. METHODS: This was a single-center, observational study design evaluating the microbial air quality and aerosol distribution during normal clinical sessions at 5% (sessions 1 and 2) and at > 50% (session 3) treatment capacity of dental aerosol generating procedures. Sessions 1 and 2 were evaluated on the same day with a 30-minute fallow time between the sessions. Session 3 was evaluated on a separate day. For each session, passive air-sampling technique was performed for three collection periods: baseline, treatment, and post-treatment. Blood agar plates were collected and incubated at 37°C for 48 hours. Colonies were counted using an automatic colony counter. Mean colony forming units (CFU) per plate were converted to CFU/m²/h. RESULTS: Kruskal Wallis test was performed to compare the mean CFU/m²/h between the clinic sessions. Statistically significant differences were observed between sessions 1 and 2 (P< 0.05), but not between sessions 2 and 3 (P> 0.05). Combining all clinical sessions, the mean CFU/m²/h were 977 (baseline), 873 (treatment), and 1,631 (post-treatment) for the collection periods. A decrease-to-increase CFU/m²/h trend was observed from baseline to treatment, and from treatment to post-treatment that was observed for all clinic sessions and was irrespective to treatment capacity. Higher amounts of CFU/m²/h were found near the air exhaust outlets for all three clinic sessions. Microbial aerosol distribution is most likely due to the positions and power levels of the air inlets and outlets, and to a lesser extent with patient treatment capacity. CLINICAL SIGNIFICANCE: Dental clinics should be designed and optimized to minimize the risk of airborne transmissions. The results of this study emphasize the need to evaluate dental clinic ventilation systems.

Exposure of Barriers Used in Guided Bone Regeneration: Rate, Timing, Management, and Effect on Grafted Bone-A Retrospective Analysis.

The purpose of this study is to compare the exposure rate of 3 different barrier types after a guided-bone regeneration procedure as well as to compare the percentage grafted bone dimensional loss with and without exposed barriers. Patient records from September 2007 to May 2015 were reviewed to identify subjects who had received a bone graft followed by implant placement procedure after the graft had completely healed. The subjects were divided into 3 groups: (1) resorbable barrier, (2) nonresorbable barrier, and (3) titanium-mesh barrier. Incidences of barrier exposure were recorded. Cone-beam computerized tomography images before treatment (T0), right after grafting (T1), and after healing (T2) were used to determine the percentage of grafted bone dimensional loss and am quantitative amount of grafted bone remaining (mm2). Three cross-sectioned areas, at 1-mm apart, of preplanned implant positions at the grafted site were measured using cone-beam computerized tomography to calculate the remaining grafted bone and grafted bone dimensional change. The exposure rate of all guided bone regeneration was 36.9%. The exposure rate of the resorbable barrier (23.3%) was significantly lower than titanium mesh (68.9%) and nonresorbable (72.7%; χ2, P < .001). The results of this study revealed that barrier types have a significant effect on the exposure rate. There was also a significant difference in grafted bone dimensional loss between sites with barrier exposure (58.3%) and sites with no barrier exposure (44.1%) during the healing period (Mann-Whitney U test, P = .008).

Heat and Sound Generation During Implant Osteotomy When Using Different Types of Drills in Artificial and Bovine Bone Blocks.

The purpose of this study was to compare heat and sound generated during implant osteotomy when different types of drill were used in artificial bone and bovine bone blocks. A total of 80 implant osteotomies were formed using 4 implant drilling systems: N1 (OsseoShaper) (Nobel), NobelActive (Nobel), V3 (MIS), and BLX (Straumann) in both artificial bone and bovine bone blocks. Thermocouple probes were used to record temperature change at the depths of 5.0 mm and 13.0 mm of each implant osteotomy formed by the final drill. In addition, thermographic images, drilling sound, and drilling time were recorded and evaluated. Statistical analyses were performed at α = 0.05. The mean temperature changes as recorded by thermocouple probes and thermocamera were significantly lower in OsseoShaper than most other drill-bone combinations (P < .05). The mean drilling times and sound generation for OsseoShaper were significantly higher and lower than most other drill-bone combinations (P < .05), respectively. Minimal heat and sound generation can be expected when implant osteotomies are performed using OsseoShaper at a low rotational speed (50 rpm) even without irrigation. However, extended drilling time is required.

