Surgical outcomes of the surgical techniques following management of iatrogenic trigeminal nerve injuries: A systematic review.

Objective: To investigate the effectiveness of the microsurgical treatment in restoring full sensory recovery following trigeminal nerve injuries caused by iatrogenic oral and maxillofacial surgical interventions. Methods: A detailed search was conducted on the Cochrane central register of controlled trials, Medline and Embase. Clinical studies with at least twelve months of follow up were included and assessment of risks of bias was made using the Robbin I assessment tool. Results: Six studies were identified in the searches which include 227 patients. The lingual nerve was the most common injured nerve, followed by the inferior alveolar nerve. Third molar removal was the most frequent cause of nerve injury, followed by root canal treatment, pathology excision, coronectomy, orthognathic surgery, dental implants and then local anaesthetic injections. Overall, surgical interventions for nerve injuries showed neurosensory improvement postoperatively in the majority of patients. Conclusion: Direct neurorrhaphy is still the gold-standard technique when the tension at the surgical site is minimal. Promising results have been noted on conduit applications following traditional repair or grafting. Further research is needed on the efficacy of allografting and conduit applications in nerve repair.

Medical and Dental Professions' Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study.

AIMS: This study aimed to assess the awareness of the risk of medication-related osteonecrosis of the jaw (MRONJ) among general dental practitioners (GDPs) and primary care physicians (PCPs), focusing on the clinical implications and coordination of treating or identifying high-risk patients. MATERIALS AND METHODS: Two Google Forms electronic questionnaires were distributed to 724 GDPs and 617 PCPs in primary care settings. One for PCPs with eight multiple choice questions and the other for GDPs with 10 multiple choice questions. A clinical case scenario and a section on open-ended comments were included in both questionnaires. The data obtained from each group were statistically analyzed and compared. RESULTS: A total of 239 GDPs and 220 PCPs participated in the study, with a response rate of 34.23%. The mean age of participants was 29.5 years and 54.35% were females (51.2% and 57.5% in the GDPs and PCPs group, respectively). Most participants had graduated from Saudi Arabia. Almost all dentists were aware of osteonecrosis of the jaw (95.1%), 68.3% of them were aware of the guidelines regarding bisphosphonate-related osteonecrosis of the jaw (BRONJ) and MRONJ, 60.5% rated their general knowledge about MRONJ as very poor to poor, and 91.8% did not know any guidelines regarding BRONJ or MRONJ. Among the participants, 75.3% did not know how MRONJ was present in the oral cavity. A total of 69.9% of participants were unaware of other factors associated with an increased risk of MRONJ. CONCLUSION: MRONJ risk awareness varies greatly between dentists who diagnose and manage patients in dental clinics and physicians who write about medicines and therapies. Counseling sessions and greater coordination between dental and medical specialists are strongly suggested while prescribing antiresorptive drugs to prevent the consequent development of MRONJ. CLINICAL SIGNIFICANCE: This study shows a significant lack of knowledge regarding MRONJ among GDPs and PCPs, which may affect the prevention and treatment of patients. Therefore, we urge GDPS and PCPs to take more information from scientific sources on this topic and more cooperation from specialties for the benefit of patients. How to cite this article: Aljohani MH, Aljohani AS, Aljohani RM, et al. Medical and Dental Professions' Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study. J Contemp Dent Pract 2024;25(1):62-67.

Effect of the Dynamic Orthotic Garment on Postural Control, and Endurance in Children with Spastic Diplegic Cerebral Palsy: A Randomized Controlled Trial.

Purpose: To investigate the effect of dynamic orthotic garments (Thera togs) on foot pressure distribution, postural control, and endurance in children with spastic diplegic CP. Patients and Methods: This is a single-blind randomized controlled clinical trial involving 34 (8-10 years) with spastic diplegic CP. The control group received conventional physical therapy (CPT), whereas the study group received CPT in addition to wearing TheraTogs. We recorded foot pressure distribution, trunk control measurement scale, trunk position sense, Pediatric Berg Balance Scale (PBS), and six-minute walking distance (6MWD). Results: Both groups showed improvement. The study group had significant improvement in foot pressure distribution (p-value 0.003, 0.001, <0.001 for forefoot, midfoot, and rearfoot mean pressures respectively, and 0.005, <0.001, and 0.005 for forefoot, midfoot, and rearfoot peak pressures respectively), Pediatric balance scale, The trunk control measurement scale, and Trunk position sense (p-value < 0.001) and six-minute walking distance (p-value 0.029). Our data suggest that adding TheraTogs to conventional physiotherapy improves foot pressure, postural control, and endurance in children with spastic diplegic cerebral palsy. Conclusion: Both TheraTogs and conventional physical therapy corrected foot pressure distribution, trunk control, improved balance, and increased 6MWD in children with spastic diplegic CP but the improvement was more significant in TheraTogs group. Clinical Trial Registration: NCT05271149.

