Rehabilitation using milled-bar with attachment maxilla overdenture in a patient with peri-implantitis fixed prosthesis: A case report / 대한치과보철학회지

There are various methods for restoring the dentition of completely edentulous patients. Removable complete dentures have the advantage of being relatively economical, but they can be uncomfortable to wear. With the introduction of implant prosthodontics, various options such as implant-supported overdentures and hybrid prostheses have become available. If there is inadequate remaining ridge or limited financial resources, an overdenture supported by a few implants with additional attachments may be more suitable. In this case, due to severe peri-implantitis and other complications, the implants were removed. Subsequently, four implants (two on each side) were placed in the maxilla and a milledbar with attachment was fabricated for each side of the maxilla.

Three-dimensional morphometric analysis of facial units in virtual smiling facial images with different smile expressions

PURPOSE@#Accuracy of image matching between resting and smiling facial models is affected by the stability of the reference surfaces. This study aimed to investigate the morphometric variations in subdivided facial units during resting, posed and spontaneous smiling. @*MATERIALS AND METHODS@#The posed and spontaneous smiling faces of 33 adults were digitized and registered to the resting faces. The morphological changes of subdivided facial units at the forehead (upper and lower central, upper and lower lateral, and temple), nasal (dorsum, tip, lateral wall, and alar lobules), and chin (central and lateral) regions were assessed by measuring the 3D mesh deviations between the smiling and resting facial models. The one-way analysis of variance, Duncan post hoc tests, and Student’s t-test were used to determine the differences among the groups (α = .05). @*RESULTS@#The smallest morphometric changes were observed at the upper and central forehead and nasal dorsum; meanwhile, the largest deviation was found at the nasal alar lobules in both the posed and spontaneous smiles (P < .001). The spontaneous smile generally resulted in larger facial unit changes than the posed smile, and significant difference was observed at the alar lobules, central chin, and lateral chin units (P < .001). @*CONCLUSION@#The upper and central forehead and nasal dorsum are reliable areas for image matching between resting and smiling 3D facial images. The central chin area can be considered an additional reference area for posed smiles; however, special cautions should be taken when selecting this area as references for spontaneous smiles.

How do we trade off benefits and harms of anticancer drugs for advanced cancer patients?

The overall survival rate of advanced cancer patients has improved thanks to the development of modern medical treatments, particularly new and innovative chemotherapeutic agents such as targeted therapies and immune checkpoint inhibitors.Current Concepts: Chemotherapy is administered in neoadjuvant, adjuvant, and palliative settings, and its ultimate goal is to improve overall survival. Chemotherapy has several proven and valuable clinical benefits, but also many side effects that cannot be ignored, especially in patients with poor European Cancer Oncology Group performance status. Therefore, we must carefully weigh and trade off the benefits and harms from many chemotherapy agents. In fact, it can be difficult to determine whether advanced cancer patients really benefit from chemotherapy, which is why a number of value measurement tools such as the American Society Clinical Oncology-Value Framework and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale have been developed.Discussion and Conclusion: We need to include individual cancer patients in decision-making processes and use appropriate shared decision-making to decide whether or not to administer chemotherapy. Furthermore, we should perform rational trade-offs in consideration of limited health resources.

Importance and requirements for dental prosthesis order platform services: a survey of dental professionals

Purpose@#This study aimed to gain better understanding of the importance of dental prosthesis order platform services and to identify the essential elements for their enhancement and wider adoption among dental professionals. @*Materials and Methods@#A survey was conducted to assess the perspectives of dentists, dental technicians, dental hygienists, and dental industry professionals toward dental prosthesis ordering and associated platform services (a total of 53 respondents). The questionnaire was devised after an expert review and assessed for reliability using Cronbach’s alpha coefficient. Factor analysis revealed that 57 factors across five categories accounted for 88.417% of the total variance. The survey was administered through an online questionnaire platform, and data analysis was conducted using a statistical software, employing one-way analysis of variance and Tukey’s honestly significant difference test (α = 0.05). @*Results@#The essential elements identified were accurate information input, effective communication, delivery of distortion-free impressions, convenience in data transmission and storage, development of stable and affordable platform services (P < 0.05). Furthermore, significant differences were observed in the importance of these items based on age, dental profession, and career experience (P < 0.05). @*Conclusion@#The dental prosthesis ordering platform services, the requirements of dental personnel were stability, economic efficiency, and ease of transmitting and storing prosthesis data. The findings can serve as important indicators for the development and improvement of dental prosthesis order platform services.