Dental Students' Knowledge, Attitude, and Confidence toward Evidence-based Dentistry: A 5-year Retrospective Study.

AIM: The purpose was to assess dental students' knowledge, attitude, and confidence toward evidence-based dentistry in five graduating Doctor of Dental Surgery (DDS) classes. MATERIALS AND METHODS: All dental students (class of 2019, 2020, 2021, 2022, and 2023) enrolled in the D3 research design course were required to take a pre-Knowledge, Attitude, and Confidence in Evidence-based Dentistry (KACE) survey. On completion of the 11-week course, a post-KACE survey was distributed to compare the differences in the three domains of evidence-based dentistry (EBD). For the knowledge domain, the responses from the 10 questions were converted to either correct (1) or wrong (0) so that the compiled scores could range from 0 to 10. The attitudes and confidence domains used a five-point Likert scale. The compiled attitude score was a sum of the responses from 10 questions yielding a range from 10 to 50. For confidence, the compiled score ranged from 6 to 30. RESULTS: The mean knowledge scores of all classes together before and after training were 2.7 and 4.4, respectively. Overall, there was a statistically significant difference between pre- and post-knowledge indicating an improvement in knowledge associated with the training (p < 0.001). The mean attitudes of all classes together before and after the training were 35.3 and 37.2, respectively. Overall, there was a statistically significant improvement in attitude (p < 0.001). The values of mean confidence of all classes together before and after the training were 15.3 and 19.5, respectively. Overall, there was a statistically significant improvement in confidence (p < 0.001). CONCLUSIONS: A dental curriculum emphasizing Evidence-based practice (EBD) resulted in increased knowledge acquisition, improved attitude, and confidence toward EBD of dental students. CLINICAL SIGNIFICANCE: Educational initiatives emphasizing evidence-based dentistry increase students' knowledge acquisition, improved attitude, and confidence toward EBD that may also translate to active implementation of EBD in their future practices.

Impact of COVID-19 on Teaching the Tooth Morphology Course to the New Generation of Learners: A Cross-sectional Study.

AIM: The purpose of the study was two-fold. First, to evaluate students' learning style and relate it to their academic performance. Second, to highlight changes implemented in the tooth morphology (TOMO) course as a response to the coronavirus disease-2019 (COVID-19) pandemic. MATERIALS AND METHODS: The study was performed during 2021-2022 with 101 dental students. Didactic lectures were delivered online and students challenged with nine quizzes and one final examination. Didactic score was calculated by averaging the scores of quizzes and the final exam. Lab score was a combination of five lab projects and the final competency. At course completion, students received a survey on their learning style and how they would like to receive feedback. Kruskal-Wallis test was used to assess differences in didactic and lab scores among groups. RESULTS: Many students perceived themselves as visual learners (39%) followed by kinesthetic (24%), aural (19%), and reader (18%). There was no difference among learning style groups in performance of didactic (p = 0.340) and lab scores (p = 0.845). Students preferred that the instructor talks them through the questions for feedback on quizzes (41%) while they preferred demonstrations when receiving feedback on their wax-ups (51%). Most students (75%) preferred a TOMO teacher that uses demonstrations. 2020-2021 marked the year of the pandemic where all lectures were delivered online and waxing projects were performed at-home. A postpandemic transformation occurred during 2021-2022, reverting to conventional in-person lab sessions while keeping online didactic lectures. CONCLUSION: We conclude that TOMO should be delivered by using various teaching styles rather than focusing on a single method while providing more demonstrations. CLINICAL SIGNIFICANCE: Teaching tooth morphology to the new generation type of learners efficiently will affect the clinical work of dental graduates.

The Outcome of a New Teledentistry Initiative in Response to the COVID-19 Pandemic: A Cross-sectional Study.

