Occlusal Analysis in Natural Dentition: Systematic Review.

This study aimed to evaluate the effectiveness of conventional occlusal analysis in contrast with digital occlusal analysis in natural dentition. Occlusal analysis allows the identification of normal and abnormal occlusal contact points that alter the craniomandibular cervical system. We searched for articles with keywords [[dental occlusion]], [[natural dentition]], [[occlusal adjustment]], [[Immediate Complete Anterior Guidance Development]] [[mastication]], [[bite force]], [[premature contact]], [[occlusal balance]] [[articulating paper]]], [[spray]], [[Occlusal contacts]], and [[bite strength]]. They were considered observational , odds ratio and case control studies. We found 189 items. After evaluating the abstracts and full texts of the articles, 10 papers met the inclusion criteria. It was found that occlusal analysis allows the identification of the relationship between poor occlusion and the sensitivity of the teeth due to occlusal trauma, which is also related to temporomandibular joint pain in dynamic occlusion. The contacts of greater strength were observed in nonfunctional cusps, 48%, without ruling out the functional cusps, 24%. Despite being the universal method of occlusal control to date, the use of joint paper, remains subjective compared to the digital occlusal control device. Posture is considered directly related to occlusal trauma and temporomandibular disorders; without proper occlusal analysis, a clear diagnosis of the patient's joint condition cannot be obtained. Digital occlusal analysis is more objective than traditional occlusal analysis.

Evaluación de zonas de esfuerzo entre implante personalizado sinterizado e implante prefabricado mediante fotoelasticidad / Evaluation of effort zones between custom implant sinterized and the prefabricated implant though photoelasticity

Resumen Introducción: el uso de implantes personalizados es un tratamiento utilizado con mayor frecuencia, valorando y comparando su comportamiento frente a implantes convencionales. Este estudio tuvo como objetivo analizar si las zonas de esfuerzo del implante personalizado son diferentes a las que presenta el implante prefabricado convencional mediante fotoelasticidad. Métodos: muestra n=10 dientes premolares superiores, n=10 implantes personalizados sinterizados y n=10 implantes prefabricados convencionales, sometidos a 3 presiones fijas y controladas, observados a través de un polariscopio para analizar la distribución del esfuerzo generados. Resultados: zonas de esfuerzo presentes en las diferentes muestras analizadas aplicando 3 presiones. La cantidad de esfuerzo en la presión 1 (test de Chi-cuadrado, p=0,596) es diferente entre los dos tipos de implantes al igual que con la presión 2 (test de Chi-cuadrado, p=0,407), al aplicar la presión 3 (test de Levene, p=0,899) no hay diferencia en la distribución de fuerzas entre los dos tipos de implantes. Conclusiones: se determinó que el implante prefabricado convencional distribuye y concentra mejor el esfuerzo generado bajo diferentes presiones en comparación con el implante personalizado sinterizado.

Abstract Introduction: the use of custom implants is a very common treatment; we assess and compare their behavior against that of conventional implants. This study aimed to make sure that the stress zones of the custom implant are different from those presented by the conventional prefabricated implant by photoelasticity. Methods: we subjected samples of n=10 bicuspid teeth, n=10 sintered custom implants, and n=10 conventional prefabricated implants to 3 fixed and controlled forces and observed the samples through a polariscope to analyze the distributions of effort generated. The effort zones present in the different samples were analyzed under 3 different forces. Results: the amounts of effort in the two types of implants under force 1 (chi-square test, p=0.596) are different, as is also the case under force 2 (chi-square test, p=0.407). Under force 3 (Levene test, p=0.899), there is no difference in the distributions of effort between the two types of implants. Conclusions: it was determined that the conventional prefabricated implant distributes and concentrates the effort generated under different forces better than the sintered custom implant.

Infrared thermography to assess proliferation and involution of infantile hemangiomas: a prospective cohort study.