Ipsilateral versus contralateral static endurance- balance abilities among healthy college students.

Objectives: This study sought to determine the association and the difference, if any, between the levels of the contralateral and between the levels of the ipsilateral sides during static endurance-balance exercise. Methods: One hundred twelve healthy active- college students (55 females and 57 males) participated in this cross-sectional study. Each participant performed the contralateral (raising one arm and opposite-side leg) quadruped bird dog exercise and balanced in static condition. Side bridge exercise was performed from lying on your side then engaging your core muscles and lifting your upper body and hips off the ground, maintaining a straight line and holding this position as long as tolerated. Results: Wilcoxon signed rank test showed significant difference (p = 0.004) between the contralateral right and left quadruped bird dog but insignificant difference (p = 0.059) between the ipsilateral right and left side bridge endurance-balance exercises. Mann-Whitney U test showed that the holding time was significant across gender for the contralateral but was insignificant for the ipsilateral endurance-balance exercise. Mann-Whitney U test was insignificant (p > 0.05) between those being recreationally active or inactive. Kruskal-Wallis test revealed insignificant difference between body mass index categories. Spearman's rho correlation coefficient showed strong positive correlation equals 0.85 and 0.75 (p < 0.001) of the contralateral quadruped bird dog and the ipsilateral side bridge exercises respectively. Conclusions: A significant difference was observed for contralateral, while no significant difference was found for ipsilateral endurance-balance abilities. Therefore, clinicians and rehab specialist should consider these findings when assessing the endurance-balance abilities to properly devise appropriate exercise progression of different trunk stabilizers.

Current Rehabilitation Practices and Return to Sports Criteria After Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists in Saudi Arabia.

CONTEXT: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. DESIGN: Online cross-sectional survey-based study. METHODS: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. RESULTS: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. CONCLUSIONS: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements.

Effect Of Texting And Handwriting On Hand-Grip And Key-Pinch Strength Among Female-Collegiate Students: Randomized Controlled Trial.

OBJECTIVE: To evaluate immediate and long-term effect of texting or handwriting on hand-grip and key-pinch strength among healthy female students. Methods: The single-blind, randomised controlled trial was conducted between February and April 2021 after approval from the ethics review committee of the College of Medical Rehabilitation Sciences, Taibah University, Saudi Arabia, and comprised female Physio Therapy students aged 19-23 years who were right-hand dominant and had normal body mass index. The subjects used smartphones and electronic gadgets for >2hrs daily, writing more than 10min/day. They were randomised using sealed envelopes into five groups. Group A practised 10min texting, group B 15min texting, group C 10min writing, group D 15min writing, and group E used the phones only for talking or watching, with no texting or writing, and was taken as the control group. Hand-grip strength and key- pinch strength were assessed one minute before starting, and within one minute after having finished the assigned hand activity. All measurements were recorded in the sitting position using a single hand-grip dynamometer. Data was analysed using SPSS 23. RESULTS: Of the 65 individuals assessed, 60(92.3%) were initially enrolled, but the study was finished by 50(83.3%) subjects with a mean age of 20.88±0.98 years and mean body mass index 20.8±2.30kg/m2. There were 12(24%) subjects in group A, 7(14%) in group B, 12(24%) in group C, 10(20%) in group D and 9(18%) in group E. The association of the time-based groups with hand-grip and key-pinch strength was not significant (p>0.05). CONCLUSIONS: Texting and handwriting did not have any significant immediate effect on hand- grip or key-pinch strength. Clinical Trial Number: (NCT04810416).

Conservative management and follow-up of bilateral condylar fractures in pediatric patients: A case report.