AIM: The purpose of this study was to assess the overall satisfaction of a new learning experience and evaluate the outcome of LLUSD's educational teledentistry initiative through a survey based on Kirkpatrick's multidimensional model of training evaluation. MATERIALS AND METHODS: An IRB application was approved (#5210385) for a cross-sectional study that included Loma Linda University School of Dentistry (LLUSD) dental students of the class of 2022 and 2023. The 9-question survey consisted of three sections. The first section included demographic questions on gender and the graduating class. The second section was related to perceived teaching effectiveness, attitude, behavior, and significance. The third section included an open-ended question. The survey was distributed by three student investigators. Descriptive statistics were calculated, and categorical variables were compared using the Chi-squared test (χ2 test). RESULTS: The perceived teaching effectiveness of the newly implemented educational initiative was high for increasing the ability to communicate with patients and for screening and identifying the need for referrals. A majority of students believed that teledentistry is an important means to improve patients' access to dental care and that the School has been providing a good educational environment in providing teledentistry sessions to patients. There were no significant differences in the frequencies of positive and negative responses to all questions (N = 6) by gender and by class (p >0.05, in all instances). CONCLUSIONS: Teledentistry eVisits allowed the continuation of patient contact and initial assimilation of patient information. There is potential for this educational initiative to be more actively and comprehensively implemented in the future. CLINICAL SIGNIFICANCE: New educational initiatives allow the continuation of patient contact that will ensure that students will graduate as competent oral health care providers despite challenges imposed by the pandemic.

Micro computed tomography analysis of abrasivity of toothpaste tablets compared to conventional toothpaste.

PURPOSE: To evaluate with microCT dentin and enamel abrasion depth caused by toothpaste tablets when compared to conventional toothpastes. METHODS: Dentin (N= 64) and enamel blocks (N=64) were randomized into four experimental groups of 16 specimens each for dentin and enamel. CP: Colgate Cavity Protection, served as the low abrasive toothpaste; AW: Colgate Total Advanced Whitening was used to represent a highly abrasive toothpaste. Two different types of toothpaste tablets were used. DT: Denttabs and BT: Bite tabs. To prepare the slurries, 40 mL of water was added to 25 g of each toothpaste and 4.4 g of each toothpaste tab. Blocks were brushed for a total of 10,000 and 40,000 strokes for dentin and enamel, respectively following ISO standard 11609. On completion of brushing, specimens were scanned with a microCT system. Tomographic 3D reconstruction followed by abrasion depths measurements were performed. Kruskal-Wallis procedure tested abrasion depths among the different groups. Tests of hypotheses were two-sided with an alpha level at 0.05. RESULTS: There was a statistically significant difference in dentin abrasion depth among the groups (P< 0.001). The mean dentin/enamel abrasion depths in microns were 25.3/4.4, 36.8/4.4, 66.8/3.0, and 230.3/15.5 for DT, BT, CP, and AW respectively. Dentin and enamel abrasion depth of AW was the highest and was different from all other groups after multiple comparisons (P< 0.05). CLINICAL SIGNIFICANCE: Dentin abrasivity of toothpaste tabs is negligible as determined with microCT.

A randomized, blinded, clinical investigation of breath odor reduction efficacy of a stabilized chlorine-dioxide containing flavored mouthwash.

PURPOSE: To evaluate the efficacy of a flavored, non-fluoridated, alcohol-free mouthwash containing 0.1% chlorine dioxide in reducing oral malodor. METHODS: This was a randomized, 8-week, single site, double blind, crossover design with a 2-week washout period between crossover phases. Fifty subjects with clinically diagnosed intrinsic oral malodor were enrolled according to inclusion/exclusion criteria and randomized to one of two groups. Washout period initiated at end of Phase I and crossover design implemented prior to Phase II. Calibration for organoleptic judges performed at baseline for both phases. RESULTS: 48 subjects completed the study. No significant differences in intensity scores at baseline were found for both groups during both phases (P> 0.05). Within group comparisons for placebo revealed no significant differences with organoleptic intensity scores for all visits during both phases (P> 0.05). During Phase I, the mean changes in organoleptic scores for the test group were significantly different from the baseline at each visit: Weeks 1 to 3 (P< 0.05). After crossover, significant differences were found for the last two visits: Weeks 7 and 8 (P< 0.05). No adverse effects to oral tissues were observed or reported. This product is safe to use for up to 3 weeks and resulted in a decrease in oral malodor. CLINICAL SIGNIFICANCE: Results suggested that twice-daily use of a 0.1% chlorine dioxide-containing flavored mouthwash, in conjunction with normal oral hygiene care, provided clinically relevant improvements in oral malodor for up to 3 weeks.

