Renal angiomyolipoma selective arterial embolization: Australian tertiary centre experience over 10 years.

INTRODUCTION: The purpose of this study is to evaluate the patient selection methods, treatment outcomes, complications, clinical and radiological follow-up after renal angiomyolipoma (AML) treatment with selective arterial embolization (SAE) in an Australian metropolitan tertiary centre. METHODS: This study presents a retrospective single-centre review of patients' medical records who underwent SAE for renal AML during the period of 1st January 2012 and 1st January 2023. RESULTS: A total of 32 SAE procedures for renal AML occurred during the study period. Three episodes were classified as emergency cases [9.38%] and the remaining 29 were treated electively. Mean AML size pre-treatment was 69.45 mm (range = 33-177; SD = 31.69). All AMLs demonstrated hyper-vascularity on contrast-enhanced cross-sectional imaging (arterial-phase enhancement characteristics and/or prominent tortuous feeding vessels) [n = 32; 100%] or an intralesional aneurysm or pseudoaneurysm [n = 12; 42.85%]. Periprocedural complications [n = 3; 9.38%] included: one intralesional haemorrhage after embolization, one vascular access site complication, and one lipiduria-associated urinary tract infection. No patients suffered a life-threatening complication, non-target embolization, deterioration in renal function or death following SAE. Re-treatment with SAE was performed in only three patients [10.71%]. Hospital mean length of stay was 1.58 days. Median durations of clinical and radiological follow-up post-treatment were 493 days (range = 104-1645) and 501 days (range = 35-1774), respectively. Follow-up imaging revealed AML total size reduction in all cases [mean = -17.17 mm; -26.51%] and 50% had obliteration of lesion hyper-vascularity after one episode of SAE. Outpatient clinical follow-up signifies that none of the patients included in the study have re-presented with lesion haemorrhage after successful SAE. CONCLUSION: In this study, renal AMLs were treated safely with a high degree of success by using SAE, and there were very low rates of periprocedural complications. Follow-up of patients after SAE treatment of renal AML should include both radiological (assessment for reduction in lesion vascularity and size) and clinical review in an outpatient clinic setting (either by an interventional radiologist or urologist).

Conservative zirconia bridge for anterior tooth replacement.

The demand for metal-free restorations coupled with the desire for conservation of tooth structure has put new demands on our profession. There is a symbiotic synergy among the great skills of our ceramists, the commitment to successful chemistry of our researchers and manufacturers, and the unwavering desire for happy patients and long-lasting restorations by clinicians (Figure 20). With continually improving bonding materials and when tooth preparation and occlusion are well planned, conservative anterior bridges should be considered in many partially edentulous cases (Figure 21). This treatment option was particularly appropriate in the case described in this article, where an impacted cuspid limited the choices of treatment and the desire for conservative dentistry was maintained (Figure 22).

Excellence in photography: heightening dentist-ceramist communication.

The goal of the dentist is to share accurate color and other tooth characteristics about the tooth being matched. The doctor must also communicate what preparation (stump) shades the ceramist is tasked with covering since this may influence the final outer porcelain color, depending on the restorative material selected. The higher the quality of the data that we share with our dental technicians, the greater chance they have to provide us with a final restoration that matches what we and the patient sees. Dental technicians are at a great disadvantage since they are usually not able to actually see the patient. Therefore, quality digital photo images can fill that important missing link. Precise digital images can be a tremendous asset for most dental offices and they provide a mechanism for heightened communication with the ceramist and the dental laboratory team--one of the keys to aesthetic restorative success.

Quality of Care for Huntington's Disease in the United States: Findings from a National Survey of Patients and Caregivers.

BACKGROUND: Little is known about the quality of care for people living with Huntington's disease (HD) in the United States. OBJECTIVE: To document the current HD care experience and identify gaps in care provision in the United States. METHODS: Web-based surveys for persons self-identifying as being affected by HD (PAHD, which included individuals with, or at risk for HD) or as caregivers/family members, were developed and refined with targeted input from focus groups comprised of caregivers and family members. The surveys were disseminated via social media and patient advocacy partners from April-May 2017. RESULTS: Total valid responses numbered 797, including 585 caregiver/family respondents and 212 PAHD responses. Respondents reported care provision from HD specialty centers, primary care, movement disorder clinics, and other settings. One in five respondents reported that the person with HD was not currently receiving medical or community care. Respondents generally reported a good level of care, with HD specialists providing the highest rated healthcare experience. Caregiver/family respondents reported helping with a range of activities including budget/finances (60.5%), housekeeping (57.1%) and daily help (53.2%). Most respondents (97.9%) reported searching online, including general information about HD (86.4%), using HD social media channels (61.3%) and looking up clinical trials (59.8%). Respondents emphasized a need for support in financial planning and accessing care, and also for more HD education in the medical community. CONCLUSIONS: There is need for more support for HD patients and families. People desire more credible, accessible information. Improving resources available to patients and families should be a goal for HD organizations, along with measurement of patient outcomes.