Positional deviation between CBCT-based digital facebow transfer and analog facebow transfer: case series

. The findings indicate that analog facebow transfer produced a linear deviation ranging from 3 to 16 mm and an angular deviation of the occlusal plane between 5 to 7 degrees. This case report confirms that, across two patients, analog facebow transfer can result in varying degrees of positional deviation, thereby potentially leading to inaccuracies in the fabrication of dental pros-theses. These results suggest that, in clinical practice, the use of analog facebow transfer may yield significant deviations during the process of mounting maxillary casts.

A case report of brain activity during mastication / 대한구강보건학회지

Objectives@#The aim of this study was to evaluate brain activity in youth during chewing gum and wood stick using functional magnetic resonance imaging (fMRI). @*Methods@#Two participants chewed wax gums and wood stick on the rhythm of 1 Hz during MRI scanning. The task paradigm was a block design and each chewing-rest procedure was repeated five times for 30s. @*Results@#The brain regions activated during chewing gum and wood stick were the precentral gyrus, postcentral gyrus, supplementary motor area, thalamus cerebellum. The medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), hippocampus, and precuneus were additionally activated by mastication of the wood stick. Brain activation induced by chewing wood stick was higher than chewing gum. @*Conclusions@#Our results suggest that mastication contribute to cognitive improvement through brain activity, this effect is stronger during chewing wood than gum. Therefore, eating harder foods may improve cognitive function more effectively.

Analysis of Cancer Patient Decision-Making and Health Service Utilization after Enforcement of the Life-Sustaining Treatment Decision-Making Act in Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to confirm the decision-making patterns for life-sustaining treatment (LST) and analyze medical service utilization changes after enforcement of the Life-Sustaining Treatment Decision-Making Act. @*Materials and Methods@#Of 1,237 patients who completed legal forms for life-sustaining treatment (hereafter called the LST form) at three academic hospitals and died at the same institutions, 1,018 cancer patients were included. Medical service utilization and costs were analyzed using claims data. @*Results@#The median time to death from completion of the LST form was three days (range, 0 to 248 days). Of these, 517 people died within two days of completing the document, and 36.1% of all patients prepared the LST form themselves. The frequency of use of the intensive care unit, continuous renal replacement therapy, and mechanical ventilation was significantly higher when the families filled out the form without knowing the patient’s intention. In the top 10% of the medical expense groups, the decision-makers for LST were family members rather than patients (28% patients vs. 32% family members who knew and 40% family members who did not know the patient’s intention). @*Conclusion@#The cancer patient’s own decision-making rather than the family’s decision was associated with earlier decision-making, less use of some critical treatments (except chemotherapy) and expensive evaluations, and a trend toward lower medical costs.

Portal Biliopathy Misdiagnosed as Hilar Cholangiocarcinoma / 대한소화기학회지

Portal biliopathy refers to the changes in the bile duct caused by portal vein thrombosis or obstruction. It is assumed to be caused by cavernous transformation due to the development of the venous system surrounding the bile duct, but the exact pathology is still unknown. Biliary morphologic abnormalities of portal biliopathy are discovered incidentally on radiographic images, but it is sometimes difficult to differentiate them from cholangiocarcinoma. Given the poor prognosis of cholangiocarcinoma, a surgical approach can be considered when the diagnosis is uncertain. Herein, we report a case of portal biliopathy with bile ductal wall thickening, which was diagnosed after surgical resection was performed due to the presumed diagnosis of cholangiocarcinoma.

