Zirconia CAD/CAM machining vibrations related to zirconia blank shape and initial digital nesting.

AIM: To evaluate CAD/CAM milling vibrations related to zirconia disk design, framework, and location of digital crown nesting during zirconia soft milling. MATERIALS AND METHODS: In the present in vitro study, 25 round zirconia disks of 98 mm (R group) and 15 D-shaped zirconia disks of 71 mm (D group) were placed in a 5-axis CAD/CAM milling unit. The R group had 3 crown milling sites (n = 75) and the D group had 2 crown milling sites (n = 30). In the R group, site A was located 57 mm, site B was 92 mm, and site C was 123 mm from the machine holder attachment. In the D group, site A was 57 mm and site C was 123 mm from the machine holder attachment. A vibration meter (VB-8200; Lutron) was connected to the disk holder, and data (mm/second) were collected during the milling process at the different nesting locations. One-way ANOVA with post-hoc tests and Bonferroni correction for multiple tests were used to compare the groups (α = 0.05). RESULTS: In the R group, site C exhibited the highest mean vibration values compared with site A (P = 0.001). The first and second cutting tools (2.5 and 1 mm) exhibited statistically significant differences between the D and R groups at milling sites A and C (P < 0.001 and P = 0.003, respectively). CONCLUSIONS: Milling vibration increased as the distance between the machine holder arm and a digitally nested site increased. Round zirconia disks induced higher vibration values compared with D-shaped disks.

Combined reconstruction of the medial patellofemoral and medial patellotibial ligaments: outcomes and prognostic factors.

PURPOSE: To report outcomes after combined medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) reconstruction and test associations between prognostic factors and clinical outcomes. It was hypothesised that combined MPFL and MPTL reconstruction would result in significant improvement in function, and that outcomes would be associated with age, sex, Beighton score, concomitant articular lesions, and preoperative function. METHODS: All combined reconstructions of MPFL and MPTL were reviewed. Inclusion criterion was minimum 2-year follow-up. Exclusion criteria were age at surgery ≥ 35 years and concomitant osteotomies. Kujala, Tegner and Marx scores were completed prospectively. Patients were evaluated at a minimum 2-year follow-up. Associations between potential prognostic factors and Kujala and Tegner scores were tested using bivariate analyses followed by multivariate regression models. RESULTS: Of 22 patients (26 knees), 19 (23 knees) met inclusion criteria, and 16 (20 knees) were available for follow-up. Mean age at surgery was 18 years (range 14.5-23). Mean follow-up was 43 months (range 24-73). Postoperative Kujala score significantly improved compared to before surgery (86.4 ± 12.5 vs. 54.9 ± 15.2, p < 0.01). Postoperative Tegner score was nonsignificantly higher compared to before surgery (4.8 ± 2.4 vs. 4 ± 3, p = ns) and lower compared to before first patella dislocation (4.8 ± 2.4 vs. 5.9 ± 1.2, p < 0.01). Postoperative Kujala score was associated with male sex (p = 0.02), with medial patellofemoral chondral lesions (p = 0.01) and with preoperative Kujala score (p = 0.05). Postoperative Tegner score was associated with male sex (p < 0.01), with preoperative Tegner level (p < 0.01), and with Beighton score (p < 0.01). Patella apprehension was recorded in two knees (10%) in two patients. CONCLUSION: Combined MPFL and MPTL reconstruction in young adults results in significant improvement in subjective knee function with minimal risks, although preinjury activity levels are not consistently restored. Associated factors of improved outcome include higher preoperative knee scores and activity levels, medial patellofemoral chondral lesions, decreased Beighton scores, and male sex. This supports the advisability of the procedure and can also assist in setting realistic goals for specific groups of patients. LEVEL OF EVIDENCE: Case series, Level IV.

First clinical experience with a new injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma for the treatment of lateral epicondylar tendinopathy (tennis elbow).