Using digital photography to visualize, plan, and prepare a complex porcelain veneer case.

Visualization and pre-operative plan are critical to efficient and thorough case preparation. Congenitally missing teeth, coupled with improper tooth positioning, can compromise the aesthetic rehabilitation outcome. Utilizing pre-treatment digital photography as an outline for tooth reduction and laser tissue re-contouring may help to create a symmetric and pleasing smile, even under less ideal conditions.

Assessing aesthetic composite veneer placement via digital photography.

Restoring teeth using direct composite veneers can be quite challenging for a clinician. Achieving natural color blending, masking dark teeth, removing decay, and providing a natural finish require meticulous placement with various composite opacities and shades. Critical self-evaluation using digital photography, documentation, and follow-up visits to perform veneer enhancements are critical to ensure an aesthetic outcome. This article will demonstrate how digital photography is used to achieve an aesthetic result in the placement of eight direct resin veneers.

Efficient, conservative treatment of symptomatic cracked teeth.

Every practice has patients who complain of cold sensitivity and pain on biting while showing no obvious signs of irreversible pulpitis. After loading each cusp and fossa in a symptomatic quadrant and ruling out pulp and periodontal pathology, definitive treatment can be performed to alleviate the patient's symptoms in a consistent, conservative manner using esthetic computer-aided design/computer-aided manufacturing porcelain restorations. Single-appointment definitive restorations can be advantageous for the patient because of the elimination of many steps involved in laboratory fabrication of porcelain or metal restorations.

Correction of congenitally missing lateral incisors with porcelain veneers.

The ability of the dental professional to improve a patient's smile has become a benchmark in modern aesthetic dentistry. When one type of tooth is transformed into another through the restorative process, special care must be taken to ensure correct preparation and gingival contours to create the illusion that the teeth are in their correct position. With accurate digital photographic planning, active patient consultation, detailed tooth preparation, and a meticulous laboratory sequence, porcelain laminate veneers can be functional and can achieve the aesthetic expectations of the patient.

Immediate definitive CAD/CAM restoration of a non-submerged implant.

Implant placement has become a widely accepted treatment for tooth replacement. There are many restorative options, but it is best for the patient and most efficient for the office if the implant is placed and restored in as few appointments as possible. If diagnosis is thorough and accurate, placing the implant and doing a definitive restoration in 1 appointment can be as predictable as the traditional 2 appointment technique. Restoring the implant with computer-assisted designed and machined porcelain can provide predictable fit, esthetics, and restoration and be clinically efficient.

Efficient correction of endodontic obturation and single-appointment CAD/CAM restoration.

Endodontic treatment, when performed with proper instrumentation, canal disinfection, and obturation can be a tremendous service to a dental patient and a key component of any restorative practice. It can be complicated by factors such as poor diagnosis, incomplete canal debridement, ineffective obturation, bacterial invasion, and insufficient restorative treatment. Retreatment or even tooth loss can occur when the canal space is not handled properly. This article demonstrates a procedure for the correction of pre-existing obturation and subsequent treatment with an all-ceramic restoration in a single visit.

Practical posterior composites. Efficient placement and predictable results.

Certainly, we could spend more time matching shades, applying characterizations, placing secondary anatomy, and even finishing. However, if posterior composite restorations are to be a viable alternative to amalgam in appropriate cases, we must accomplish efficient and predictable placement so that fees for the two types of restorations are somewhat in line. Contact must be solid, sensitivity must be kept to a minimum, and placement and finishing must be fairly simple and organized. If the problems with posterior composites aren't kept to a minimum, all of dentistry will suffer. Our contacts are excellent most of the time, but occasionally we need to redo a "light" one. Our best estimate is that about one in 100 fillings that had no preoperative symptoms needed some postoperative care after restoring. Usually these complaints are corrected by occlusal adjustment, and very rarely by replacing the restoration. We have not yet made a perfect restoration in our practice--we are still trying.