Three-Dimensional Printing Methods for Bioceramic-Based Scaffold Fabrication for Craniomaxillofacial Bone Tissue Engineering.

Three-dimensional printing (3DP) technology has revolutionized the field of the use of bioceramics for maxillofacial and periodontal applications, offering unprecedented control over the shape, size, and structure of bioceramic implants. In addition, bioceramics have become attractive materials for these applications due to their biocompatibility, biostability, and favorable mechanical properties. However, despite their advantages, bioceramic implants are still associated with inferior biological performance issues after implantation, such as slow osseointegration, inadequate tissue response, and an increased risk of implant failure. To address these challenges, researchers have been developing strategies to improve the biological performance of 3D-printed bioceramic implants. The purpose of this review is to provide an overview of 3DP techniques and strategies for bioceramic materials designed for bone regeneration. The review also addresses the use and incorporation of active biomolecules in 3D-printed bioceramic constructs to stimulate bone regeneration. By controlling the surface roughness and chemical composition of the implant, the construct can be tailored to promote osseointegration and reduce the risk of adverse tissue reactions. Additionally, growth factors, such as bone morphogenic proteins (rhBMP-2) and pharmacologic agent (dipyridamole), can be incorporated to promote the growth of new bone tissue. Incorporating porosity into bioceramic constructs can improve bone tissue formation and the overall biological response of the implant. As such, employing surface modification, combining with other materials, and incorporating the 3DP workflow can lead to better patient healing outcomes.

Do onlays and crowns offer similar outcomes to posterior teeth with mesial-occlusal-distal preparations? A systematic review.

OBJECTIVE: Teeth prepared for mesial-occlusal-distal (MOD) restorations have a significant risk of cusp fracture. Crowns and onlays can provide cusp coverage to reinforce posterior teeth at risk. Onlays are often more conservative of tooth structure which may be an advantage for teeth with large MOD preparations. It remains uncertain how onlays and crowns compare for posterior teeth with MOD tooth structure loss. The purpose of this systematic review was to compare the resistance to fracture, success rate, survival rate, and failure rate of teeth with MOD preparations restored with onlays or crowns. MATERIALS AND METHODS: An electronic search queried Medline (PubMed), Embase (Ovid), Scopus, the Cochrane Library, and grey literature (OpenGrey) from database inception through April 29, 2023. RESULTS: After eliminating duplicates and irrelevant records, 32 manuscripts were assessed. Only three publications met the criteria for inclusion. Most exclusions were due to poor reporting of restorative design and the amount of tooth structure remaining, or due to combining various restorative designs. Due to the limited sample size and high heterogeneity, no meta-analysis was conducted. One study observed a better outcome for onlays and two observed no difference. All three studies reported the mode of failure for crowns as more catastrophic whereas teeth with onlays could be salvaged. CONCLUSIONS: Onlays may be an advantageous alternative to crowns for teeth with MOD preparations, but the level of evidence is insufficient to draw meaningful conclusions. CLINICAL SIGNIFICANCE: Current evidence is insufficient to determine whether onlays or crowns are providing a different outcome when used to restore posterior teeth with MOD tooth structure loss. However, the fracture of teeth with MOD tooth structure loss restored with onlays appears to be less catastrophic than when restored with crowns.

A technique to guide implant placement with the long axis parallel to the path of insertion of removable partial dentures.

This article describes a novel technique that allows the planning and placing of dental implants with their long axis parallel to a path of insertion chosen for a prospective removable partial denture. The technique is straightforward, uses digital technologies efficiently, and enables prosthetically driven implant placement. It also optimizes the outcome when dental implants are used in association with removable partial dentures.

How to approach and take care of minor adolescents whose situations raise ethical dilemmas? a position paper of the European academy of pediatrics.

In the care of adolescents, health care providers often face situations raising ethical concerns or dilemmas, such as refusal of a treatment or hospitalization, or request of confidentiality while engaging in risky behaviors or facing unplanned pregnancy. This position paper provides concrete avenues as how to assess the adolescent's capacity for autonomous decision making, e.g. the patient's competence in a specific situation, and how to elicit informed choice or consent. To do so, professionals need to be sensitized and trained as how to assess the cognitive and socio-psychological development of the young patient. Another challenge for the health professionals is to balance the needs to support patient's autonomy while offering secure guidance and protection if needed. To optimize such a process, they establish a climate of trust and empathy that will allow the patient to participate freely in the decision. In addition, especially when the decisions have potentially important consequences on the health and life, the professionals include, with the adolescent's permission, parents, caregivers or other significant adults, as well as they may request the opinion of other members of the health care team or expert colleagues such as ethicists.