BACKGROUND: Lateral epicondylitis is a tendinopathy of the common extensor origin at the elbow. When traditional conservative treatment fails, more effective therapies are needed. Vergenix Soft Tissue Repair (STR) Matrix (CollPlant Ltd., Ness-Ziona, Israel) is an injectable gel composed of cross-linked bioengineered recombinant human type I collagen combined with autologous platelet-rich plasma (STR/PRP). The complex forms a collagen-fibrin matrix that promotes cell migration and tissue repair. Based on positive outcomes from preclinical trials, this study is the first clinical trial of STR/PRP on tendinopathy. We hypothesized that STR/PRP would be a safe and effective treatment for lateral epicondylar tendinopathy. METHODS: Patients with chronic lateral epicondylitis underwent treatment with STR/PRP. Outcome assessment included grip strength, functional disability, and changes in sonographic tendon appearance for up to 6 months after treatment. RESULTS: The study enrolled 40 patients. No systemic or local severe adverse events were reported. Clinical evaluation revealed an improvement in the mean Patient-Rated Tennis Elbow Evaluation score from 64.8 before treatment and showed a 59% reduction at 6 months. The 12-Item Short-Form Health Survey questionnaire showed improvement from a mean score of 30.7 to 37.7 at the final follow-up. Grip strength increased from 28.8 kg at baseline to 36.8 kg at 6 months. Improvements in sonographic tendon appearance were evident among 68% of patients. CONCLUSION: STR/PRP is a safe treatment that effectively induces clinically significant improvements in elbow symptoms and general well-being as well as objective measures of strength and imaging of the common extensor tendon within 6 months of treatment of elbow tendinopathy recalcitrant to standard treatments.

Comparison of marginal fit between CAD-CAM and hot-press lithium disilicate crowns.

STATEMENT OF PROBLEM: Hot-pressing and computer-aided design and computer-aided manufacturing (CAD-CAM) are major techniques for the fabrication of lithium disilicate crowns. They exhibit different accuracies regarding marginal fit, an important factor in restoration survival. However, studies comparing the marginal fit of different fabrication methods are lacking. PURPOSE: The purpose of this in vitro study was to compare the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of lithium disilicate crowns produced by the hot-press and CAD-CAM techniques. MATERIAL AND METHODS: Thirty typodont teeth were divided into 2 groups. Fifteen teeth were scanned with the CEREC Omnicam intraoral scanner, and crowns were fabricated with the CEREC MC XL chairside CAD-CAM milling unit from IPS e.max CAD blocks. Fifteen typodont teeth were sent to a dental laboratory, and lithium disilicate crowns were fabricated from IPS e.max press ingots using the hot-press technique. The 30 crowns were cemented and then sectioned with a precision saw. The MD and AMD were measured for each crown with a light microscope. One-way ANOVA was conducted to analyze significant differences in crown marginal fit between the fabrication systems (α=.05). RESULTS: For the CAD-CAM technique, the mean values of the AMD measurements were 115 µm, and for the hot-press technique, 130 µm. The MD measurements were 87 µm for the CAD-CAM technique and 90 µm for the hot-press technique. One-way ANOVA revealed no significant differences between the fabrication methods regarding marginal fit (P>.05). CONCLUSIONS: No significant differences were found between the fabrication methods tested. Both the CAD-CAM and hot-press techniques for producing monolithic lithium disilicate crowns produced MD values of less than 120 µm, within the clinically acceptable range.

An in vitro evaluation of marginal fit zirconia crowns fabricated by a CAD-CAM dental laboratory and a milling center.

