Single implant-supported crowns in the aesthetic zone: patient satisfaction with aesthetic appearance compared with appraisals by laypeople and dentists.

OBJECTIVE: To appraise the patients' satisfaction with aesthetic outcomes following an implant restoration in the anterior maxilla as compared to appraisals made by dentists and laypeople. MATERIAL AND METHODS: Randomly selected patients (n = 116) restored with an implant-retained crown in the anterior maxilla were invited to rate their satisfaction with aesthetic outcomes using a questionnaire containing seven criteria, each graded from excellent to poor. Projected images of the patient smiles were appraised by dentists (n = 8) and laypeople (n = 6) using the same assessment criteria in a room setting. In addition, the laypeople judged the same cases on printed 10 × 15 cm photographs in a separate setting. Jemt papilla scores, pink aesthetic score (PES) and white esthetic score (WES) were assigned by the dentists. Differences in the levels of satisfaction between the patient, and appraisals by the dentists and the laypeople were compared using non-parametric statistical tests. RESULTS: Patients' opinions of their aesthetic appearance following the placement of a single implant-supported crown in the aesthetic zone were in general very favourable. The laypeople were more critical than the dentists when the aesthetic outcomes were appraised on magnified images projected onto a screen. Laypeople became less critical when evaluating the aesthetic outcomes on printed photographs compared to appraisals on a screen. Patient satisfaction with their aesthetic appearance differed from dentists' and laypeople's appraisals. CONCLUSION: Factors other than the actual aesthetic outcome itself appear to influence patients' satisfaction with their end results. Laypeople's appraisal is influenced by the magnification and method used for appraising the aesthetic outcomes.

Unilateral tongue atrophy as the initial clinical manifestation in a patient with prostate cancer.

Key Clinical Message: Unilateral tongue atrophy can be a rare and crucial early indicator of metastatic prostate cancer, highlighting the need for vigilant monitoring in clinical assessments. This case underscores the importance of considering cranial nerve involvement, especially the twelfth, for timely intervention and comprehensive patient care. Abstract: Prostate cancer, ranking among the most prevalent cancers, often manifests with skeletal metastases. Cranial nerve involvement, particularly the twelfth cranial nerve (XII), as an initial presentation is exceptionally rare. This case report outlines a unique instance of unilateral tongue atrophy as the primary clinical manifestation in a patient diagnosed with metastatic prostate cancer. A 54-year-old man presented with dysarthria and progressive weakness, later revealing signs of hypoglossal nerve paralysis, unilateral tongue atrophy, and skeletal metastases involving the base of the skull. Imaging studies, including CT and MRI, confirmed diffuse lytic lesions and cranial nerve entrapment. Further investigations identified elevated PSA levels, confirming acinar prostate adenocarcinoma. The patient underwent hormone therapy due to the poor prognosis. Prostate cancer's skeletal metastases are well-documented, but cranial nerve involvement remains rare, particularly with isolated XII nerve manifestation. The discussion emphasizes the diagnostic challenges, imaging techniques' roles, and the impact on prognosis and quality of life. This case underscores the rarity of unilateral XII nerve involvement as the initial presentation of metastatic prostate cancer. Clinicians should consider this manifestation, especially in men over 40, warranting a thorough diagnostic approach, including PSA measurement and referral for appropriate oncological and urological interventions.

Waldmann's disease: Primary intestinal lymphangiectasia diagnosed by 99mTc-labeled albumin macroaggregate scintigraphy-A case report in an adult patient.