Effects of remeshing algorithms on trueness of fit when used to compress .stl files for dental models: A narrative review.

OBJECTIVES: In recent years, there has been a transition toward using and storing digitized dental models instead of physical casts. The size of .stl files is directly correlated with a need for higher computer processing power, longer operation time and a need for more storage space. Several studies explored the impact of decreasing the mesh resolution to decrease file size while maintaining trueness of fit between the original and modified files. Multiple authors suggested to compress .stl files by removing a fixed percentage of triangular faces. However, certain variables which are not yet fully investigated may impact the outcome of remeshing and compressing .stl files. METHODS: This narrative review explores concepts that may have a significant impact on the outcome of remeshing and compressing .stl file. RESULTS: When restructuring digital meshes to compress .stl files, variables such as initial mesh density, adaptive resolution, scanning technology, rendition and remeshing algorithms, as well as the clinical situation, can affect the outcome. CONCLUSION: Prior to applying subjective compression to .stl files by a static percentage, multiple variables must be considered to ensure trueness of fit is preserved. The results obtained for specific situations may not extrapolate to others. CLINICAL SIGNIFICANCE: Remeshing algorithms used to reduce .stl file size, or to optimize the files prior to manufacturing, may cause the loss of important data. Further research is needed to guide clinicians safely altering digital meshes.

Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic.

During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.

Adolescent pregnancy: An important issue for paediatricians and primary care providers-A position paper from the European academy of paediatrics.

Adolescent pregnancy and childbearing, remain a widespread health-related problem with potential short and long-term consequences. Comprehensive social, economic, environmental, structural, and cultural factors heavily impact on adolescents' sexual and reproductive health and early pregnancy. Health professionals can play a pivotal role in the prevention of unplanned pregnancy. Improved access to family planning, sexuality education in schools, community-based interventions, and policies contribute greatly to reduce the risk of adolescent pregnancy and the adoption of respectful and responsible sexual behaviour. Additionally, health care professionals can support pregnant adolescents in making decisions under these circumstances and provide adequate health care. This review highlights actions that can guide healthcare professionals in empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future.

Comparison of the torque transferred to the implant-bone interface when tightening abutment screws and when torque testing implants: An in vitro study.

STATEMENT OF PROBLEM: Before dental implants are restored, osseointegration is often verified by torque testing the implant. For this test, it might be appropriate to select the torque subsequently used to tighten the abutment screw during prosthetic delivery. However, whether the full torque applied to the abutment screw is transferred to the implant-bone interface remains unknown. PURPOSE: The purpose of this in vitro study was to assess whether the same torque is transferred to the implant-bone interface when tightening abutment screws and when torque testing implants and to investigate whether the implant system used affects the torque transfer. MATERIAL AND METHODS: A digital torque gauge was used to register the torque directed to a simulated implant-bone interface. Twenty implants from 4 different manufacturers were successively secured to the digital torque gauge. An implant driver was used to torque test the implant. An implant abutment screw was then tightened to attach a universal base (TiBase) abutment to the implant. During both tests, a mechanical torque limiting device was used to apply the same manufacturer-specific torque. For both experiments, the peak torque transferred to the simulated implant-bone interface was recorded. To allow pooling data from different torque targets, the data were converted into absolute difference. A t test was used to evaluate whether the same magnitude of torque was transferred to the implant-bone interface when tightening abutment screws and when torque testing implants. An ANOVA was used to test whether the percentage of torque transferred to the implant-bone interface was impacted by the implant system used (α=.05). RESULTS: No significant difference was found between the torque transmitted when tightening an abutment screw and that transmitted when torque testing the implant (P=.600). Also, no difference was found in the percentage of torque transferred to the simulated implant-bone interface of different implant systems (P=.996). CONCLUSIONS: Regardless of the implant system used, when tightening abutment screws and when torque testing implants, the same amount of torque is transferred to the implant-bone interface.