BACKGROUND: Marginal fit is critical for the success and longevity of a dental restoration. Zirconia crowns can be fabricated either chair-side, in a dental laboratory or in a milling center; each can give different marginal fits results. However, discussion of the marginal fit of zirconia crowns when different fabrication methods are compared is lacking in the literature. PURPOSE: To compare the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of computer-aided design, and computer-aided manufacturing (CAD-CAM) used in a dental laboratory and a milling center for producing monolithic zirconia crowns. METHODS: The marginal fit of 30 zirconia crowns cemented to typodont teeth was evaluated by means of a sectioning technique. Fifteen crowns were fabricated with a CEREC inLAB MC X5 from IPS e.max ZirCAD blocks. Fifteen crowns were fabricated using a LAVA milling center from LAVA Plus Zirconia Blocks. The 30 crowns were sectioned with a precision saw, and MD and AMD were subsequently measured using a light microscope. Data were analyzed using the one-way ANOVA technique to investigate significant differences in the marginal fit between the two fabrication systems (α = .05). RESULTS: The AMD dimension of the CEREC inLAB system was significantly smaller (P < .05). Mean AMD values for zirconia crowns fabricated by the CEREC inLAB were 85 µm, and for the LAVA milling center 133 µm. There was no significant difference between the two systems regarding the MD dimensions. The MD values for zirconia crowns fabricated by the CEREC inLAB were 53 µm and for the LAVA milling center 61 µm. CONCLUSIONS: The CEREC inLAB system demonstrated significantly better marginal fit in relation to the AMD. However, no difference between the systems was found in the MD. Monolithic zirconia crowns fabricated by the CAD-CAM CEREC inLAB system and the LAVA system milling center showed MD values of less than 120 µm, which is within the clinically acceptable range.

[HOW HEALTH SERVICES IN ISRAEL COPED WITH THE POLIO EPIDEMIC OF THE 1950'S].

INTRODUCTION: Today, the introduction of a new medicine or vaccine or the clinical trial of some new potion requires the approval of a variety of bodies in accordance with Helsinki Agreement rules, National Health Laws and Health Ministry regulations. The creation of the World Health Organization (WHO) in 1946 added another essential layer to the firm base of principles governing the conduct of clinical trials that exist today. Its main contribution was to create a new reality following The Second World War and the subsequent Nuremberg Trials. The Declaration of Helsinki was only adopted eighteen years later, in 1964. In its first years of independence the infant State of Israel was attacked by a serious outbreak of polio which claimed many victims - mostly children and youngsters. Infantile paralysis - poliomyelitis (polio) was then considered as being untreatable. The disease affected 0.1% of the population of Israel. In 1950, out of a total population of 1.2 million, 1,500 were infected by polio. The epidemic struck over three successive seasons and affected more than 3,000 victims. The mortality rate stood at 10%. Experts, charlatans and fame seekers all presented their inventions to the country - creams, medicines and research projects all designed to bring relief to the sick children. Against all these stood the newly formed Ministry of Health, determined to bring order to the chaos. The only trial conducted by the Health Ministry was unsuccessful, but it was accompanied by the most stringent controls that would not have shamed even today's researchers. The clinical trials of Zibaline were conducted in the early 60's, after the polio vaccine had been introduced and the epidemic had passed. The purpose of this paper is to examine the influence of medical ethics, norms and morals on the way that medical practice dealt with the epidemic at a time when there were no laws or rules.

Displaced mid-shaft clavicular fractures: is conservative treatment still preferred?

BACKGROUND: A clavicular fracture accounts for 2.6%-5% of adult fractures. Fractures in the middle-third (OTA 15-B) represent 69%-82% of all clavicular fractures. There is no consensus among orthopedic surgeons regarding treatment for these fractures: many support conservative treatment even for displaced middle-third clavicular fractures, while others choose operative treatment. OBJECTIVES: To assess the attitudes of orthopedic surgeons regarding treatment of displaced mid-shaft clavicular fractures. METHODS: We conducted a survey in which we interviewed orthopedic surgeons from various countries during the 2012 EFORT meeting in Berlin. The questionnaire included an X-ray of a displaced middle-third clavicular fracture, as well as questions regarding the surgeon's proposed treatment plan. RESULTS: A total of 177 orthopedic surgeons completed the questionnaire; 49% preferred operative treatment for a displaced middle-third clavicular fracture. Among the orthopedic trauma specialists, 58% suggested operative treatment, as did 82% of shoulder specialists. Most surgeons preferred a locking plate for fixation. CONCLUSIONS: The treatment approach for a displaced middle-third clavicular fracture seems to be evenly split between conservative and operative approaches. The tendency toward operative treatment was.even more remarkable among orthopedic trauma specialists and shoulder specialists who completed the questionnaire. Most surgeons prefer a locking plate as a fixation system for this type of fracture.