Key Clinical Message: Rare yet significant, this case sheds light on the uncommon presentation of Waldmann's disease in adults, showcasing the diagnostic challenges it poses. A multidisciplinary approach, integrating clinical, endoscopic, histological, and radiological evaluations, is crucial for accurate diagnosis and management. Further research is needed to deepen our understanding of this complex disorder. Abstract: Waldmann's disease, or primary intestinal lymphangiectasia, is a rare disorder characterized by protein-losing enteropathy due to dilation and leakage of intestinal lymphatic vessels. Although typically diagnosed in early childhood, we present a case of a 55-year-old male with a complex medical history. The patient's history included intestinal obstruction, multidrug-resistant pulmonary tuberculosis, and primary antiphospholipid syndrome. He presented with a 2-year history of chronic diarrhea, weight loss, and lower limb edema. Endoscopic and histological examination revealed scattered white spots in the duodenum and terminal ileum, indicative of intestinal lymphangiectasia. Nuclear medicine studies confirmed abnormal protein loss. The rarity of Waldmann's disease in adulthood and its association with other significant medical conditions pose diagnostic challenges. The distinct endoscopic and histological findings, coupled with scintigraphy results, contribute to a comprehensive understanding of this complex case. Differential diagnoses and management considerations are discussed. This case highlights the atypical presentation of Waldmann's disease in adulthood, emphasizing the importance of a multidisciplinary approach for accurate diagnosis and management. Further research is warranted to enhance our understanding of this uncommon disorder and its potential implications for patients with complex medical histories.

Comparison of occlusal bite force distribution in subjects with different occlusal characteristics.

OBJECTIVE: To analyze bite force distribution in subjects with different occlusal characteristics. METHODS: This prospective study included 132 candidates (50 males, 82 females) seeking orthodontic treatment, who were divided into four groups based on Angle's classification of malocclusion. T-Scan® III Version 7.0 was used to record their relative distribution of bite forces, which were compared using gender, Angle's occlusal classification, overjet, overbite, space analysis, sagittal, and transverse skeletal relations variables. RESULTS: ANOVA revealed significant differences in posterior/anterior bite force ratios between sagittal dental and skeletal relationships, overjet, and overbite groups (p < 0.05). No significant difference was found between different space analysis and transverse relationship groups (p > 0.05) or between genders (p > 0.05). CONCLUSION: Subjects with Class III, decreased overjet and decreased overbite displayed higher bite force in posterior teeth compared to other groups. This feature must be considered when evaluating patients with dental and periodontal pathologies that might be affected by excessive tooth stress, especially in subjects with oral parafunctions and bruxism.

The Association Between Long-Term Corticosteroids Use and Dental Caries: A Systematic Review.

Corticosteroids (CSs) are a group of medications prescribed regularly to treat a wide range of inflammatory and immune-related conditions with great benefit. The impact of long-term use of CSs on the oral cavity has been reported before, including increased risk of periodontal disease and dental caries. Thus, the aim of this study is to evaluate the prevalence of dental caries in patients using CSs. A literature review was completed using PubMed and Cochrane search engines. The search was based on questions related to adults and children (P); corticosteroids (I); no corticosteroids (C); and dental caries (O) (PICO questions) using the keywords "steroids" and "caries" with all relevant variations and MeSH terms. Decay missing filling tooth/decay missing filling surface (DMFT/DMFS) scores were selected as parameters to assess the effects of CSs on caries prevalence. Data was extracted and analyzed for comparisons. The search yielded 1,206 articles from January 2001 to January 2023, of which 21 papers were eligible for analysis. Overall, 14 studies reported an increase in caries with CSs use. However, seven studies failed to report an association of caries prevalence with CSs use. Current evidence supports the correlation between increased risk of caries with chronic CSs use, specifically for inhaler formulation. Future studies with randomized controlled clinical studies are warranted to confirm these findings.

Management of medication-induced gingival hyperplasia: a systematic review.

