Physiotherapy-led care versus physician-led care for persons with low back pain: A systematic review.

OBJECTIVE: To summarise the evidence on the effect of physiotherapy-led versus physician-led care on clinical outcomes, healthcare use, and costs in persons with low back pain. DATA SOURCES: PubMed, Web of Science, CINAHL, Embase, and PEDro were systematically searched with the latest search performed in July 2024. Reference lists of articles were hand-searched. REVIEW METHODS: Studies comparing clinical outcomes, healthcare use, or costs between adults with low back pain first consulting a physiotherapist and those first consulting a physician were included. Methodological quality was assessed with the Newcastle-Ottawa Scale. Study design, clinical setting, patient characteristics, and group effects were extracted. Findings on outcomes assessed in two or more studies were synthesised narratively. Certainty of evidence was determined using the GRADE approach. RESULTS: Eighteen studies comprising 1,481,980 persons with low back pain were included. Most studies were non-randomised retrospective or prospective cohort studies. In primary care (15 studies), consistent evidence, though of mostly very low certainty, indicated that physiotherapy-led care leads to higher patient satisfaction, less use of medication, injections and imaging, fewer physician's visits, lower total healthcare costs, and less sick leave compared to physician-led care, without increased harm. In emergency care (three studies), evidence of very low certainty showed that physiotherapy-led care leads to shorter waiting and treatment times, and fewer hospital admissions. CONCLUSION: Physiotherapy-led care is a clinically, time- and cost-effective care pathway for low back pain, although the certainty of evidence was overall very low. Further high-quality research with a greater focus on clinical outcomes is warranted.

Development of impression trays for treating infants with trisomy 21 before their deciduous teeth erupt.

The treatment of infants with trisomy 21 (TS21) with a myostimulation plate can improve their development and quality of life. The manufacture of these plates requires an accurate cast of the maxilla, and their efficacy relies on their stability and retention. As such, the quality of the impression is a determining factor. The lack of commercially available stock trays for infants with TS21 creates difficulties, including inadequate impression quality and the risk of inhaling impression material. The present technique simplifies impression making for infants with TS21 from 3 months of age to when their maxillary deciduous teeth erupt by using computer-aided design and computer-aided manufacturing (CAD-CAM) impression trays. Sixty-five stored gypsum maxillary casts from infants with TS21 that had been used to manufacture myostimulation plates were analyzed to select four differently sized representative casts for designing the impression trays. A CAD software program was used to digitally shape four sizes of the impression tray from the selected gypsum casts. Practitioners interested in this approach can download and export the standard tessellation language (STL) files using a quick response (QR) code. The impression trays should be manufactured with the stereolithography additive technique using biocompatible resin. This technique allows practitioners to make accurate maxilla impressions for infants with TS21 by manufacturing their own impression trays using the free-access STL files rather than the cumbersome conventional method.

Effect of dimensional variations on the manufacturing process and the 3D shrinkage ratio of stereolithographic dental alumina ceramics.

The purpose of the present study was to evaluate the influence of height and length variations of alumina ceramics manufactured by stereolithography on deformations caused by the manufacturing process and on the 3D shrinkage ratio to control the final dimensions and improve the adaptation of stereolithographic ceramic dental prostheses. Two different U-shaped models were designed with variable heights or lengths. The specimens were manufactured by stereolithography and were scanned using a microtomographic device before and after the heat treatment. Dimensional variations were measured using inspection software. The number and surface of layers of alumina ceramic influenced the reliability of the stereolithography manufacturing but did not influence the 3D shrinkage ratio. The larger the layer surface, the larger the deformation of the ceramic. Dental ceramics manufactured by stereolithography with smallest layer surface are the most reliable. This helps in the selection of the build orientation.

Impact of type of bonding agent on adhesion of CAD-CAM denture bases and teeth manufactured using different techniques: A preliminary study.