Key Clinical Message: Conservative treatment of bilateral condylar fractures, including intermaxillary fixation using arch bars and elastic bands, yields satisfactory results in pediatric patients. Therefore, the conservative approach should be considered the first line of treatment for bilateral condylar mandibular fractures in pediatric patients. Abstract: Road traffic accidents (RTAs) are considered the leading cause of mortality and morbidity of children and adults in Saudi Arabia. Head injuries and fractures are the most common form of injuries resulting from RTAs, with mandibular fractures being the most common head injury; condylar fractures are the most frequent type of mandibular fracture. A review of the literature reveals diverse opinions about the best approach for treating bilateral condylar fractures in pediatric patients. The findings of the literature review are reported in this study. The case presented here shows the result of adopting a conservative approach to treating a bilateral extracapsular displaced condylar fracture. An elastic band was fixed onto intermaxillary fixation (IMF) screws at the midline upper and lower jaws; the patient was followed up for almost 3 years. The conservative approach yielded excellent results, as both condyles were fully repositioned and healed, without causing any deviation or limitation of the mouth opening. The results of this case support considering the conservative approach as the first line of treatment for bilateral condylar mandibular fractures in pediatric patients.

Establishing local diagnostic reference levels for computed tomography examinations using size-specific dose estimates.

OBJECTIVES: To establish local DRL (LDRL) for computed tomography (CT) examinations based on size-specific dose estimates (SSDEs), which consider patient size. The concept of diagnostic reference level (DRL) was introduced to limit patient exposure to unnecessary radiation. However, traditional DRL values do not consider patient size. METHODS: Following institutional committee approval, data were collected from CT examinations of adult patients at Madinah General Hospital, Al Madinah Al Munawwarah, Saudi Arabia from January to March 2023. The SSDE was calculated for each patient using the effective diameter (Deff). RESULTS: The LDRLs of the brain, cervical spine, chest, thoracic spine and kidneys, ureters, and bladder (KUB) examinations were 118 mGy, 12 mGy, 8 mGy, 17 mGy, and 7 mGy, respectively. A strong correlation was observed between SSDEs and the volume computed tomography dose index (CTDIvol) for all examinations except chest scans (p<0.05). Size-specific dose estimates were higher than the CTDIvol, with a greater difference for patients with smaller Deff (p<0.05). CONCLUSION: The established LDRL was within the international DRL. The use of SSDE has the potential to provide more accurate and relevant data for radiation safety practices; however, widespread adoption of SSDE in new CT scanners is necessary for promoting consistency and standardization methodologies.

The Effect Of Gender On Vastus Medialis Oblique/Vastus Lateralis Activation Ratio During Weight And Non-Weight Bearing Activities In Recreationally Subjects.

Objectives: To investigate the effect of gender on the activation ratio of vastus medialis oblique to vastus lateralis during straight leg raising and stepdown activities. Method: The cross-sectionalstudy was conducted at the College of Medical Rehabilitation Sciences, Taibah University, Medina, Kingdom of Saudi Arabia, from September 2021 to March 2022, and comprised recreationally active subjects without knee pathology who were distributed in 2 gender-based groups. All the participants were subjected to straight leg raising and stepdown activitiesthrice and the average value of each activity was noted. The vastus medialis oblique and vastus lateralis electromyographic activity of the dominant limb was recorded using surface electromyography during the activities. The normalised value of the activation ratio of vastus medialis oblique to vastus lateralis levels was calculated. Data was analysed using SPSS 25. RESULTS: Of the 60 subjects, there were 30(50%) males with mean age 30.00±5.91 years, mean height 167±5.63cm, mean body weight 66.76±6.14kg, and mean body mass index 23.97±3.02kg/m2 . There were 30(50%) females with mean age 29.03±5.34 years, mean height 186±6.20cm, mean body weight 68.5±5.6 kg and mean body mass index 23.76±3.22 kg/m2 . There was no significant difference in the normalized electromyography activities of the vastus medialis oblique and vastuslateralis muscles between males and females(p>0.05). Also, no significant difference was found in the activation ratio between the genders (p>0.05). CONCLUSIONS: There were no gender-based differencesin the activation ratio of vastus medialis oblique to vastuslateralis during weight-bearing and non-weight-bearing activities.

Quality of Clinical Guidelines on Oral Care for Children with Special Healthcare Needs: A Systematic Review.