OBJECTIVE: Medication-induced gingival hyperplasia (MIGH) has been linked to several medications, with a reported prevalence ranging between 0.5% and 85%. The aim of this study was to systematically review the management approaches for MIGH and estimate recurrence rate and time to relapse. STUDY DESIGN: An electronic literature search was conducted using PICO questions (P = patients with medication-induced gingival hyperplasia; I = surgical and/or nonsurgical treatment options; C = no control is required; and O = partial or complete resolution and recurrence) and medical subject heading terms in the PubMed and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol up to December 2019. All English-language articles on MIGH surgical and nonsurgical management options were included. Eligible articles were systematically reviewed and assessed for bias using preset criteria and multiple levels of elimination. Data were extracted from eligible studies and analyzed. RESULTS: Twenty-two eligible articles were included in this study. Management approaches included discontinuation or change of the offending medication if medically feasible in addition to surgical and nonsurgical interventions. Nonsurgical approach included scaling and root planing, oral hygiene instructions, and antimicrobial mouthrinses. Persistent or relapsed cases had complete resolution with excision of hyperplastic gingiva. Laser-assisted surgeries combined with intensive plaque control measures demonstrated less risk of recurrence. CONCLUSIONS: Several treatment options for MIGH have been reported with variable outcomes. Duration and size of hyperplastic gingival tissue may have an effect on overall recurrence rate.

A radiopaque implant template for partially edentulous patients.

This article describes a technique to fabricate a radiographic template using a vacuum-formed template with radiopaque putty impression material. This allows the position and contour of the proposed restoration to be seen with computerized tomography (CT). After planning, the radiographic template can be modified to be used as a surgical guide.

Management of dental waste in dental offices and clinics in Jeddah, Saudi Arabia.

Management of dental wastes became a recent challenge facing health care practitioners and is one of the highly-sensitive environmental problems. The main purpose of this study was to assess oral health care provider's knowledge and behavior about dental waste management and evaluate their behavior toward it. A cross-sectional descriptive study was conducted on 314 dental health care providers working in four dental colleges, and 20 private dental clinics in Jeddah, Saudi Arabia. A pretested questionnaire composed of close-ended questions was used. The mean age of the participants was 27 years. About 78% of the participants reported that they were working in the public sector. Only 33.4% of the study sample received professional training on waste management. The mean behavior and knowledge scores were 3.7 ± 1.3 (out of 6) and 1.4 ± 1.3 (out of 8), respectively. Statistically significant association was noted between gender and knowledge scores but not between gender and behavior scores. On the other hand, statistically significant associations were noted between both knowledge and behavior scores and rank of the participant, type of practice, and years of experience. Oral health care providers' knowledge about the effective procedure that should be followed for segregating, collecting, transporting, and treating dental waste was weak and substandard. There is an urgent need to develop policies and regulations for dental waste management in Saudi Arabia. Implications: This study shed light for the first time on the knowledge and behavior of dentists in Jeddah, Saudi Arabia in regard to the dental waste management. Participants knowledge and behavior in regard to dental waste segregation, collection, transportation, and treatment were determined to be week and substandard. Currently, different procedures related to dental waste management in health care facilities are not clearly described. The urgent need for the development of policies and regulations for the dental waste management is obvious. This study can be a starting point for future nation-wide surveys to assess knowledge, behavior and practices related to dental waste management among oral health care providers. In addition, more efforts should be directed to incorporate this subject into dental curriculum and continuous education courses.

Significance of CEP78 and WDR62 gene expressions in differentiated thyroid carcinoma: Possible predictors of lateral lymph node metastasis.

OBJECTIVES: This study aimed at investigating the clinical significance of CEP78 and WDR62 in differentiated thyroid carcinoma (DTC). This study also aimed at finding predictors that help in detecting patients with DTC who have high risk for lateral lymph node metastasis (LNM). METHODS: Quantitative real-time polymerase chain reaction (RT-qPCR) was performed to examine CEP78, and WDR62 mRNA expressions in 40 tissue specimens of DTC, and 40 goiter tissue specimens. Additionally, we reviewed clinical, ultrasound, laboratory, pathological data of patients to analyze the associations between these characteristics and lateral LNM. RESULTS: Our results demonstrated that relative CEP78 mRNA levels were significantly decreased in thyroid cancer tissues than goiter tissues (P = 0.002). ROC curve analysis confirmed the diagnostic value of CEP78 mRNA expression, providing an AUC equals to 0.698 (95% confidence intervals (CI), 0.583-0.813; P = 0.002). The relative WDR62 mRNA expression was not statistically different in DTC tissues and goiter tissues (P = 0.686). Furthermore, the DTC patients had been included to examine risk factors for lateral LNM. In multivariate analysis, the significant factors for predicting lateral LNM were low CEP78 mRNA expression (cut off value ≤0.54; P = 0.03; OR = 19.62; 95% CI, 1.3-296.23), central LNM (P = 0.011; OR = 33.6; 95% CI, 2.24-503.6) and calcifications (P = 0.023; OR = 27.187; 95% CI, 1.57-469.5). CONCLUSIONS: CEP78 can be used as a promising molecular biomarker for differentiation between DTC and goiter tissues, in addition it might serve as a predictor of lateral LNM in DTC along with central LNM and calcifications. Unlike CEP78, WDR62 mRNA expression was not statistically different in DTC and goiter.