Effect of charcoal dentifrices on tooth whitening and enamel surface roughness.

PURPOSE: To evaluate tooth color change and surface roughness after the use of charcoal dentifrices. METHODS: Bovine teeth (n= 64) used for color measurements were stained in tea solution and embedded in acrylic resin. Specimens were randomized into four groups of 16 specimens each. Cavity Protection (Colgate-Palmolive) was the negative control. Whitening dentifrices used were Black is White (Curaden AG); and My Magic Mud (Carbon and Clay Company) containing activated charcoal and Optic White (Colgate-Palmolive) containing hydrogen peroxide. Instrumental color measurements were performed at baseline, 1-week post-brushing, 30-day post-brushing, and 1-month follow-up. Another set of bovine teeth (n= 64) used for roughness measurements were embedded in acrylic resin and the surface ground flat. The experimental groups and brushing protocol were the same as for the color evaluation part. Surface roughness was measured with a contact type profilometer at baseline and after the last brushing session. Kruskal-Wallis procedure tested changes in color and surface roughness among the different groups. All post-hoc comparisons were conducted with Bonferroni corrections. Tests of hypotheses were two-sided with an alpha level at 0.05. RESULTS: Overall color change was not significantly different among groups at 1-week post-brushing and at 1-month follow-up. However, the hydrogen peroxide group had a significantly higher reduction in chroma in the yellow-blue axis when compared to negative control group at 30-day post-brushing and 1-month follow-up (P< 0.05). There was no significant difference in roughness among the groups at baseline (P= 0.2973) and post treatment (P= 0.8169). CLINICAL SIGNIFICANCE: The use of charcoal dentifrices did not have the claimed whitening effect but did not increase enamel surface roughness.

Dental and Dental Hygiene Students' Knowledge and Perception on Fluoride Use in Dentistry.

AIM: The 75th anniversary of community water fluoridation in the United States was celebrated in 2020. However, there are studies that stimulate polarized discussion over the use of fluoride in dentistry. The purpose of this study was to evaluate dental and dental hygiene students' knowledge and perception of fluoride use in dentistry. MATERIALS AND METHODS: A survey was conducted to gauge participant's knowledge and perception of fluoride and their opinion on the need for developing viable alternatives to fluoride. An Institutional Review Board (IRB# 5190496) application was filed and approved. A hard copy survey was distributed to all student classes at Loma Linda University School of Dentistry (U.S.) between January 13, 2020, and February 5, 2020. Descriptive data were compiled and analyzed. Knowledge-based questions were compared using Kruskal-Wallis procedure to evaluate correct percentage among different classes. Perception questions were analyzed using a Likert scale and also a Chi-squared test. All tests were two-sided with α at 0.05. RESULTS: Out of 482 students, 282 students responded (58.5%). The mean of correct responses for knowledge ranged from 49 to 69%. There was a statistically significant difference among the classes. Overall the perception of the use of fluoride in dentistry was positive, and it changed with exposure to lectures on fluoride over the years. CONCLUSION: There was a correlation between knowledge and the perception of the use of fluoride in dentistry, indicating the importance of adequate delivery of didactic teaching on knowledge of fluoride to dental and dental hygiene students. CLINICAL SIGNIFICANCE: The oral healthcare provider plays a pivotal role in communicating pertinent information on the benefits of fluoride in preventing dental caries to the general public, prompting adequate delivery of didactic teaching on this topic in dental education.

PSMA-targeted Radiotracers versus 18F Fluciclovine for the Detection of Prostate Cancer Biochemical Recurrence after Definitive Therapy: A Systematic Review and Meta-Analysis.

