A Comparative Study on the Voxel Values in Alveolar Bones Acquired by MDCT and Newly Developed Dental Dual-Energy CBCT.

The purpose of this study was to analyze the effectiveness of newly developed dental dual-energy (DE) cone-beam computed tomography (CBCT) to compare both the voxel values in hard bone tissue of DE-CBCT and multidetector computed tomography (MDCT) images, collected in a clinical trial conducted at Seoul National University Dental Hospital. A software implemented as a scripted module of a three-dimensional (3D) slicer was developed to register the volume data from the MDCT space to DE-CBCT, locate the same 3D regions of interest (ROIs) in each image space, and extract the statistics of the ROIs. The mean values were paired and used as representative values of the ROIs. A scatter plot with the line of equality and Bland-Altman (BA) plot of difference for a pair of measured means were used for statistical analysis. Of the ROI pairs, 96% were within ±15% from the identity line, and more than 95% of the measured ROI pairs were within the limits of agreement of the 95% confidence intervals (CIs), with the CI of the limits in BA plots. The newly developed dental DE-CBCT showed a level of voxel value accuracy similar to that of MDCT.

Pulsed and conventional radiofrequency treatment: which is effective for dental procedure-related symptomatic trigeminal neuralgia?

OBJECTIVES: Many patients develop dental treatment-related symptomatic trigeminal neuralgia. However, the effectiveness of pulsed radiofrequency (PRF) treatment and conventional radiofrequency thermocoagulation (RFTC) for treatment of this disorder has not been determined. This retrospective study was conducted to compare the effectiveness and complications of PRF and RFTC in these patients. METHODS: Fifty-four patients who experienced the onset of symptomatic trigeminal neuralgia after a dental treatment were managed by PRF or RFTC. Data were collected by reviewing their medical records and conducting a questionnaire. Patients' characteristics, the dental procedures that caused the trigeminal neuralgia, the baseline and posttreatment pain intensities, duration of pain relief, complications, and satisfactions to the treatment were evaluated. RESULTS: Pain intensities were lower at 1 week (3.0/10 vs 6.4/10), at 1 month (2.5/10 vs 5.9/10), 3 months (2.6/10 vs 5.5/10), 6 months (3.1/10 vs 7.1/10) and 1 year (4.8/10 vs 7.2/10) in the RFTC group (28 patients) than in the PRF group (26 patients) (P < 0.05). The duration of pain relief without medication in the RFTC group (10.8 months) was longer than that in the PRF group (0 months). The incidence of complications in the RFTC group (46.4%) was higher than that in the PRF group (3.8%) (P < 0.05). The RFTC group reported higher satisfaction ratings (3.86/5) than the PRF group (2.19/5) (P < 0.05). CONCLUSIONS: Although the RFTC group had more complications than the PRF group, most were minor and transient, and the patient satisfaction rate with RFTC was very high. Therefore, RFTC is an effective tool for the treatment of dental procedure-induced trigeminal neuralgia.

The 90° rotation technique improves the ease of insertion of the ProSeal™ laryngeal mask airway in children.

BACKGROUND: A previous study using a 180° rotation to insert the ProSeal™ laryngeal mask airway (LMA ProSeal) in children did not show improvement over the standard technique. We used a 90° rotation technique to insert the LMA ProSeal in pediatric patients and compared ease of insertion and pharyngeal trauma with the standard technique. METHODS: This prospective randomized controlled study included 126 patients aged three to nine years. Anesthesia was induced with thiopental and rocuronium, and the LMA ProSeal used in the study ranged in size from 2 to 3 depending on the patient's body weight. In the control group (n = 63), the LMA ProSeal was inserted using the index finger. In the rotation group (n = 63), the entire cuff of the LMA ProSeal was placed in the patient's mouth without finger insertion and rotated 90° counter clockwise around the tongue. The LMA ProSeal was then advanced and rotated back until resistance was felt. The primary outcome was the insertion success rate at first attempt. RESULTS: The success rate of insertion at first attempt was higher with the rotation technique than with the standard technique (97% vs 70%, respectively; P < 0.001) and the insertion time was shorter (16 ± 6 sec vs 30 ± 24 sec, respectively; P < 0.001). Mean blood pressure after LMA ProSeal insertion increased significantly in the control group (62 ± 12 to 69 ± 17 mmHg; P = 0.01), but not in the rotation group. The incidence of blood staining was lower in the rotation group than in the control group (10% vs 25%, respectively; P = 0.03), but the incidence of sore throat was not significantly different (24% vs 22%, respectively; P = 0.9). CONCLUSIONS: The 90° rotation technique improves ease of insertion of the LMA ProSeal in children, and it decreases the risk of pharyngeal trauma. (ClinicalTrials.gov number, NCT01076725).