The pattern of risk-factor profile in Egyptian patients with acute coronary syndrome: phase II of the Egyptian cross-sectional CardioRisk project.

BACKGROUND: Egypt is the most populous country in the Middle East and North Africa and has more than 15% of the cardiovascular deaths in the region, but little is known about the prevalence of traditional risk factors and treatment strategies in acute coronary syndrome (ACS) patients across Egypt. METHODS: From November 2015 to August 2017, data were collected from 1 681 patients with ACS in 30 coronary care centres, covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta and Upper Egypt, with a focus on risk factors and management strategies. RESULTS: Women constituted 25% of the patients. Premature ACS was common, with 43% of men aged less than 55 years, and 67% of women under 65 years. Most men had ST-elevation myocardial infarction (STEMI) (49%), while a larger percentage of women had unstable angina and non-ST-elevation myocardial infarction (NSTEMI) (32% each; p < 0.001). Central obesity was present in 80% of men and 89% of women, with 32% of men and women having atherogenic dyslipidaemia. Current smoking was reported by 62% of men and by 72% of men under 55 years. A larger proportion of women had type 2 diabetes (53 vs 34% of men), hypertension (69 vs 49%), dyslipidaemia, and obesity (71 vs 41%) (p < 0.001 for all). There were no gender differences in most diagnostic and therapeutic procedures, but among STEMI patients, 51% of men underwent primary percutaneous coronary intervention compared to 46% of women (p = 0.064). CONCLUSIONS: Central obesity and smoking are extremely prevalent in Egypt, contributing to an increased burden of premature ACS, which warrants tailored prevention strategies. The recognised tendency worldwide to treat men more aggressively was less pronounced than expected.

Fracture strength and fatigue resistance of all-ceramic molar crowns manufactured with CAD/CAM technology.

PURPOSE: All-ceramic crowns are subject to fracture during function, especially in the posterior area. The use of yttrium-stabilized zirconium-oxide ceramic as a substructure for all-ceramic crowns to improve fracture resistance is unproven. The aim of this study was to compare fracture strength and fatigue resistance of new zirconium-oxide and feldspathic all-ceramic crowns made with computer-aided design/computer-aided manufacturing (CAD/CAM). MATERIALS AND METHODS: An ivorine molar was prepared to receive an all-ceramic crown. Using epoxy resin, 40 replication dies were made of the prepared tooth. Twenty feldspathic all-ceramic crowns (Vita Mark II) (VMII) and 20 zirconium-oxide crown copings (In-Ceram YZ) (YZ) were made using CAD/CAM technique (CEREC-3D). The YZ copings were sintered and veneered manually with a fine-particle ceramic (VM9). All crowns were cemented to their respective dies using resin cement (Panavia F 2.0). Ten crowns in each group were subjected to compressive fatigue loading in a universal testing machine (instron). The other ten crowns from each group were loaded to fracture at a crosshead speed of 1 mm/min. Data were statistically analyzed using independent t-test and Fisher's exact test at alpha= 0.05. RESULTS: There was a significant difference between the survival rates of the two materials during the fatigue test (p < 0.001). All VMII crowns survived without any crack formation, while all YZ crowns fractured (40%) or developed cracks (60%). All the YZ crown fractures occurred within the veneering layer during the fatigue test. There was no significant difference in mean fracture load between the two materials (p= 0.268). Mean fracture loads (standard deviation) in N were: 1459 (492) for YZ crowns and 1272 (109) for VMII crowns. CONCLUSIONS: The performance of VMII crowns was superior to YZ crowns in the fatigue test. The premature fractures and cracks of the YZ crowns were attributed to weakness in the YZ veneer layer or in the core/veneer bond.