Experience of Violence and Hospital Violence Attitude according to Gender and Gender-Role Identity of Clinical Nurses / 한국직업건강간호학회지

Purpose@#This study aims to examine differences in experiences of violence and hospital violence attitude according to gender and gender-role identity of clinical nurses. @*Methods@#The quota sampling method, was used to select the research subjects. They were divided into two groups male and female nurses who worked for three general hospitals or higher level-hospitals in Incheon and Gyeongbuk. The data of 219 subjects was used for final analysis. The IBM SPSS 22.0 was used to analyze the data t-test and ANOVA. @*Results@#According to gender, the hospital violence experience of female nurses was oserved frequently when the verbal violence came from guardians, and when the physical threats came from others. For male nurses, the experiences of hospital violence was obserbed. According to gender, the hospital violence attitude revealed significant differences in female nurses that the negative attitude was higher (t=-4.69, p<.001). According to gender-role identity, the undifferentiated and femininity showed significant differences (F=4.86 p=.003). @*Conclusion@#The differentiated strategies of coping measures and violence preventive education considering the gender and gender-role identity of clinical nurses would help formulate measures for the effective management of hospital violence.

Impact of scanning strategy on the accuracy of complete-arch intraoral scans:a preliminary study on segmental scans and merge methods

PURPOSE@#. This study investigated the accuracy of full-arch intraoral scans obtained by various scan strategies with the segmental scan and merge methods. @*MATERIALS AND METHODS@#. Seventy intraoral scans (seven scans per group) were performed using 10 scan strategies that differed in the segmental scan (1, 2, or 3 segments) and the scanning motion (straight, zigzag, or combined). The three-dimensional (3D) geometric accuracy of scan images was evaluated by comparison with a reference image in an image analysis software program, in terms of the arch shape discrepancies. Measurement parameters were the intermolar distance, interpremolar distance, anteroposterior distance, and global surface deviation. One-way analysis of variance and Tukey honestly significance difference post hoc tests were carried out to compare differences among the scan strategy groups (α = .05). @*RESULTS@#. The linear discrepancy values of intraoral scans were not different among scan strategies performed with the single scan and segmental scan methods. In general, differences in the scan motion did not show different accuracies, except for the intermolar distance measured under the scan conditions of a 3-segmental scan and zigzag motion. The global surface deviations were not different among all scan strategies. @*CONCLUSION@#. The segmental scan and merge methods using two scan parts appear to be reliable as an alternative to the single scan method for full-arch intraoral scans. When three segmental scans are involved, the accuracy of complete arch scan can be negatively affected.

Comparison of antibody responses after the 1st and 2nd doses of COVID-19 vaccine with those of patients with mild or severe COVID-19

Background/Aims@#Data comparing the antibody responses of different coronavirus disease 2019 (COVID-19) vaccine platforms according to dose with natural severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection-induced antibody responses are limited. @*Methods@#Blood samples from adult patients with mild and severe COVID-19 and healthcare workers who received ChAdOx1 nCoV-19 vaccine (2nd dose at 12-week intervals) and BNT162b2 vaccine (2nd dose at 3-week intervals) were collected and compared by immunoglobulin G immune responses to SARS-CoV-2 specific spike protein using an in-house-developed enzyme-linked immunosorbent assay. @*Results@#A total of 53 patients, including 12 and 41 with mild and severe COVID-19, respectively, were analyzed. In addition, a total of 73 healthcare workers, including 37 who received ChAdOx1 nCoV-19 and 36 who received BNT162b2, were enrolled. Antibody responses after the first and second doses of the ChAdOx1 nCoV-19 vaccine or the first dose of the BNT162b2 vaccine were similar to those in convalescent patients with mild COVID-19, but lower than those in convalescent patients with severe COVID-19, respectively. However, after the second dose of the BNT162b2 vaccine, the antibody response was comparable to that in convalescent patients with severe COVID-19. @*Conclusions@#Our data suggest that the second dose of mRNA vaccination may be more beneficial in terms of long-term immunity and prevention of SARS-CoV-2 variant infection than a single dose of COVID-19 vaccination or homologous second challenge ChAdOx1 nCoV-19.