The state of adolescent medicine as a specific field: an international exploratory survey.

OBJECTIVES: The emergence of adolescent medicine (AM) as a specific area of training and health care delivery is progressing at various pace around the world. The objective of this exploratory survey was to inquire about the existence of official bodies and institutions offering recognition of the discipline as a specific field and on the status of related training initiatives. METHODS: A questionnaire was spread among a convenience sample of 21 colleagues involved in adolescent health care around the world, and answers were collected and analysed manually. RESULTS: All 21 colleagues from the North and South American, African, Asian and European regions have responded. Only seven countries report the existence of adolescent inpatient wards in some hospitals, while 16 have specialized outpatient clinics; in only eight countries is formal mandatory training in AM required for paediatricians; in seven others, such a stay is available but optional. Six countries have implemented a systematic assessment tackling AM in the certification process of paediatricians and just four recognize AM as a sub-specialty. Only two countries mention compulsory training in AM for family doctors. Fourteen countries report on the existence of an AM association. CONCLUSIONS: Despite an encouraging number of initiatives testifying the growing place of AM in the practice of medicine, our data bring a worrisome portray of the status of AM in the involved countries and call for the development of appropriate health care and training centres.

Management of atypical occlusal discrepancy after condylar resection: A clinical report.

This clinical report describes the prosthetic management of occlusion for a patient who had received condylar resection as part of cancer treatment. Previous reports have identified that patients with unrepaired segmental resection of the mandible experienced a frontal plane rotation of the mandible toward the nonsurgical side. In contrast, because of preservation of temporomandibular muscles and their attachments, the mandible rotated toward the surgical side, and occlusal contacts were limited to a pair of molars on that side. Manual manipulation and instructions for muscular stretching and massages were provided to reduce muscular tension. A mandibular guidance prosthesis was fabricated and gradually adjusted to guide the mandible progressively toward a normal position. These treatments helped improve general comfort, mastication, occlusion, and the gradual rotation of the mandible toward a normal position.

Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations.

In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.

The impact of the Ebola epidemics on children's rights: a scoping review.

BACKGROUND: The Ebola virus is known as one of the deadliest pathogens to infect humans. Children represent a minority of Ebola Virus Disease cases globally. Yet, the different Ebola outbreaks in Africa had a wide impact on children's lives and children' rights. OBJECTIVE: Review the published literature to date on Children's rights during Ebola outbreaks. Outcomes shall contribute to get a better understanding of the main limitations or violations of children's rights, identify potential gaps in the literature and support the promotion and protection of children's rights for current and future health crisis. METHODS: A scoping review from PubMed, Medline, Cochrane Library and Web of Science was performed using PRISMA-ScR guidelines. Articles, reports and editorial, published on Ebola Outbreaks between 1976 and 2020 were retrieved. The UNCRC clusters of rights and treaty specific guidelines were used as a framework. Documents were found through a targeted search of websites from international or regional organisations involved in Ebola crises and children's protection. RESULTS: 48 articles and reports were reviewed. Few documents focused solely on children's rights. Several articles covered the topic of children and Ebola outbreaks. Most of the data are linked to basic health, education, discrimination of orphans and survivors. 31% of the reviewed articles underline the violence against the children (rape, abuse, Female genital mutilations), while 21% focus on the right to education. 23% cover the topic of orphans. Impact on mental health and SRH were amongst the other covered topics. CONCLUSION: A lack of data on children's rights and their violations during epidemics is observed. Regional and international collaboration is needed to document the situation of children in health emergencies. Health measures and strategies based on children's opinions and raising awareness of their crucial role in society is key. Child-centred guidelines should be developed based on these elements.

The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics.

Adolescents aged 10 to 19 live a period of their life marked by opportunities and vulnerabilities during which the issue of mental health is of prime importance. Since several decades, and especially since the start of the COVID pandemic, mental health problems and disorders among adolescents have increased around the world. Depression, self-harm and suicidal behavior are common during this period of life, and pediatricians can play a pivotal role in identifying affected or vulnerable youngsters. This article describes risk factors for self-harm and suicidal behavior and reviews how primary care pediatricians and health professionals can respond to such situations. This scoping review is based on existing evidences as well as the authors clinical experience. It suggests concrete actions that can be taken to secure the life of at risk teenagers, and discusses how to organize the transfer to mental health professionals when needed.