Comparison of two insertion techniques of ProSeal laryngeal mask airway: standard versus 90-degree rotation.

BACKGROUND: This study compared two insertion techniques of ProSeal laryngeal mask airway. METHODS: A total of 160 female patients (American Society of Anesthesiologists physical status I or II; age 18-80 yrs) undergoing gynecologic surgery were randomly allocated to the standard or rotational technique groups. In the standard technique group (n = 80), ProSeal laryngeal mask airway insertion was performed by a single experienced user using digital manipulation. In the rotational technique group (n = 80), the ProSeal laryngeal mask airway was rotated counter clockwise through 90 degrees in the mouth and advanced until the resistance of the hypopharynx was felt, and then straightened out in the hypopharynx (n = 80). The ease of insertion was assessed by the success rate at the first attempt. Heart rate and mean blood pressure were recorded 1 min before and 1 min after insertion. Postoperative complications were noted. RESULTS: The success rate of insertion at the first attempt was higher for the rotational technique (100% vs. 85%, P < 0.001). The overall success rate, i.e., successful insertion within three attempts, was 94% for the standard technique versus 100% for the rotational technique. There was no significant change in heart rate, but mean blood pressure increased significantly with the standard technique (P = 0.001). The incidence of blood staining (9% vs. 36%, P < 0.001) and sore throat (8% vs. 25%, P = 0.005) was lower with the rotational technique. CONCLUSION: The rotational technique is more successful than the standard technique and is associated with less pharyngeal mucosal trauma, as evidenced by a lower incidence of sore throat and mucosal bleeding.

A clinical pilot study of jawbone mineral density measured by the newly developed dual-energy cone-beam computed tomography method compared to calibrated multislice computed tomography.

PURPOSE: This clinical pilot study was performed to determine the effectiveness of dual-energy cone-beam computed tomography (DE-CBCT) in measuring bone mineral density (BMD). MATERIALS AND METHODS: The BMD values obtained using DE-CBCT were compared to those obtained using calibrated multislice computed tomography (MSCT). After BMD calibration with specially designed phantoms, both DE-CBCT and MSCT scanning were performed in 15 adult dental patients. Three-dimensional (3D) Digital Imaging and Communications in Medicine data were imported into a dental software program, and the defined regions of interest (ROIs) on the 3-dimensional surface-rendered images were identified. The automatically-measured BMD values of the ROIs (g/cm3), the differences in the measured BMD values of the matched ROIs obtained by DE-CBCT and MSCT 3D images, and the correlation between the BMD values obtained by the 2 devices were statistically analyzed. RESULTS: The mean BMD values of the ROIs for the 15 patients as assessed using DE-CBCT and MSCT were 1.09±0.07 g/cm3 and 1.13±0.08 g/cm3, respectively. The mean of the differences between the BMD values of the matched ROIs as assessed using DE-CBCT and calibrated MSCT images was 0.04±0.02 g/cm3. The Pearson correlation coefficient between the BMD values of DE-CBCT and MSCT images was 0.982 (r=0.982, P<0.001). CONCLUSION: The newly developed DE-CBCT technique could be used to measure jaw BMD in dentistry and may soon replace MSCT, which is expensive and requires special facilities.

Fibrin glue versus staple mesh fixation in single-port laparoscopic totally extraperitoneal inguinal hernia repair: A propensity score-matched analysis.