Fluoride ion release and solubility of fluoride enriched interim cements.

STATEMENT OF PROBLEM: Interim and definitive restorations cemented with interim cements for a prolonged interval are susceptible to bacterial infiltration and caries formation. PURPOSE: The purpose of this in vitro study was to evaluate the long-term fluoride release and solubility of aged ZnO-based interim cements enriched separately with 0.4% NaF and SnF2. MATERIAL AND METHODS: Four different brands of cements (Tempbond, Tempbond NE, Procem, and Freegenol) were tested for fluoride release and solubility. For every test, 6 disk specimens of each cement with NaF and SnF2, and 6 with no fluoride enrichment (control) were fabricated, for a total of 72 specimens. The disks were incubated in deionized water. Fluoride ion release was recorded at 1, 7, 14, 21, 63, 91, and 182 days. Solubility was calculated as weight percent after 90 days of incubation. The data were analyzed by analysis of variance with repeated measures and the Tukey honestly significant difference post hoc test (P<.05). RESULTS: Cements mixed with fluorides released fluoride ions for at least 182 days. Cements mixed with NaF released more fluoride ions than those mixed with SnF2 (P<.001). The cumulative release rates from all the tested cements mixed with either NaF or SnF2 were linear with respect to t(½) (r>.97), indicating a diffusion-controlled fluoride release. Cement and fluoride types were the main affecting factors in fluoride ion release. The addition of fluorides slightly increased the solubility of the cements. CONCLUSIONS: Given their long-term sustained and diffusive controlled release, these fluorides, particularly NaF when mixed with ZnO-based interim cements, may be useful for caries prevention under provisionally cemented restorations.

Effect of Silica-Modified Aluminum Oxide Abrasion on Adhesion to Dentin, Using Total-Etch and Self-Etch Systems.

This study compared the shear bond strength (SBS) and micromorphology of composite resin to human dentin after pre-treatment with silica-modified aluminum oxide air abrasion. Forty-six molar teeth were treated with either Scotchbond Multi-Purpose (SCMP) or Clearfil SE Bond (CLSE) adhesive. Buccal surfaces were pre-treated with the CoJet air abrasion system (SB), and lingual surfaces were controls. The adhesion of light-cured resin composite to the treated dentin surface was evaluated with SBS. After debonding, substrate surfaces were examined with an optical microscope for failure analysis. In addition, 15 molar teeth were sectioned and randomly assigned to one of five groups, according to the dentin surface pre-treatment and adhesive type, and examined with high-vacuum scanning electron microscopy/energy dispersive X-rays (SEM/EDS). The type of adhesive had a significant effect on SBS (p = 0.000); CLSE had the highest values. SB did not affect SBS (p = 0.090). SEM/EDS revealed residual aluminum and/or silicon on all dentin surfaces after SB, except for the control. Treatment with 32% phosphoric acid in the SCMP adhesive decreased the amounts of aluminum and silicon compared to SB dentin only, whereas CLSE resulted in similar quantities of aluminum and silicon as air-abraded dentin. The results of this study indicate that CLSE might have a higher bond strength to dentin than SCMP. Pre-treatment with SB does not appear to affect bonding strength.

Fluorescent Marker as a Tool to Improve Strategies to Control Contaminated Surfaces and Decrease Danger of Cross-Contamination in Dental Clinics, during and beyond the COVID-19 Pandemic.

The COVID-19 pandemic posed an increased threat to dental personnel and patients. Close encounters with patients' breath and saliva and the use of intraoral rotating instruments which disperse microscopic airborne particles both increase the possibility of environmental infection. In this study, fluorescent marker (FM) was used to assess and enhance surface cleanliness in the dental clinics and public areas of a major dental school. Initially, 574 surfaces in various areas of a dental school were marked with FM for 3 consecutive months to monitor the surface cleanliness. The initial evaluation results were visually presented to both students and para-dental and cleaning personnel during a designated educational session, and were used to stress the importance of preventing cross-contamination. Following educational intervention, 662 surfaces were re-examined for an additional 3 months, using the same method. A significant improvement in the surfaces' cleanliness (ANOVA, F(1) = 10.89, p < 0.005) was observed post-intervention. The results were more prominent in students' clinics, which were the students' cleaning responsibility. The results show that fluorescent markers can serve as an educational tool to improve strategies to control contaminated surfaces in large clinics, such as dental schools. Their use can substantially decrease the hazard of cross-contamination during the pandemic and beyond.