PURPOSE: To evaluate two agents for bonding denture bases and teeth manufactured either by stereolithography (SLA) or by the subtractive mixed technique. METHODS: Two types of cylinders [small for the tooth resin and large for the base resin) were designed using CAD software according to the ANSI/ADA 15-2008 (R2013)] specification. For SLA manufacturing, 30 small cylinders were shaped with Denture Teeth resin and 30 large cylinders with Denture Base resin. For the mixed technique, 30 large cylinders were manufactured by SLA with V-print dentbase resin, and 30 small cylinders were milled with a CediTEC DT disk. Half the specimens were bonded with liquid Denture Base resin and half with CediTEC Primer and Adhesive, according to the manufacturers' protocols. Shear bond strength was measured using a universal testing machine. The failure mode was noted for all the specimens. RESULTS: The shear bond strength values were not significantly different between the groups (P> 0.05). Specimens bonded with liquid Denture Base resin displayed cohesive failure (P> 0.05, ײ= 0). Of the specimens bonded with CediTEC Primer and Adhesive, cohesive failures were observed with five specimens manufactured with the SLA technique and one specimen manufactured with the mixed technique (P> 0.05, ײ= 3.33). The Chi-square test results were significant between groups with different bonding agents regardless of the technique used (P< 0.001). Within the limitations of the present study, even if the shear bond strength values were similar, the failure mode analysis suggests that the uncured liquid Denture Base resin may be more effective than the CediTEC Primer and Adhesive for bonding denture bases and teeth manufactured either by SLA or the mixed technique. CLINICAL SIGNIFICANCE: The present study suggests that the uncured liquid resin (Denture Base) used as a bonding agent and the denture base and tooth materials (V-Print and CediTEC DT) manufactured by SLA and the subtractive technique are clinically compatible.

Sodium carbonate improves adherence of two-layer alginate for preliminary impressions of complete dentures.

PURPOSE: This in vitro study evaluated the effect of sodium carbonate (Na2CO3) concentration on adhesion between two layers of irreversible hydrocolloid wash impression material. METHODS: The first layer of irreversible hydrocolloid was brushed with three concentrations (0.1, 0.7, or 7.0 wt.%) of Na2CO3. Irreversible hydrocolloid not brushed with Na2CO3 was used as a negative control. Adhesion between the two layers (bond strength and adhesion energy) was then evaluated using a traction test, and the fracture modes were identified. The results of traction test were analyzed with a one-way ANOVA followed by a Tukey post hoc test. Chi-square test was used for analyzed failure mode after testing (α= 0.05). RESULTS: The bond strength (0.034 ±0.005 MPa) and adhesion energy (60.240 ±12.817 J.m⁻ ²) of the 0.7% Na2CO3 group were significantly higher than those of the other groups (P< 0.05). The 0.7% Na2CO3 group displayed only cohesive failure (ײ= 16; P< 0.0001). CLINICAL SIGNIFICANCE: Conditioning the surface of the first layer of irreversible hydrocolloid with 0.7% sodium carbonate improved adhesion between the two layers and may help clinicians improve the quality of the preliminary impressions of removable complete dentures.

Effect of build orientation on the manufacturing process and the properties of stereolithographic dental ceramics for crown frameworks.

STATEMENT OF PROBLEM: Stereolithography (SLA) ceramic crown frameworks are suitable for clinical use, but the impact of SLA build orientation has not been identified. PURPOSE: The purpose of this in vitro study was to investigate the effect of 3 build orientations on the physical and mechanical properties and the microstructure of SLA alumina dental ceramics. MATERIAL AND METHODS: The physical and mechanical properties and microstructures of 3 different oriented SLA alumina ceramics (ZX, ZY, and XY) were evaluated by visual observation, hydrostatic weighing (n=10/group), Weibull analyses (n=30/group), scanning electron microscopy, 3-point flexural strength (n=30/group), fracture toughness (indentation, single-edge-V-notched-beam) (n=4/group), and Vickers hardness (n=15/group) testing. The hydrostatic weighing, 3-point flexural strength, fracture toughness, and Vickers hardness testing data were statistically analyzed (α=.05). RESULTS: The minimum resting period of slurries between the polymerization of 2 layers was shorter for the ZY- and ZX-oriented specimens and increased with the layer surface. The density and Vickers hardness of the SLA-manufactured specimens were similar for all groups (P>.05). The 95% confidence intervals of the Weibull moduli of the ZX- and ZY-oriented specimens were higher than that of the XY-oriented specimens, with no overlap fraction. The ZY-oriented specimens displayed significantly higher 3-point flexural strength (P<.05) and fracture toughness as evaluated by the single-edge-V-notched-beam method than the ZX-oriented specimens (P<.05). They also displayed significantly higher 3-point flexural strength than the XY-oriented specimens (P<.05). The microstructural analysis showed that the texturing was heterogeneous and that the major axis of the large grains of alumina ran parallel to the orientation of the layers. CONCLUSIONS: The ZY orientation produced a reliable dental ceramic by SLA, with the shortest general manufacturing time and the highest mechanical strength when the layers were perpendicular to the test load surface.