Should We Consider Value Frameworks for Cancer Drugs as Oncology's Landscape Evolves?; from an Oncologist Perspective in Korea

Background@#As the role of immunotherapies and personalized medicine grow, cancer patients have faced many choices in treatments and have suffered financial toxicity. These challenges brought the need for the value framework (VF) to guide treatment decision making. @*Methods@#A survey was taken to 102 oncologists about perception for VF. They were asked about priorities among several considerations when they prescribe cancer drugs. Their views on the need for development and potential implications of VF in Korea were assessed, also. @*Results@#The survey shows that 90% of the respondents choose clinical efficacy as the most important value in cancer drugs selection, and the cost of drug was more weighted value in immune checkpoint inhibitors (13.7%). Approximately half (53.9%) answered that they were aware of the existing VFs. Over 90% of respondents agreed with the need for development of a VF for cancer drugs based on Korean healthcare system and further usefulness for decisions about reimbursement issues. Seventy-one percent answered that two representative VFs (American Society Clinical Oncology-VF and European Society for Medical OncologyMagnitude of Clinical Benefit Scale) should be reflected in value measurement of cancer drugs in Korea. @*Conclusion@#The Korean oncologists recognized the necessity for the clinical application of VF. Further discussion between the stakeholders should be followed to alleviate the financial burden through the value-based decision making of cancer drugs.

Evaluation of sleep quality and stress response in patients requiring dental prosthetic treatment / 대한치과보철학회지

Purpose@#The purpose of this study is to investigate the stress response and sleep state of the new patients who visit the hospital for prosthodontic treatment due to tooth loss to make reference to further treatment direction. @*Materials and methods@#Examinations, consultations, and surveys were conducted on 236 patients (94 males, 142 females, and 24-86 years old), who newly registered at the department of prosthodontics at Pusan national university hospital, for 2 years from 2018. The number of remaining teeth, edentulous arch, possibility of mastication, and future prosthetic treatment directions were recorded. The visual analogue scale (VAS), stress response inventory (SRI) and Insomnia severity index (ISI) were used as tools to measure patient’s subjective discomfort, stress response, and sleep status. @*Results@#Among the entire prosthodontic patient group, the average value of ‘fatigue’ was significantly higher among the 7 items of SRI, and the value of ‘aggression’ was significantly lower (P<.001). There are a significant difference between the edentulous and full dentition in the oral discomfort value measured by VAS (P=.004). In cases where less than 20 teeth remain, mastication is impossible, and patients who are planning treatment with removable prostheses, VAS value and ‘depression’ and ‘fatigue’ values in SRI were higher than those in the reverse case (P<.05).The patients showed severe level in VAS value have high value of ‘tension’, ‘somatization’, ‘depression’, ‘fatigue’and ‘frustration’in SRI than non-serious patients (P<.05). Clinical insomnia occurred in 11.4% of all patients, and women had significantly lower sleep quality than men (P=.044). Patients with insomnia showed significantly higher scores on the VAS value and all 7 SRI items than those of normal sleepers (P<.05). @*Conclusion@#The new prosthetics had high ‘fatigue’ value among the 7 items of SRI. The oral condition, number of residual teeth and mastication function and clinical insomnia affected oral discomfort and the stress response.