BACKGROUND: Mesh fixation minimizes the risk of recurrence following laparoscopic inguinal hernia repair. Mesh fixation using staples has been implicated as a cause of chronic inguinal pain. We investigated whether fibrin glue mesh fixation reduces acute or chronic postoperative pain in patients undergoing single-port laparoscopic totally extraperitoneal inguinal hernia repair (SP TEP). METHODS: Inguinal hernia patients undergoing SP TEP between October 2013 and September 2016 were evaluated. Propensity score matching was performed to compare short-term and chronic pain in patients undergoing mesh fixation involving either staples or fibrin glue. RESULTS: Stapling was performed in 82 patients and 78 underwent fibrin glue mesh fixation; these individuals were balanced into 50 pairs. Immediately after surgery, the fibrin glue group required significantly less analgesia than did the staple group (p = 0.023). Otherwise, no significant between-group differences in postoperative pain scores or analgesia requirements were noted during the initial 7 postoperative days. Activities of daily living (ADLs) resumed earlier in patients undergoing fibrin glue mesh fixation, compared with staples (p = 0.016). At 6 months, no significant differences in the incidence of chronic pain were observed. CONCLUSIONS: The short-term outcomes of SP TEP were comparable regardless of the mesh fixation method, but the immediate postoperative analgesia requirement was significantly less for those in the fibrin glue group. The time to resume ADLs was shorter for the fibrin glue group. Fibrin glue for mesh fixation during SP TEP may be an efficacious alternative to stapling during minimally invasive inguinal hernia repair.

Biological efficacy of silk fibroin nanofiber membranes for guided bone regeneration.

The favorable biological properties of silk fibroin (SF) nanofiber membrane make it a good candidate for clinical applications as a device in bone and periodontal regenerative therapy. The purpose of this study is to evaluate the biocompatibility of the SF nanofiber membrane, and to examine its effect on bone regeneration in a rabbit calvarial model. To examine the biocompatibility of the electrospun SF membrane, we investigated cell proliferation, morphology, and differentiation. The bone regenerative efficacy of the membrane was evaluated in the calvarial defect of rabbits. The cell numbers and osteocalcin production labels were significantly increased in accordance with culture period. Cells had a stellate shape and broad cytoplasmic extensions on the membrane. The cells showed activity of ALPase that was comparable to culture dishes, and were calcified similarly to culture dishes. In in vivo tests, a complete bony union across the defects was observed after 8 weeks. At 12 weeks, the defect had completely healed with new bone. In conclusion, the SF nanofiber membrane was shown to possess good biocompatibility with enhanced bone regeneration and no evidence of any inflammatory reaction. These results strongly suggest that the SF membrane should be useful as a tool for guided bone regeneration.

Comparison of effective dose for imaging of mandible between multi-detector CT and cone-beam CT.

PURPOSE: The aim of this study was to compare the effective dose for imaging of mandible between multi-detector computed tomography (MDCT) and cone-beam computed tomography (CBCT). An MDCT with low dose technique was also compared with them. MATERIALS AND METHODS: Thermoluminescent dosimeter (TLD) chips were placed at 25 organ sites of an anthropomorphic phantom. The mandible of the phantom was exposed using 2 different types of MDCT units (Somatom Sensation 10 for standard-dose MDCT, Somatom Emotion 6 for low-dose MDCT) and 3 different CBCT units (AZ3000CT, Implagraphy, and Kavo 3D eXaM). The radiation absorbed dose was measured and the effective dose was calculated according to the ICRP 2007 report. RESULTS: The effective dose was the highest for Somatom Sensation 10 (425.84 µSv), followed by AZ3000CT (332.4 µSv), Somatom Emotion 6 (199.38 µSv), and 3D eXaM (111.6 µSv); it was the lowest for Implagraphy (83.09 µSv). The CBCT showed significant variation in dose level with different device. CONCLUSION: The effective doses of MDCTs were not significantly different from those of CBCTs for imaging of mandible. The effective dose of MDCT could be markedly decreased by using the low-dose technique.

Enhanced ridge preservation by bone mineral bound with collagen-binding synthetic oligopeptide: a clinical and histologic study in humans.