Dental injuries in taekwondo athletes practicing in Saudi Arabia.

OBJECTIVES: To assess the incidence and awareness of taekwondo athletes in Saudi Arabia regarding oral and maxillofacial (OMF) injuries and their prevention. Methods: In this cross-sectional study, an online questionnaire about the incidence and awareness of OMF injuries and their prevention was developed and distributed to taekwondo athletes in Saudi Arabia via their coaches.  Results: Sixty-eight responses were collected. The mean age of the participants was 29.3±9.1 years and 97% of them were males. Most of the participants (83%) believed that they are vulnerable to OMF injuries during practice. Approximately 23% of the participants reported a previous injury of the OMF area, while approximately 56% reported injuries in other areas. Most dental injuries (94%) were tooth fracture or displacement, while 6% were tooth avulsion. Eight participants (12%) were aware of the possibility of returning an avulsed tooth to its socket. More than 50% of those participants had inadequate knowledge on the appropriate storage media for the avulsed tooth or the maximum time allowed to return it to its socket. Eighty-one percent of the participants knew about the mouthguard, while 56% reported that they are actually using one. The most frequently reported barriers for not using a mouthguard during practice were difficulty in practicing with it, not being convinced of its importance, and lack of information where to get one. Conclusions: Most of the participants are aware of OMF injuries; however, their knowledge and behavior towards preventing and managing them are inadequate.

Benchmarking Outcomes in Implant Prosthodontics: Partial Fixed Dental Prostheses and Crowns Supported by Implants with a Turned Surface over 10 to 28 Years at the University of Toronto.

PURPOSE: The aim of this noninterventional, retrospective study was to benchmark the outcomes of patients with partial fixed prostheses supported by implants treated at the University of Toronto at least 10 years earlier. A study protocol for assessing outcomes on like patients developed at the University of Bern, Switzerland, was followed. MATERIALS AND METHODS: All patients who had received at least one implant before 2002 were considered eligible to be included in the study (n = 298). The treatment histories were recorded from the patient chart of the participants, or from the participants' dentists by consent. Calibrated clinicians examined the study participants clinically and radiologically and recorded peri-implant mucosal status and observable technical and mechanical failures. Past adverse events were identified in the patient charts. Independent assessors measured bone levels on digitized radiographs. Statistical analysis included descriptive statistics at implants, teeth, and study participant levels, respectively. RESULTS: Of the 298 eligible patients, 121 attended a clinical examination (41%), while 12 declined (4%). The 121 study participants had received 321 implants between 1983 and 2001. The implants showed a success rate of 88.9% and a survival rate of 94% after an average of 17.5 years (SD 5.2, range 10 to 28 years). Approximately 5% of the surviving implants showed signs, or were associated with a prior history, of peri-implantitis. The distance from the implant shoulder to the first bone contact varied from -3 mm to 7 mm (mean = 1.52 mm [SD 1.57], median = 2.2 mm). Approximately half of the study participants had experienced at least one defect of their superstructure, representing a 52% "success rate," while the survival rate was 70%. The majority were very satisfied or satisfied with the treatment (102/121). CONCLUSION: A high proportion (94%) of conventional machined Brånemark System implants placed between 1983 and 2001 remained in function after an average of 17.5 years. The original superstructures predominantly fabricated as prefabricated acrylic teeth and acrylic resin reinforced with a cast palladium-silver alloy core were still in place for 70% of the participants, and 48% of the superstructures had never undergone any form of repairs.