Rethinking the Current "Stage-and-Wait" Paradigm.

INTRODUCTION: The experience of terrorist incidents involving a secondary explosive device that targeted rescue forces led to changes in the safety protocols of these forces in most countries of the world. These protocols are the foundation of the current "Stage-and-Wait" paradigm that prohibits the entry of Emergency Medical Services (EMS) from entering the scene and treating casualties until it is deemed safe. These guidelines were established absent of an evidence-base detailing the risk to responders and the potential consequences to the injured on-scene. The lack of clarity is compounded by the fact that different situations, as well as operational considerations, such as the length of time until bomb squad arrival at the scene versus time of massive bleeding injuries, for example, impact outcomes must be taken into account. OBJECTIVE: This study sought to shed light on this matter while employing an evidence-based approach exploring the investigations of the frequency of secondary explosion threats in terrorist attacks over the last 20 years and discussing some of the ethical challenges and ramifications ensuing. While this study does not propose an outright change to current guidelines, in light of the evidence gathered, an open review and discussion based on the findings may be beneficial. METHODS: The Global Terrorism Database (GTD) was used as the data source of bombing incidents world-wide. RESULTS: The results revealed that approximately 70 per-1,000 bombing incidents involved secondary explosions across regions and countries within the study period. CONCLUSION: This study emphasizes the need to rethink the current "Stage-and-Wait" paradigm by recommending brainstorming conferences comprised of multi-sectoral experts aimed at deliberating the matter. World-wide experts in emergency medicine, bioethics, and disaster management should cautiously consider all aspects of bomb-related incidents. These brainstorming deliberations should consider the calculated risk of secondary explosions that account for approximately 70 per-1,000 bombing incidents. This study highlights the need to re-examine the current versus new paradigm to achieve a better balance between the need to ensure EMS safety while also providing the necessary and immediate care to improve casualty survival. This ethical dilemma of postponing urgent care needs to be confronted.

Possible Association between Methylphenidate and Mandibular Bone Characteristics Detected by Dental Panoramic Radiograph in Children and Adolescents with ADHD.

Some studies have shown that children treated with psychostimulants for attention-deficit hyperactivity disorder (ADHD) have decreased bone mineral density (BMD). Mandibular cortical width (MCW) may be used as a surrogate measure for evaluating BMD. We compared the MCW measured on digital panoramic radiographs (DPR) of 38 children and adolescents with ADHD who were treated with methylphenidate for at least 12 months to the MCW of 58 children and adolescents without ADHD (control). The two groups had a similar mean age (p = 0.3). Mean MCW was significantly lower among children with ADHD compared to those in the control group (2.77 ± 0.33 mm vs. 3.04 ± 0.46 mm, p = 0.004). Additionally, each of the MCW sides were significantly smaller in the group with ADHD compared with the control group. In conclusion, treatment with methylphenidate is associated with low MCW in children and adolescents with ADHD. Analysis of MCW on DPR may help in screening children that are at risk of bone health alterations that may result in low BMD in adulthood. Dentists may be the first to identify bone health abnormalities and should be aware of their role in referring their patients to further follow-up.

Sleep-Related Breathing Disorders in Children-Red Flags in Pediatric Care.