Background National guidelines endorse fluorine 18 (18F) fluciclovine PET/CT for the detection of prostate cancer (PCa) in men with biochemically recurrent PCa. The comparative performance between fluciclovine and gallium 68 or 18F prostate-specific membrane antigen (PSMA) PET/CT, a newer examination, is unclear. Purpose To compare the detection of biochemical recurrence using fluciclovine versus PSMA-targeted radiotracers in patients with a prostate-specific antigen (PSA) level less than 2 ng/mL. Materials and Methods With use of the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy, or PRISMA-DTA, guidelines, a systematic review of PubMed and EMBASE databases between 2012 and 2019 was performed. Studies of fluciclovine PET/CT or PSMA PET/CT in biochemical recurrence were identified. PSA levels, clinical data, and reference standards were obtained when available. A random-effects model was applied to pooled estimates and 95% confidence intervals (CIs) around the prevalence of a positive examination, stratified according to PSA tier. Results Quantitative analysis included 482 patients (median age, 67 years; interquartile range, 67-67 years) in six fluciclovine studies and 3217 patients (median age, 68 years; interquartile range, 67-70 years) in 38 PSMA studies. Pooled detection rates for PSMA and fluciclovine were 45% (95% CI: 38%, 52%) and 37% (95% CI: 25%, 49%), respectively, for a PSA level less than 0.5 ng/mL (P = .46); 59% (95% CI: 52%, 66%) and 48% (95% CI: 34%, 61%) for a PSA level of 0.5-0.9 ng/mL (P = .19); and 80% (95% CI: 75%, 85%) and 62% (95% CI: 54%, 70%) for a PSA level of 1.0-1.9 ng/mL (P = .01). A reference standard was positive in 703 of 735 patients (96%) in the PSMA cohort and 247of 256 (97%) in the fluciclovine cohort. Conclusion Patient-level detection rates for biochemically recurrent prostate cancer were greater for prostate-specific membrane antigen-targeted radiotracers than fluciclovine for prostate specific antigen levels of 1.0-1.9 ng/mL. © RSNA, 2020 Online supplemental material is available for this article.

A conservative approach to select patients with ischemic wounds is safe and effective in the setting of deferred revascularization.

OBJECTIVE: The Wound, Ischemia, and foot Infection classification system has been validated to predict benefit from inmediate revascularization and major amputation risk among patients with peripheral arterial disease. Our primary goal was to evaluate wound healing, limb salvage, and survival among patients with ischemic wounds undergoing revascularization when intervention was deferred by a trial of conservative wound therapy. METHODS: All patients with peripheral arterial disease and tissue loss are prospectively enrolled into our Prevention of Amputation in Veterans Everywhere limb preservation program. Limbs are stratified into a validated pathway of care based on predetermined criteria (immediate revascularization, conservative treatment, primary amputation, and palliative care). Limbs allocated to the conservative strategy that failed to demonstrate adequate wound healing and were candidates, underwent deferred revascularization. Rates of wound healing, freedom from major amputation, and survival were compared between patients who underwent deferred revascularization with those who received immediate revascularization by univariate and multivariate analysis. RESULTS: Between January 2008 and December 2017, 855 limbs were prospectively enrolled into the Prevention of Amputation in Veterans Everywhere program. A total of 203 limbs underwent immediate revascularization. Of 236 limbs stratified to a conservative approach, 185 (78.4%) healed and 33 (14.0%) underwent deferred revascularization (mean, 2.7 ± 2.6 months). The mean long-term follow-up was 51.7 ± 37.0 months. Deferred compared with immediate revascularization demonstrated similar rates of wound healing (66.7% vs 57.6%; P = .33), freedom from major amputation (81.8% vs 74.9%; P = .39), and survival (54.5% vs 50.7%; P = .69). After adjustment for overall Wound, Ischemia, and foot Infection stratification stages, deferred revascularization remained similar to immediate revascularization for wound healing (hazard ratio [HR], 1.5; 95% confidence interval [CI], 0.7-3.2), freedom from major amputation (HR, 0.7; 95% CI, 0.3-1.7) and survival (HR, 1.2; 95% CI, 0.6-2.4). CONCLUSIONS: Limbs with mild to moderate ischemia that fail a trial of conservative wound therapy and undergo deferred revascularization achieve similar rates of wound healing, limb salvage, and survival compared with limbs undergoing immediate revascularization. A stratified approach to critical limb ischemia is safe and can avoid unnecessary procedures in selected patients.

Systematic review of in vitro studies evaluating tooth bleaching efficacy.