Robust evidence-based guidelines are important in everyday clinical practice, especially when delivering and managing oral care needs to a vulnerable group such as children with special healthcare needs (SHCNs). METHODS: To assess the quality of guidelines on the management of oral care for children with special healthcare needs (SHCNs) and to find appropriate guidelines, an electronic search of MEDLINE Ovid was carried out alongside an additional search of common guideline websites. The AGREE II tool was used to assess the quality of the guidelines. Assessment was undertaken independently by three assessors. Furthermore, the underlying evidence used to formulate recommendations in the identified guidelines was qualitatively assessed. RESULTS: There were nine guidelines, with 41 recommendations, that met the eligibility criteria. The quality of the guidelines was generally found to be poor. Only one guideline was assessed as "recommended" by the assessors, based on the quality of the methods, the reporting, or both. Only 2 of the 41 sets of recommendations, made across the nine guidelines, were judged to be valid and based on a rigorous systematic review of the evidence. CONCLUSIONS: The current state of guidelines on oral care management for children with special healthcare needs (SHCNs) is, on the whole, of very low quality. The scientific community should work together to enhance the quality and strength of the current clinical guidelines and to ensure that they are trustworthy prior to implementation.

Evidence based recommendations to improve the children oral health in Saudi Arabia.

Aim: Identify the existing evidence base with regards to interventions that address high levels of dental caries. A discussion of the applicability of the evidence to possible replication in Saudi Arabia is presented, alongside recommendations to help reduce dental caries rates in children in Saudi Arabia. Methods: A comprehensive systematic review following PRISMA methods was conducted using three databases: MEDLINE via OVID; EMBASE via OVID and Cochrane Library. Studies were included according to inclusion criteria. AMSTAR2 was used to assess the quality of the included studies, while GRADE was used to assess the quality of evidence. Results: Ten studies were included in this review. The quality of these were 'high' (in two review), moderate (in two studies), low (in one study) and to 'critically low' (5 reviews). The quality of the evidence presented by the reviews ranged from 'moderate' to 'very low'. The interventions methods included MI, one-to-one nutrition advice, educational interventions and dental screening. The applicability of the findings in relation to dental care in Saudi Arabia is discussed and summarized in a narrative. Conclusion: No strong evidence that supported interventions to improve the child oral health in Saudi Arabia was found. None of the included reviews included studies conducted in Saudi Arabia or evaluated interventions among the local community. As for different culture values, norms, beliefs and attitude to those demographics explored in the reviews, it is unclear if interventions with improve oral health among Saudi children. Further research is needed to explore the efficacy of these interventions in a Saudi context.

Assessment of dental anxiety using modified dental anxiety scale among adults with cleft lip and/or palate.

OBJECTIVES: This study aimed to investigate dental anxiety levels among adults with cleft lip and/or palate (CL/P) and compare to adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender and age on the perceived dental anxiety. METHODS: The study was composed of a sample of 70 adult participants who received and completed dental treatments. After sending self-addressed envelopes with consent forms and Modified Dental Anxiety Scale (MDAS) to 192 potential participants, 35 participants with CL/P (CL/P group) and 35 participants with no CL/P (control group), agreed to participate. Data were analysed using Mann-Whitney U test. A two-tailed P-value < 0.05 was considered as statistically significant. RESULTS: 54.3% of adults with CL/P (23 females and 12 males, age range from 16 to 72 years) reported normal dental anxiety, while the remaining 45.7% reported moderate dental anxiety. No extreme dental anxiety were recorded in the CL/P group. These results were similar to the control group and there were no significant differences between groups (p > 0.05). Female participants recorded higher median anxiety scores than male participants in the CL/P group, and participants with cleft lip had higher median scores than participants with cleft lip and palate. However, these were not statistically significant. CONCLUSION: The results suggest that CL/P did not affect dental anxiety levels for participants with the CL/P as there were no extreme cases and their results were comparable to a general non-cleft sample.

Evaluation of Oral Health-related Quality of Life for Adult Individuals with Cleft Lip and/or Palate Using OHIP-49 and Compared with a Control Group: A Cross-Sectional Study.