OBJECTIVES: In recent years, we have witnessed a growing interest in pediatric sleep-related breathing disorders (SRBD). Although a Pediatric Sleep Questionnaire (PSQ) exists and was found reliable in screening SRBD in children, many of the children remain underdiagnosed. The aim of the present study was to define anamnestic and clinical findings that can serve as red flags indicating the presence of SRBD in children. METHODS: 227 children aged 4-12 years old were evaluated with regard to the following parameters: (i) anamnestic variables (e.g., general state of health, oral habits, bruxism, esophageal reflux, sleep continuity, snoring); (ii) clinical parameters (e.g., oral mucosa, palate, tonsils, tongue, floor of the mouth, angle classification, gingival health, caries risk) and (iii) presence of SRBD (through the PSQ). RESULTS: Significant differences between children with and without SRBD were observed regarding continuous sleep, developmental delay, mouth breathing, and snoring. Taking medications for ADHD increased the odds of SRBD in children by over seven times, non-continuous sleep increased the odds of SRBD by six times, mouth breathing increased the odds by almost five times, and snoring increased the odds by over three times. CONCLUSIONS: Child caregivers from various fields (dentists, orthodontists, pediatric physicians, school nurses) should actively inquire about disturbed sleep, medications for ADHD, snoring, and mouth breathing among their young patients. Initial screening through a few simple questions may help raise red flags that can assist in the early detection of SRBD in children and lead to proper diagnosis and treatment.

Assessing Children's Dental Age with Panoramic Radiographs.

(1) Background: The aim of the study was to assess the dental age of the subjects and compare it to their chronological age; to assess the dominant tooth for evaluation of dental age; and to investigate possible individual differences between the left and right side of the dental arch. (2) Methods: This study involved evaluating panoramic radiographs of patients aged 7-13 years. A separate assessment was performed for each tooth according to the degree of germ development. Each subject's dental age was estimated. (3) Results: The study involved evaluating 349 panoramic radiographs. No difference was found between stages of tooth development on the right side and left side. Correlation between the stages of tooth development and the chronological age was found to be highest in the second permanent molar teeth. The age can be predicted with the estimated age of tooth #37 and the gender of the patient. (4) Conclusions: The chronological age of children aged 7-13 may be estimated based on a modified seven-stage London Atlas of tooth development, where the most accurate landmark(s) of use are second molars.

Effect of Denture Base Fabrication Technique on Candida albicans Adhesion In Vitro.

Denture stomatitis is a common manifestation of oral candidiasis affecting some 65% of denture wearers. This condition is initiated by the adherence of Candida albicans to denture base acrylic resin. The present study aimed to test the in vitro effect of traditional and novel fabrication methods on Candida albicans adhesion to denture base samples. Denture based acrylic discs were fabricated using: (i) computerized milling, (ii) 3D printing, (iii) heat curing, and (iv) cold curing. Discs were tested for surface roughness (Ra), hydrophobicity (contact angle), mucin adsorption (Bradford assay), and Candida albicans adhesion. 3D printing significantly increased microbial cell adhesion as compared with heat curing, and computerized milling significantly decreased it. These results were associated with mucin adsorption levels rather than surface roughness. Results suggest that 3D printing may increase the risk for developing denture stomatitis, whereas computerized milling may decrease it as compared with traditional heat curing denture base fabrication.

Arthroscopic rotator cuff repair: clinical outcome of 607 patients.

The purpose of this study was to evaluate the clinical results of rotator cuff tendon tears treated by arthroscopic repair with suture anchors. This prospective study included a cohort of 607 consecutive patients who underwent arthroscopic rotator cuff repair surgery. Most patients had a single-row type of repair using metal anchors. All patients were independently assessed pre- and post-operatively utilizing the UCLA (University of California at Los Angeles) scoring system with a minimum of 1 year follow-up. Demographic and operative details were noted; including the patient age, workers compensation status, tear size, type of repair performed, and concomitant procedures. The median UCLA score improved from 13 (0-28) to 35 (8-35) with a median follow-up time of 46 months (12-105), P < 0.001. The majority of the patients (529) achieved good to excellent results. The results were found to be independent of age, workers compensation status, tear size, type of repair performed and concomitant procedures. In conclusion, arthroscopic rotator cuff repair, using metal anchors with dual sutures, in a single row, utilizing margin convergence sutures and performing concomitant procedures when necessary, gave satisfactory results in 87% of patients.

[On health, sense and confidentiality].