PURPOSE: To review and assess the literature on in vitro studies evaluating tooth bleaching efficacy considering the use of a negative control, type of tooth substrate, storage medium, color evaluation methods, and evaluation time points. METHODS: The following databases were searched: PubMed (MEDLINE), Web of Science. Search used Medical Subject Headings (MeSH) in PubMed in addition to free text. The following limits were applied: English, articles published between January 1989 and October 2017. Additional free text key terms included: in vitro, tooth bleaching, placebo, negative control, overall CIELAB color change (ΔE*ab), change in shade guide units (ΔSGU), tooth color stabilization, evaluation time points, bovine teeth, and staining. Search was repeated in Web of Science but no additional articles were identified. A total of 11 studies were included for qualitative and quantitative analysis. RESULTS: The meta-analysis of nine included studies that reported ΔE*ab values, revealed that the NC statistically exceeded the perceptibility threshold (PT) of 1.2 (P< 0.05). The estimate was 2.872 with lower and upper bounds of 1.955 and 3.790, respectively. CLINICAL SIGNIFICANCE: Randomized controlled trials are gold standards to evaluate bleaching efficacy of different materials. However, in vitro studies offer a way to screen for potential bleaching efficacy. It is vital to determine an appropriate cut-off value for determining bleaching efficacy in vitro and further apply for clinical relevance.

Influence of Tooth Preparation Design and Scan Angulations on the Accuracy of Two Intraoral Digital Scanners: An in Vitro Study Based on 3-Dimensional Comparisons.

PURPOSE: To evaluate the accuracy of two intraoral scanners (IOS) in terms of different preparation designs and scan angulation limitation due to the presence of adjacent teeth. MATERIALS AND METHODS: Eight different complete coverage (CC) and partial coverage (PC) tooth preparations were scanned by two IOS, the 3Shape TRIOS (TRI) and the 3M True Definition (TRU). All teeth preparations were scanned in the presence and absence of adjacent teeth. Four groups were established for each IOS; Group 1: PC preparations with adjacent teeth. Group 2: CC preparations with adjacent teeth. Group 3: PC preparations without adjacent teeth. Group 4: CC preparations without adjacent teeth. 3D analysis was performed to examine average absolute discrepancy (AAD) and maximum absolute discrepancy (MAD). A Two-way ANOVA was performed followed by a post-hoc Tukey's test HSD to evaluate the effect of adjacent teeth, preparation design, and the type of IOS used. RESULTS: For TRI, AAD for groups 1, 2, 3, and 4 were 20 ± 1.8 µm, 19.6 ± 2.4 µm, 15.5 ± 2.7 µm, and 12.9 ± 1.4 µm, respectively, whereas MAD for groups 1, 2, 3, and 4 were 109.7 ± 13.5 µm, 93.2 ± 28.9 µm, 85.6 ± 16.1 µm, and 66 ± 20.1 µm, respectively. For TRU IOS, AAD for groups 1, 2, 3, and 4 were 22.0 ± 3.6 µm, 17.9 ± 2 µm, 20 ± 5.9 µm, and 14.9 ± 1.7 µm, respectively, whereas the MAD for groups 1, 2, 3, and 4 were 151.4 ± 38.4 µm, 92.2 ± 17. µm, 92.6 ± 23.6 µm, and 71.4 ± 11.9 µm, respectively. Two-way ANOVA showed statistically significant differences between the AAD and MAD of TRI and TRU (p < 0.001). There were also statistically significant differences for presence or absence of adjacent teeth (p < 0.001), and preparation design (p < 0.001). CONCLUSIONS: PC preparation scans revealed lower accuracy than CC. The presence of adjacent teeth decreased the accuracy of both IOS. TRI gave higher accuracy than TRU for PC, but both IOS showed comparable accuracy for CC groups.

Imaging of Prostate Specific Membrane Antigen Targeted Radiotracers for the Detection of Prostate Cancer Biochemical Recurrence after Definitive Therapy: A Systematic Review and Meta-Analysis.