OBJECTIVES: This study aimed at evaluating oral health-related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P) and compared it with adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender, and age on the perceived OHRQoL. MATERIALS AND METHODS: The study was composed of a sample of 70 adult participants who received and completed dental treatments: 35 participants with CL/P (CL/P group) and 35 participants with no orofacial cleft (control group) agreed to participate. Each participant completed the Oral Health Impact Profile (OHIP-49) with no missing data. The OHIP-49 data were analyzed using the Mann-Whitney U test, and a P-value <0.05 was considered as statistically significant. RESULTS: Adults with CL/P reported higher scores in all the seven subscales of the OHIP-49. These results were statistically significant in physical disability (mean scores of 1.22, p = 0.017) and social disability (mean scores of 0.93, p = 0.046). Females with CL/P recorded better OHRQoL in the handicap domain (p = 0.026). Participants with cleft lip only recorded better OHRQoL compared with those with cleft lip and palate, and that was statistically significant at both the functional limitation (p = 0.003) and the physical pain (p = 0.046). There was a significant positive correlation between increasing age and functional limitation (p = 0.025). CONCLUSION: CL/P negatively affected OHRQoL for adults with CL/P mainly on physical and social disabilities of OHIP-49 when compared with a general non-cleft sample.

Dental fluorosis prevalence in Saudi Arabia.

AIM: In order to improve the understanding of dental fluorosis prevalence in Saudi Arabia and have a good idea of the quality of the studies that have been conducted, a systematic review was conducted to evaluate the prevalence of dental fluorosis among people who live in Saudi Arabia. METHODS: Online databases EMBASE and MEDLINE and the Cochrane Library were searched, without any restriction regarding age. In addition, there were no study design filters applied to the search engine. Study selection and data extraction were conducted in duplicate. Studies were included if they were conducted in Saudi Arabia on any population (adults and children) and collected dental fluorosis data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies. A narrative synthesis was conducted. RESULTS: Seven cross-sectional studies were identified. Areas of weakness in study design/conduct were low response rates, and identification and handling of confounding factors. Statistical pooling of data was not appropriate due to substantial heterogeneity, due in part to variation in sample size, variation of water fluoridation concentration, index used, targeted population and age group. Seven studies present dental fluorosis at any level. The proportion of dental fluorosis prevalence at any level ranged from 0.00 to 0.91. Six studies explored the prevalence of dental fluorosis of aesthetic-only level of concern. The proportion of dental fluorosis in this category ranged from 0.07 to 0.76. CONCLUSION: The proportion of dental fluorosis at any level ranged from 0.00 to 0.91 and fluorosis at aesthetics level ranged from 0.07 to 0.76. However, current data does not provide a complete assessment of dental fluorosis across Saudi Arabia. Existing studies are limited in terms of the population covered. The included studies had methodological flaws.

Dental caries in Saudi Arabia: A systematic review.

OBJECTIVES: In KSA, numerous studies are conducted to measure the prevalence of dental caries. However, the prevalence of dental caries varies in KSA. This systematic review aims to improve the understanding of the prevalence of dental caries among adults and children residing in KSA. METHODS: Online databases of MEDLINE, EMBASE, and the Cochrane Library were searched. The Saudi Dental Journal was hand-searched. Study selection and data extraction were conducted in duplicate. The studies on dental caries in the Saudi population were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the selected studies. Finally, a narrative synthesis was conducted. RESULTS: Forty-nine cross-sectional studies were identified. Areas of weakness in study design/conduct were low response rates, reliable outcome measurement, and identification and handling of confounding factors. Statistical pooling of data was not appropriate due to substantial heterogeneity, also in part to a variation in geographical location and the target population. Twenty-nine studies presented data for primary dentition. The proportion of dental caries among primary teeth ranged from 0.21 to 1.00. Eighteen studies presented data for permanent dentition. The proportion of dental caries across permanent teeth ranged from 0.05 to 0.99. CONCLUSIONS: In general, the methodological quality of the included studies was poor. Dental caries proportion level ranged from 0.05 to 0.99 in permanent teeth, and 0.21 to 1.00 across primary teeth. The available data does not provide a complete assessment of dental caries across KSA. Existing studies are limited in terms of the populations studied for dental caries.

Evaluation of Quality of Life in Adult Individuals With Cleft Lip and/or Palate.