IMPORTANCE: Infantile hemangiomas (IHs) are common benign tumors of infancy that have the potential to interfere with vital organ function and cause permanent disfigurement. Currently, few objective and validated measures exist to assess IHs. OBJECTIVE: To determine the utility of infrared thermography in assessing and monitoring the growth of IHs. DESIGN, SETTING, AND PARTICIPANTS: In a prospective cohort study conducted at an outpatient dermatology clinic of a tertiary care hospital between February 2011 and December 2012, a convenience sample of 42 infants aged 0 to 6 months with an IH were enrolled. The mean age of the study group was 3.7 months, with the majority of IHs being mixed type (57%) affecting the head and neck (81%). Of the infants, 36 (86%) were receiving active treatment during the study period, and patients were followed for a minimum of 3 clinical visits, at least 1 month apart. MAIN OUTCOMES AND MEASURES: Ability of infrared thermography to assess the proliferation and involution of IHs compared with a visual analog scale. Secondary outcomes were reliability, ease of use, and parental acceptance of the instrument. RESULTS: The mean temperature difference at baseline was 1.9°F (95% CI, 1.2°F to 2.7°F), which peaked at 3 months to 2.5°F (95% CI, 0.8°F to 4.2°F), and decreased progressively to 0.2°F (95% CI, -1.1°F to 1.4°F) at 18.5 months (P < .001). This change in temperature was inversely correlated with mean visual analog scale (r = -0.25). Mean temperature differences recorded at baseline and 30 minutes later were not significant (least squares mean baseline temperature, 87.9°F [95% CI, 87.4°F to 88.3°F], vs least squares mean temperature after 30 minutes, 88.1°F [95% CI, 87.7°F to 88.6°F] [P = .14]). Multivariate analysis demonstrated facial location (F(1,365) = 47.63, P < .001), IH type (F(2,365) = 3.26, P = .04), age (F(2,365) = 7.03, P = .001), and surface area at baseline (F(2,365) = 8.18, P < .001) as factors significantly affecting temperature difference over time. Only IH type (Wald χ(22) = 6.79, P = .03) and treatment (Wald χ(21) = 4.29, P = .04) significantly affected time to reach a zero-temperature difference. All caregivers (100%) reported IRT to be easy to implement, quick to perform, and comfortable for their child. CONCLUSIONS AND RELEVANCE: Infrared thermography is a reliable and valid measure of IH growth that is noninvasive, convenient, and well tolerated by infants, making it well suited to daily clinical practice. It has the potential to provide real-time objective results that can be used for routine monitoring and evaluating treatment efficacy.

Propranolol in the management of infantile hemangiomas: clinical response and predictors.

BACKGROUND: Recent data suggest that propranolol is an effective treatment for infantile hemangiomas (IHs). Data on the optimal dose, duration of therapy, and predictors of response are currently lacking. OBJECTIVE: To assess the clinical response to and predictors of propranolol use in the treatment of IH. METHODS: Retrospective cohort study of 44 patients. Two independent assessors evaluated improvement by comparing serial digital photographs using a 100 mm visual analogue scale (VAS), where 5 mm change represented 10% change in the size or appearance of the IH. RESULTS: Propranolol was started at a mean age of 7.8 (SD 8.21) months and was used for 7.3 (SD 4.8) months before weaning. The mean percent improvement compared to baseline (as measured by the VAS) was 78% (SD 23%). Minor adverse events were noted in 32% of patients. The most significant predictor of regrowth after weaning was a IH > 5 cm in size (p  =  .017). CONCLUSIONS: Propranolol is effective in IH, but the side effects and the possibility of regrowth should be considered.

Colonization with community-acquired methicillin-resistant Staphylococcus aureus in children with atopic dermatitis: a cross-sectional study.

BACKGROUND: Bacterial infection with Staphylococcus aureus is a common complication of atopic dermatitis (AD). The incidence of community-acquired methicillin-resistant S. aureus infection (MRSA) in the AD population is unknown. OBJECTIVES: This study aimed to assess the prevalence of S. aureus and MRSA in pediatric patients with AD, to compare disease severity, and to characterize the clonal diversity of the isolates. METHODS: We carried out a prospective, cross-sectional study of 200 patients with AD. The severity of AD was defined as mild, moderate, or severe depending on a composite AD severity score. A swab was taken from the nares of each patient and another from affected skin or folds. Genotyping of all S. aureus isolates was conducted by polymerase chain reaction (PCR) amplification of the S. aureus protein A (spa) gene. RESULTS: According to the severity score, 66.5% of subjects were ranked as having mild AD, 29.5% as having moderate and 4% as having severe AD. Staphylococcus aureus colonization was seen in 61.5% of all patients, represented by 43.7% of skin swabs and 48% of nares swabs. Only one of the isolations represented MRSA. Older age and higher AD severity scores were associated with S. aureus colonization (P = 0.03 and P < 0.001, respectively). No significant associations were noted for attendance at day care, family members with frequent skin infections, or family members working in healthcare. Isolates from spa CC015 were cultured in 19.2% of patient samples. The single MRSA culture showed a new spa type that belonged to CC127. CONCLUSIONS: The results of this study confirm a high rate of S. aureus colonization of pediatric patients with AD. The low rate of MRSA requires further proof from larger prospective studies.