BACKGROUND: The ridge-preservation technique has been applied with membrane alone or membrane plus graft. Synthetic peptides, mimicking bioactive growth factor or extracellular matrix protein, have been attempted to provide an active surface of the biomaterials in inducing bone formation while alleviating the limitations of whole protein such as short half-life, immunologic responses. The aim of the present clinical study is to examine the osteogenic effect of synthetic oligopeptide-coated bone mineral compared to bone graft without peptide when applied with collagen membrane in a ridge-preservation technique. METHODS: Synthetic oligopeptide from the collagen-binding domain of osteopontin was chemically synthesized and coated onto the surface of bone mineral particulates. Ridge preservations were performed at 44 extraction sites in 42 patients (20 males and 22 females). Analyses of clinical parameters and histomorphometric evaluations were conducted to compare the osteogenic effects of the grafts between baseline and 6 months. RESULTS: In the bone grafts of the control group treated without synthetic peptide, new bone formation was only seen around borders and basal areas. However, new bone was observed broadly in the defects of the test group treated with synthetic peptide-coated bone mineral, as seen not only at peripheries but also in the central and coronal parts of bone cores in the defects. The average percentage of new bone formation was significantly higher in the test group (5.3% ± 8.3% versus 10.4% ± 4.6%). The contact percentages between the graft particles and the new bone were 8.2% ± 11.3% for the control group and 20.4% ± 7.5% for the test group (P <0.05). CONCLUSIONS: The ridge-preservation approach using synthetic oligopeptide-coated bone mineral with collagen membrane effectively prevented the resorption of hard tissue with higher bone-to-graft contact, and the oligopeptide-coated bone may be a choice for ridge-preservation procedures while assuring new bone formation.

Synthetic peptide-coated bone mineral for enhanced osteoblastic activation in vitro and in vivo.

A 15-mer synthetic peptide, designated P1, was derived from the bone morphogenetic protein (BMP) receptor I and BMP receptor II binding domains of BMP-2 for the purpose of enhancing bone regeneration capacity of inorganic bovine bone mineral. A second peptide, denoted P2, was designed by adding seven glutamic acid residues to the N-terminal of P1 to increase the surface coating efficiency onto bone mineral. The coating efficiency of P1 increased with the concentration of peptide. P2 peptide, in contrast, had a higher coating efficiency at lower peptide concentrations. The peptides properly transduced intracellular signals properly via the Smad and ERK pathways, thereby increasing mineralization in vitro, implying that the peptides alone can induce osteoblastic differentiation. Adhesion of cells to bone mineral was greater when peptides were present than in bone mineral alone. P1- and P2-coated bone mineral increased osteoblastic differentiation, as demonstrated by ALPase activity. P1-coated bone mineral stimulated more new bone regeneration in bone defect sites after 2 weeks than the peptide-free control. These peptides, in combination with bone grafts or implants, have the potential to enhance osteoblastic differentiation and bone regeneration.

Injectable polysaccharide microcapsules for prolonged release of minocycline for the treatment of periodontitis.

Injectable polysaccharide microcapsules holding minocycline were fabricated from alginate and chitosan for the treatment of periodontitis. The microcapsules were examined for the release and degradation of minocycline, as well as antimicrobial activity. The microcapsules were biodegradable and released minocycline between 10 and 1000 microg ml(-1), which was higher than the usual therapeutic concentration (1-5 microg ml(-1)), for up to 7 days. These microcapsules showed a statistically significant suppression of pathogenic bacteria, such as Prevotella intermedia causing periodontitis. The microcapsules are thus potentially useful for drug delivery for the treatment of periodontitis.

Hypoglycemic effect of a Lentinus edodes exo-polymer produced from a submerged mycelial culture.

The hypoglycemic effect of an exo-polymer produced from a submerged mycelial culture of Lentinus edodes was investigated in streptozotocin-induced diabetic rats. The administration of the exo-polymer (200 mg/kg BW) reduced the plasma glucose level by as much as 21.5%, and increased plasma insulin by 22.1% as compared to the control group. It also lowered the plasma total cholesterol and triglyceride levels by 25.1 and 44.5%, respectively. Gel chromatography of the exo-polymer revealed a single peak which is likely to have been a glycoprotein with a molecular weight of 52 kDa and was found to contain 83.5% carbohydrate and 16.5% protein. The Sugar and amino acid compositions of the exo-polymer were analyzed in detail.