PURPOSE: Prostate specific membrane antigen targeted radiotracers are promising agents for imaging patients with prostate cancer biochemical recurrence after definitive therapy. We report the results of a systematic review and meta-analysis of the detection of biochemical recurrence after definitive therapy for prostate cancer stratified by prostate specific antigen levels and using prostate specific membrane antigen targeted radiotracers. MATERIALS AND METHODS: According to the Preferred Reporting Items for Systematic reviews and Meta-Analysis Diagnostic Test Accuracy guidelines, we searched for articles in PubMed® and EMBASE® databases in our systematic review from 2012 to July 2018. Studies evaluating men with prostate cancer biochemical recurrence after definitive therapy and without known metastatic disease who underwent prostate specific membrane antigen positron emission tomography/computerized tomography to detect recurrent disease were included in analysis. The risk of bias and applicability concerns were assessed by QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). Statistical heterogeneity was assessed with the Cochrane Q and an I2 estimate. The reference standard was pathology findings, followup imaging or a prostate specific antigen decline after salvage treatment. We calculated pooled estimates and the 95% CI around the prevalence of a positive examination in the study population using a random effects model. RESULTS: A total of 5,113 patients in 43 studies were included in this systematic review. Of the studies 15 (34.8%) were prospective, 3 (6.9%) were multi-institutional and the remainder were done at a single center. A total of 18 studies (41.8%) were done in subjects after radical prostatectomy, 2 (4.6%) were in subjects after radiotherapy and 23 (53.5%) were in subjects after radical prostatectomy and radiotherapy. Median prostate specific antigen was 1.6 ng/ml (IQR 0.7-4.4) and median subject age was 68 years (IQR 67-70). Of the 43 studies 33 (76.7%) evaluated 68Ga prostate specific membrane antigen-11 (Ga-HBED-CC) positron emission tomography/computerized tomography. The pooled detection rate was 70.2% (95% CI 65.0-75.4) in the entire cohort. For prostate specific antigen less than 0.5, 0.5 to 0.9, 1 to 1.9 and 2 ng/ml or greater the pooled detection rate was 44.9% (95% CI 36.0-53.9), 61.3% (95% CI 52.3-70.3), 78.2% (95% CI 70.8-85.6) and 93.9% (95% CI 92.0-95.8), respectively. A reference standard was confirmed to be positive in 684 of the 715 patients (95.7%). There were significant study heterogeneity and publication biases (p <0.01). CONCLUSIONS: Prostate specific membrane antigen targeted radiotracers are likely effective to detect biochemically recurrent prostate cancer at low prostate specific antigen levels. However, existing studies are limited by retrospective design, limited reference standards, publication bias and a lack of interagent comparison.

Trans-Atlantic Inter-Society Consensus Class D Aortoiliac Lesions: A Comparison of Endovascular and Open Surgical Outcomes.

OBJECTIVE. The purpose of this study is to compare the clinical and safety outcomes between two groups of patients with Trans-Atlantic Inter-Society Consensus class D (TASC II D) aortoiliac occlusive disease (AIOD): those with higher-risk comorbidity who underwent endovascular reconstruction and those with lower-risk comorbidity who underwent surgical bypass. MATERIALS AND METHODS. Thirty-two consecutive patients with symptomatic TASC II D AOID who underwent surgical bypass or endovascular reconstruction from 2012 to 2017 were retrospectively reviewed. Lesion characteristics, technical approach, survival, limb salvage, patency, and change in clinical symptoms were analyzed. RESULTS. Nineteen patients with higher comorbidity underwent endovascular reconstruction, whereas 13 patients with lower comorbidity underwent surgical bypass. Patients undergoing endovascular reconstruction had an older median age (67.0 vs 62.0 years; p = 0.007), higher rates of hypertension (94.7% vs 61.5%; p = 0.018) and coronary artery disease (26.3% vs 0%; p = 0.044), and advanced renal impairment (mean [± SD] chronic kidney disease stage, 1.4 ± 1.5 vs 0.7 ± 1.3; p = 0.005). There were no significant differences in Rutherford classification between the groups. During long-term follow-up of 2.76 years, endovascular reconstruction and surgical bypass showed equivalent rates of survival (89.5% vs 84.6%; p = 0.683), limb salvage (100.0% vs 92.3%; p = 0.219), and primary or primary-assisted patency (85% vs 85%; p = 0.98). Groups showed similar clinical improvements in walking distance, rest pain, and tissue loss at 30 days (95% vs 85%; p = 0.158) and at long-term follow-up (74% vs 62%; p = 0.599). CONCLUSION. For properly selected patients, the clinical outcomes of endovascular reconstruction versus surgical bypass for TASC II D AOID may be equivalent at 2.5 years after the procedure. The decreased operative risk associated with endovascular reconstruction suggests that it is the technique of choice for high-risk patients.