Management of prosthodontic patients with severe gag reflex using the questionaire and behavior technique: A case report / 대한치과보철학회지

Although gag reflex is an essential function and a useful physiological defense mechanism, it can become an obstacle in a dental treatment. In this case, a questionnaire was designed and used in consultations to objectify the factors associated with gag reflex. Based on the questionnaire, various treatment protocols were planned, such as behavioral control, which is a systematic desensitization that adapts by placing dental instruments in the oral cavity, and habit control to eliminate vomiting habits after drinking. Except for the placement of the implant fixture under general anesthesia, all restoration procedures were performed in the outpatient clinic in the same manner as the conventional implant fixed prosthetic restoration. The systematic desensitization and behavior technique were repeated until the patient was able to endure discomfort and relieve gag reflex in dental treatment. The patient was successfully received the implant-fixed prosthetic restoration in the partial edentulous region.

Should We Consider Value Frameworks for Cancer Drugs as Oncology's Landscape Evolves?; from an Oncologist Perspective in Korea

Background@#As the role of immunotherapies and personalized medicine grow, cancer patients have faced many choices in treatments and have suffered financial toxicity. These challenges brought the need for the value framework (VF) to guide treatment decision making. @*Methods@#A survey was taken to 102 oncologists about perception for VF. They were asked about priorities among several considerations when they prescribe cancer drugs. Their views on the need for development and potential implications of VF in Korea were assessed, also. @*Results@#The survey shows that 90% of the respondents choose clinical efficacy as the most important value in cancer drugs selection, and the cost of drug was more weighted value in immune checkpoint inhibitors (13.7%). Approximately half (53.9%) answered that they were aware of the existing VFs. Over 90% of respondents agreed with the need for development of a VF for cancer drugs based on Korean healthcare system and further usefulness for decisions about reimbursement issues. Seventy-one percent answered that two representative VFs (American Society Clinical Oncology-VF and European Society for Medical OncologyMagnitude of Clinical Benefit Scale) should be reflected in value measurement of cancer drugs in Korea. @*Conclusion@#The Korean oncologists recognized the necessity for the clinical application of VF. Further discussion between the stakeholders should be followed to alleviate the financial burden through the value-based decision making of cancer drugs.

Current Status and Cardinal Features of Patient Autonomy after Enactment of the Life-Sustaining Treatment Decisions Act in Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The main purpose of the Life-Sustaining Treatment Decisions Act recently enacted in Korea is to respect the patient’s self-determination. We aimed to investigate the current status and features of patient self-determination after implementation of the law. @*Materials and Methods@#Between February 2018 and January 2019, 54,635 cancer deaths were identified from the National Health Insurance Service (NHIS) database. We analyzed the characteristics of decedents who complied with the law process by self-determination compared with decedents with family determination and with decedents who did not comply with the law process. @*Results@#In multivariable analysis, patients with self-determination were younger, were less likely to live in rural areas, were less likely to belong to the highest income quintile, were less likely to be treated in general hospitals, and were more likely to show a longer time from cancer diagnosis compared with patients with family determination. Compared with patients who did not comply with the law process, patients with self-determination were younger, lived in Seoul or capital area, were less likely to belong to the highest income quintile, were treated in general hospitals, were less likely to have genitourinary or hematologic malignancies, scored higher on the Charlson comorbidity index, and showed a longer time from cancer diagnosis. Patients with self-determination were more likely to use hospice and less likely to use intensive care units (ICUs) at the end-of-life (EOL). @*Conclusion@#Decedents with self-determination were more likely to be younger, reside in the Seoul or capital area, show a longer time from cancer diagnosis, and were less likely to belong to the highest income quintile. They utilized hospice more frequently, and received less ICU care at the EOL.