E-Cigarettes as a Growing Threat for Children and Adolescents: Position Statement From the European Academy of Paediatrics.

As the tobacco epidemic has waned, it has been followed by the advent of electronic nicotine delivery devices (ENDS) primarily manufactured by the tobacco industry to try to recruit replacements for deceased tobacco addicts. This document sets out the ten recommendations of the European Academy of Paediatrics (EAP) with regard to e-cigarettes and children and young people (CYP). The EAP notes that nicotine is itself a drug of addiction, with toxicity to the foetus, child and adult, and were ENDS only to contain nicotine, their use to create a new generation of addicts would be rigorously opposed. However, e-cigarettes include numerous unregulated chemicals, including known carcinogens, whose acute and long term toxicities are unknown. The EAP asserts that there is incontrovertible evidence that the acute toxicity of e-cigarettes is greater than that of "traditional" tobacco smoking, and a variety of acute pulmonary toxicities, including acute lung injuries, have been recorded due to e-cigarettes usage. The chronic toxicity of e-cigarettes is unknown, but given the greater acute toxicity compared to tobacco, the EAP cannot assume that e-cigarettes are safer in the long term. The high uptake of e-cigarettes by CYP, including under-age children, is partly fuelled by deceitful marketing and internet exposure, which is also unregulated. Although proposed as aids to smoking cessation, there is no evidence that e-cigarettes add anything to standard smoking cessation strategies. In summary, the EAP regards these devices and liquids as very dangerous, and ineluctably opposed to their use, and their direct or indirect marketing.

Counting the Dead: COVID-19 and Mortality in Quebec and British Columbia During the First Wave.

The first wave of the COVID-19 pandemic has led to excess mortality across the globe, and Canada has been no exception. Nonetheless, the pandemic experience has been very different across provinces, and the objective of this paper is to investigate these differences focusing on two extreme cases. We contrast the mortality experience of British Columbia with that of Québec to understand how large differences in mortality during the first wave of the pandemic emerged across these two provinces. We find that most of the differences can be found in excess mortality in institutions (nursing homes) and that travel restrictions, differences in how deaths are recorded, differences in the seasonality of the flu, or differences in how the pandemic spread across different economic segments of the population are unlikely explain these large differences. We document that the reported death toll from COVID-19 is about 30% larger than excess mortality in Quebec due to lower mortality from other causes of death, in particular malignant tumors, heart disease, and respiratory problems. We do not find evidence of an income gradient (measured by postal code level income) in relative excess death for the first wave.

La première vague de la pandémie de la COVID-19 a entraîné une surmortalité dans plusieurs pays à travers le monde, incluant le Canada. Par contre, l'ampleur fut bien différente à travers les provinces canadiennes et l'objectif de cette analyse est d'étudier ces différences en se concentrant sur deux provinces spécifiques. Pour ce faire, nous comparons la mortalité de la Colombie-Britannique avec celle du Québec pour tenter de comprendre les grandes différences observées entre ces deux provinces durant la première vague de la pandémie. On constate qu'une grande partie de la surmortalité différentielle est observée chez les personnes vivant en institutions de santé (maisons de soins). De plus, on remarque aussi que les restrictions concernant les déplacements internationaux, les processus d'enregistrement des décès, l'évolution de la grippe saisonnière ou les différences dans la façon dont la pandémie s'est propagée à travers les groupes sociaux-économiques de la population sont peu susceptibles d'expliquer ces grandes différences. Notre analyse montre que le nombre de décès attribués à la COVID-19 est d'environ 30% plus élevé que la surmortalité observée au Québec durant la première vague. Cet écart est, en partie, attribuable à une mortalité plus faible de d'autres causes de décès, en particulier les tumeurs malignes, les maladies cardiaques et les problèmes respiratoires durant la même période. Finalement, nous n'avons pas été en mesure de calculer un gradient de revenu (mesuré par le revenu au niveau du code postal) pour les décès excédentaires survenus lors de la première vague.Mots clés: excès de mortalité, COVID-19, institutions de santé, cause de décès.