OBJECTIVES: The purpose of the present study was to systematically review literature relating to the quality of life (QoL) in adult individuals with cleft lip and/or palate (CLP) and identify which aspect of QoL adults with CLP find to be the most problematic, in comparison to a general non-cleft population. DESIGN: Different databases were searched for this review including the Cochrane Central Register of Controlled Trials, Ovid MEDLINE and Embase. Five domains of QoL were identified to evaluate the overall results of these QoL measures. These domains were; physical function, physical pain, psychological implications and self-esteem, self-perception in relation to facial aesthetics, and social function. The studies included underwent critical appraisal and different types of bias were assessed based on the Cochrane handbook for systematic reviews of interventions. RESULTS: Ten studies were included in this review. The total number of participants was 541. The most common QoL measure for adults with CLP was Short-Form (SF-36). Seven studies out of 10 reported statistically significantly worse scores (P < 0.05) in the psychological implications and self-esteem domains of QoL in adults with CLP, indicating lower QoL in terms of these domains. The least affected QoL domain was physical function. A high heterogeneity was found among the studies, including variation in the QoL measures, types of orofacial clefts, types of treatment and comparison groups. CONCLUSION: The presence of CLP did seem to negatively affect the QoL for adults with CLP, mainly in terms of psychological implications and self-esteem.

Use of self-organizing maps to study sex- and speed-dependent changes in running biomechanics.

BACKGROUND: Up to 79% of runners get injured every year, with higher rates of injuries occurring in females than males. A self-organizing map (SOM) is a type of artificial neural network that can be used to inspect large datasets and study coordination patterns. The purpose of this study was to use an SOM to study the effects of sex and speed on biomechanical coordination patterns. METHOD: Thirty-two healthy runners ran on an instrumented treadmill at their long slow distance speed (LSD) and at speed 30% faster (LSD + 30%). Vertical ground reaction force (vGRF), vertical tibial acceleration, step parameters, electromyograms (EMG) of six lower limb muscles, and joint angles were collected across speeds. Rate of loading (ROL), tibial impact shock (TIS), coupling angle variability (CAV) and movement pattern proportions for hip/knee sagittal and hip frontal / knee sagittal plane couplings, peak EMG, step length, step rate, and knee and ankle joint angle at initial contact were used as an input for the SOM (37 variables). RESULTS: The analysis identified four clusters (i.e., running patterns). While males and females showed similar distribution across clusters at LSD (p = .36) and at LSD + 30% (p = .51), females did exhibit a significant (p = .03) shift between clusters as the speed increased from LSD to LSD + 30% whereas males did not (p = .17). The shift was associated with an increase in TIS, ROL, step length, step rate, vastus lateralis EMG, hip flexion/knee extension movement pattern proportion, and a decrease in ST EMG and CAVIC for hip sagittal/knee sagittal coupling. CONCLUSION: As running speed increased there was a significant change in the coordination pattern in females, which was characterized by increases in several variables that are purported risk factors for running related injuries.

The effect of surgical regenerative treatment for peri-implantitis: A systematic review.

OBJECTIVES: The purpose of the present study was to systematically review literature on the effectiveness of surgical regenerative treatment for peri-implantitis. METHODS: Different databases were searched including the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE. Primary outcomes were changes in probing pocket depth (PPD), bleeding on probing (BOP), radiographic marginal bone level (RBL) and signs of infection. Secondary outcomes were facial marginal recession, aesthetic outcomes and cost of treatment. Only randomised controlled trials (RCTs) with a minimum of 12 months follow-up period after regenerative surgical treatment were selected according to PRISMA guidelines. MAIN RESULTS: Five studies were selected. The highest mean reduction of PPD was 3.1 mm in a bovine-derived xenograft (BDX) group. The highest percentage reduction of BOP occurred in patients treated with implantoplasty and saline (a reduction of 85.2%). The highest mean defect fill of RBL was reported in the porous titanium granules group (3.6 mm). Mean reductions of PPD, RBL and facial marginal soft tissue recession were statistically insignificant (p-value > 0.05) in the studies included. However, the mean reduction in BOP was statistically significant (p-value < 0.05) in four studies as compared to the baseline (before treatment). A high heterogeneity among the studies included, regarding surgical protocols, defects morphology and selection of biomaterials, was found. CONCLUSION: All studies included showed an improvement in clinical conditions after surgical regenerative treatment for peri-implantitis. However, no study has shown any statistical significance in its approach. There is a lack of scientific evidence in literature regarding which type of bone substitute has superiority in the treatment of peri-implantitis, as well as the role of barrier membranes, methods for detoxification of implant surfaces and antimicrobial prescriptions. For these reasons further well-designed RCTs are recommended.