Life-Sustaining Treatment States in Korean Cancer Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment for Patients at the End of Life / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#In Korea, the “Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life” was enacted on February 4, 2018. This study was conducted to analyze the current state of life-sustaining treatment decisions based on National Health Insurance Service (NHIS) data after the law came into force. @*Materials and Methods@#The data of 173,028 cancer deaths were extracted from NHIS qualification data between November 2015 and January 2019. @*Results@#The number of cancer deaths complied with the law process was 14,438 of 54,635 cases (26.4%). The rate of patient self-determination was 49.0%. The patients complying with the law process have used a hospice center more frequently (28% vs. 14%). However, the rate of intensive care unit (ICU) admission was similar between the patients who complied with and without the law process (ICU admission, 23% vs. 21%). There was no difference in the proportion of patients who had undergone mechanical ventilation and hemodialysis in the comparative analysis before and after the enforcement of the law and the analysis according to the compliance with the law. The patients who complied with the law process received cardiopulmonary resuscitation at a lower rate. @*Conclusion@#The law has positive effects on the rate of life-sustaining treatment decision by patient’s determination. However, there was no sufficient effect on the withholding or withdrawing of life-sustaining treatment, which could protect the patient from unnecessary or harmful interventions.

Comparison of Antibody and T Cell Responses Induced by Single Doses of ChAdOx1 nCoV-19 and BNT162b2Vaccines

There are limited data directly comparing humoral and T cell responses to the ChAdOx1 nCoV-19 and BNT162b2 vaccines. We compared Ab and T cell responses after first doses of ChAdOx1 nCoV-19 vs. BNT162b2 vaccines. We enrolled healthcare workers who received ChAdOx1 nCoV-19 or BNT162b2 vaccine in Seoul, Korea. Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) S1 protein-specific IgG Abs (S1-IgG), neutralizing Abs (NT Abs), and SARS-CoV-2-specific T cell response were evaluated before vaccination and at 1-wk intervals for 3 wks after vaccination. A total of 76 persons, comprising 40 injected with the ChAdOx1 vaccine and 36 injected with the BNT162b2 vaccine, participated in this study. At 3 wks after vaccination, the mean levels (±SD) of S1-IgG and NT Abs in the BNT162b2 participants were significantly higher than in the ChAdOx1 participants (S1-IgG, 14.03±7.20 vs. 6.28±8.87, p<0.0001; NT Ab, 183.1±155.6 vs. 116.6±116.2, p=0.035), respectively. However, the mean values of the T cell responses in the 2 groups were comparable after 2 wks. The humoral immune response after the 1st dose of BNT162b2 developed faster and was stronger than after the 1st dose of ChAdOx1. However, the T cell responses to BNT162b2 and ChAdOx1 were similar.

Correlation between Reactogenicity and Immunogenicity after the ChAdOx1 nCoV-19 and BNT162b2 mRNA Vaccination

Correlation between vaccine reactogenicity and immunogenicity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. Thus, we investigated to determine whether the reactogenicity after coronavirus disease 2019 vaccination is associated with antibody (Ab) titers and T cell responses. This study was prospective cohort study done with 131 healthcare workers at tertiary center in Seoul, South Korea. The degrees of the local reactions after the 1st and 2nd doses of ChAdOx1 nCov-19 (ChAdOx1) vaccination were significantly associated with the S1-specific IgG Ab titers (p=0.003 and 0.01, respectively) and neutralizing Ab (p=0.04 and 0.10, respectively) in age- and sex-adjusted multivariate analysis, whereas those after the BNT162b2 vaccination did not show significant associations. T cell responses did not show significant associations with the degree of reactogenicity after the ChAdOx1 vaccination or the BNT162b2 vaccination. Thus, high degree of local reactogenicity after the ChAdOx1 vaccine may be used as an indicator of strong humoral immune responses against SARS-CoV-2.

The significance of diagnosis and treatment planning in periapical lesion overfilled with calcium hydroxide paste

Calcium hydroxide has been widely used for root canal dressing material in endodontic treatment. This report describes that when the accurate diagnosis and proper nonsurgical endodontic retreatment is applied to periapical lesion with accidentally extruded calcium hydroxide paste, the lesion can be successfully treated. Overfilled calcium hydroxide can affect the healing process, so the overextension of calcium hydroxide agent should be avoided.