Medical confidentiality is a cornerstone of doctor-patient relations. Although physicians are obliged to keep to themselves any information concerning their patients, it is understood that this obligation is not absolute. There are extreme situations in which doctors are expected, by law, to break medical confidentiality for the benefit of the public. One such unusual situation is the case of HIV carriers who refuse to notify their sexual partners concerning their medical condition. This ignorance on the partner's side might endanger his/her life. As there is no way to enforce the HIV carrier to expose his/her secret while he/she is not willing to do so, it is suggested that the disclosure of this sensitive information should be the physician's task. Firstly, the doctor should obtain an ethical committee's approval. It is also suggested that in these rare cases where doctors will have no choice but to reveal information concerning a patient, the issue will be publicized in a proper way, in order to let the public know the circumstances of the particular case. It is hoped that such publicity will be an appropriate answer to any doubts concerning doctors' behavior regarding medical confidentiality.

Interpretations of complications following third molar extraction.

OBJECTIVE: Surgical removal of third molars is often associated with complications. The aim of the present study was to analyze the incidence of complications following extraction of third molars relative to the risk factors. METHOD AND MATERIALS: This retrospective study included 463 patients who had mandibular third molar extraction (performed by a single surgeon, DSA) in the years 2001 to 2011. In total, 665 mandibular third molars were extracted. The average patient's age was 29 ± 11.30 years, median 26 years, and the patient age ranged from 13 to 75 years. Patients' records were obtained for medical/general data. RESULTS: The overall prevalence of postsurgical complications was 17%. Dry sockets showed the highest incidence (11.6%). Partially impacted teeth showed the highest incidence of complications (67.3%). Cigarette smoking correlated with increased complications and dry sockets, and complications were more prevalent on the left side (62.8%). CONCLUSION: Complications after mandibular third molar extraction increase with age, level of impaction, side of extraction, and cigarette smoking.

Factors Associated With Improved Function and Maintenance of Sports Activities at 5 to 10 Years After Autologous Hamstring ACL Reconstruction in Young Men.

BACKGROUND: There are limited data regarding associated factors of return to sports activities at more than 5 years after anterior cruciate ligament (ACL) reconstruction. PURPOSE: To test interrelationships between patient characteristics, concomitant articular lesions, graft laxity, and maintenance of sports activities at 5 to 10 years after ACL reconstruction. It was hypothesized that at 5 to 10 years after the operation in young adult men, maintenance of greater activity level and better knee function would be associated with greater preinjury activity level, younger age at reconstruction, absence of concomitant articular lesions, and minimal graft laxity at follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: One hundred six men with autologous hamstring ACL reconstruction between the ages of 18 and 35 years were reviewed at 5 to 10 years after surgery. Excluded patients had contralateral ACL tear, revision reconstruction, or another injury impairing function. Fifty-five patients were eligible and available for follow-up. Independent variables included preinjury Tegner score, time interval from injury to surgery, smoking status, age, articular lesions, KT side-to-side difference, and pivot-shift grade. Main outcome measures were Tegner activity level, International Knee Documentation Committee (IKDC) subjective score, and Knee injury and Osteoarthritis Outcome Scale (KOOS) score at 5 to 10 years after surgery. RESULTS: Greater Tegner activity level at follow-up was associated in a regression model with greater preinjury Tegner activity level (correlation coefficient, 0.423; P = .01), lower KT difference (correlation coefficient, -0.278; P = .04), and negative pivot shift (correlation coefficient, -0.277; P = .05). Younger age at operation predicted return to greater Tegner activity level in a univariate analysis (correlation coefficient, -0.266; P = .05) but not in a regression model (not significant). Chondral lesions at surgery predicted lower IKDC subjective scores (71.4 ± 14.3 vs 84.1 ± 11.5; P < .01) and KOOS scores but did not affect maintenance of sports activities. CONCLUSION: At 5 to 10 years after autologous hamstring ACL reconstruction in young men, predictors of greater sports activity level are primarily high preinjury activity level and reestablishment of knee laxity. Younger age at operation and moderate chondral lesions have lower impact in this respect.