Identification of major clonal complexes and toxin producing strains among Staphylococcus aureus associated with atopic dermatitis.

Staphylococcus aureus promotes the onset and severity of atopic dermatitis (AD), which is exacerbated by superantigen toxins SEB and SEC. The genetic identity of these isolates, and their relationship to common hospital- or community-associated methicillin resistant S. aureus (HA-MRSA and CA-MRSA) has not been defined. We conducted spa typing, partial multi-locus sequence typing (MLST), and toxin profiling (seb, sec, lukS-PV) of S. aureus from 119 pediatric and 40 adult AD patients. MLST clonal complexes CC45, CC5, CC15, CC1, CC8 and CC30 accounted for 79% of isolates, representing the same major groups reported for nosocomial S. aureus in hospital intensive care units. The highest disease severity was associated with CC1, which was significantly greater relative to CC15 (p = 0.017) or CC30 (p = 0.040), but with no significant difference relative to CC45, CC5 or CC8. Although there were two few lukS-PV, seb or sec isolates to infer a role in disease severity, CC45 was identified as a source of SEC producing strains, and lukS-PVL was associated with a small number of CC5 pediatric isolates. CC1 harbored the only CA-MRSA that was identified, and was a source of isolates that expressed both seb and sec, and closely resembled the USA400 strain of CA-MRSA.

Bullous Henoch-Schönlein purpura in children: a report of 6 cases and review of the literature.

Henoch-Schönlein purpura (HSP) is the most common vasculitis occurring in childhood. Clinical presentation involves the classic tetrad of abdominal pain, nonthrombocytopenic purpura, arthritis, and renal involvement. Dermatological manifestations of HSP are characteristic of the condition and consist of palpable purpura and edema of the lower extremities and buttocks. The clinical spectrum of HSP is highly variable; however, vesicles and bullae have rarely been reported as the presenting feature. To date, there are 14 case reports of bullous HSP in the literature in English. The authors report 6 additional cases of bullous HSP, including a recurrent case, presenting to the Hospital for Sick Children in Toronto, Canada.

Trichodysplasia spinulosa--a rare complication in immunosuppressed patients.

Immunosuppression is necessary in a large number of conditions to modify immune responses and control disease severity. It is a vital part of treatment regimes following organ and bone marrow transplants. However, the use of immunosuppressive drugs has been shown to cause infections with common and unusual pathogens. We present the case of a 5-year-old female heart transplant recipient. Nine months after the transplant, she developed a tender acneiform eruption on her face consisting of numerous small yellowish to pink papules and pustules. Many of the lesions had a central, firm, small spinulous excrescence or a central dell. Histopathology demonstrated abnormal maturation of the hair follicles, nucleated eosinophilic cells with trichohyalin granules. The clinical presentation and histological features were in keeping with trichodysplasia spinulosa, a rare complication in immunosuppressed subjects. Treatment trials included reduction of immunosuppression combined with topical and oral retinoids, topical acyclovir, and oral valganciclovir with limited success.

Clasificación, manejo y complicaciones de los hemangiomas de la infancia / Classification, treatment and complications of infantile hemangiomas

Los hemangiomas de la infancia o hemangiomas infantiles, HI, son los tumores benignos más comunes en pediatría. Su diagnóstico y manejo combinan la ciencia y el arte. A pesar de su alta prevalencia en poblaciones pediátricas, aún hoy en día se desconoce el mecanismo por el cual estos tumores proliferan y se entiende poco el porque de su formación, por lo tanto el manejo óptimo sigue siendo controversial. En las manos de los pediatras muchas veces recae no solo el reconocer estos tumores, sino también la dura tarea de saber cuando se debe intervenir, o cuando se debe dejar que estos tumores involucionen por cuenta propia. En este artículo se brinda una atualización sobre la clasificación, manejo, tratamiento y complicaciones de los HI.

Glioma del tronco encefálico infantil: revisión y reporte de un caso / Infant brain stem glioma: review and report of one case

Los autores presentan el caso de un paciente de 7 años con historia de inicio abrupto de alteración de la marcha, desviación de la comisura labial hacia la izquierda, estrabismo convergente, desviación lingual hacia la derecha y un sexto par izquierdo. El TAC de cerebro muestra ensanchamiento del tallo cerebral con hipodensidad izquierda. La resonacia magnética muestra una tumoración compleja del tallo cerebral afectando principalmente la protuberancia y pedúnculo cerebral izquierdo, así como caudalmente la parte alta de la médula oblongada con porción quística que ejerce compresión sobre el cuarto ventrículo sin producir hidrocefalia. Se le iniciará tratamiento radioterapéutico paliativo.