Dental practitioner recruitment for a randomized clinical trial in the field to evaluate the performance of a new glass ionomer restoration material

Background: In 2009, we began recruiting dental practitioners across Germany to participate in a clinical trial to evaluate the clinical performance of EQUIA, a new glass ionomer restoration material. The aim of this paper is to discuss the outcomes of the dental practitioner recruitment and outline the process of establishing a practice-based research network. Methods: Study proposals were sent to randomly selected dental offices in 29 cities in Germany. The proposals were sent until a minimum of 10 clinics in each city declared participation. Later on, briefing lectures informed the participating practitioners about the design, methods, and material application procedure. Participants were familiarized with the guidelines of Good Manufacturing Practice (GMP) and Good Epidemiological Practice (GEP). A questionnaire describing the characteristics of each dental office was filled out by the participating practitioner. Additionally, participation levels were characterized according to the socioeconomic status and geographic districts of residence in Germany (Regions 0 to 9). The associations between the characteristics were tested by the Kruskal-Wallis Test and Chi-squared test (P < 0.05). Results: A total of 3194 private dental clinics were invited, 1712 clinics refused to participate, 1195 did not respond to the invitation, and 323 agreed to participate. Only 144 clinics participated in the lectures held in their cities and signed the participation agreement. Based on their geographic location, the highest participation was in Region 2 with a participation rate of 14.3 %, and the lowest participation was in Region 6 with a participation rate of 1.7 %. Regions with the lowest rate of unemployment and relatively higher rates of income (Regions 7 and 8) had the highest rate of refusals (86 %). Conclusion: The initial results of the dental practitioner recruitment in this study suggest that the recruitment and pre-randomization design were successful, and by reaching out to a considerable number of private dental clinics to participate, we were able to recruit a smaller number of highly motivated dentists in this clinical study. Regional differences in socioeconomic status, practitioner specialization, and differences in patient health care insurance have to be considered when recruiting dental practitioners for clinical trials

Do brachycephaly and nose size predict the severity of obstructive sleep apnea (OSA)? A sample-based geometric morphometric analysis of craniofacial variation in relation to OSA syndrome and the role of confounding factors

Obstructive sleep apnea is a common disorder that leads to sleep fragmentation and is potentially bidirectionally related to a variety of comorbidities, including an increased risk of heart failure and stroke. It is often considered a consequence of anatomical abnormalities, especially in the head and neck, but its pathophysiology is likely to be multifactorial in origin. With geometric morphometrics, and a large sample of adults from the Study for Health in Pomerania, we explore the association of craniofacial morphology to the apnea–hypopnea index used as an estimate of obstructive sleep apnea severity. We show that craniofacial size and asymmetry, an aspect of morphological variation seldom analysed in obstructive sleep apnea research, are both uncorrelated to apnea–hypopnea index. In contrast, as in previous analyses, we find evidence that brachycephaly and larger nasal proportions might be associated to obstructive sleep apnea severity. However, this correlational signal is weak and completely disappears when age-related shape variation is statistically controlled for. Our findings suggest that previous work might need to be re-evaluated, and urge researchers to take into account the role of confounders to avoid potentially spurious findings in association studies

Artifacts In Magnetic Resonance Imaging and Computed Tomography Caused By Dental Materials

BACKGROUND: Artifacts caused by dental restorations, such as dental crowns, dental fillings and orthodontic appliances, are a common problem in MRI and CT scans of the head and neck. The aim of this in-vitro study was to identify and evaluate the artifacts produced by different dental restoration materials in CT and MRI images. METHODS: Test samples of 44 materials (Metal and Non-Metal) commonly used in dental restorations were fabricated and embedded with reference specimens in gelatin moulds. MRI imaging of 1.5T and CT scan were performed on the samples and evaluated in two dimensions. Artifact size and distortions were measured using a digital image analysis software. RESULTS: In MRI, 13 out of 44 materials produced artifacts, while in CT 41 out of 44 materials showed artifacts. Artifacts produced in both MRI and CT images were categorized according to the size of the artifact. SIGNIFICANCE: Metal based restoration materials had strong influence on CT and less artifacts in MRI images. Rare earth elements such as Ytterbium trifluoride found in composites caused artifacts in both MRI and CT. Recognizing these findings would help dental materials manufacturers and developers to produce materials which can cause less artifacts in MRI and CT images

Assessment of Frankfort Horizontal plane Reproduction on MRI

Objective: The purpose of this study was to determine the accuracy and reliability of Frankfort horizontal plane identification using displays of multi-planar reconstructed MRI images, and propose it as a sufficiently stable and standardized reference plane for craniofacial structures Materials and Methods: MRI images of 43 adolescent randomly selected subjects were obtained from the longitudinal population based cohort study SHIP-2 using a T1-weighted 3D sequence. Five examiners independently identified the three landmarks that form FH plane. Intra-examiner reproducibility and inter-examiner reliability, correlation coefficients (ICC), coefficient of variability and Bland-Altman plots were obtained for all landmarks coordinates to assess reproducibility. Intra-examiner reproducibility and inter-examiner reliability in terms of location and plane angulation were also assessed. Results: Intra- and inter-examiner reliabilities for X, Y and Z coordinates of all three landmarks were excellent with ICC values ranging from 0.914 to 0.998. Differences among examiners were more in X and Z than in Y dimensions. The Bland–Altman analysis demonstrated excellent intra- as well as inter-examiner agreement between examiners in all coordinates for all landmarks. Intra-examiner reproducibility and inter-examiner reliability of the three landmarks in terms of distance showed mean differences between 1.3 to 2.9 mm, Mean differences in plane angulation were between 1.0° to 1.5° among examiners. Conclusion: This study revealed excellent intra-examiner and inter-examiner reproducibility of Frankfort Horizontal plane through 3D landmark identification in MRI. Sufficiently stable landmark-based reference plane could be used for different treatments and studies.Einleitung: Die Überprüfung der Genauigkeit und Zuverlässigkeit der Referenzpunkte zur Lagebestimmung der Ebene der Frankfurter Horizontalen (FH) als ausreichend stabile und standardisierte Bezugsebene für kraniofazialen Strukturen im multiplanaren rekonstruierten MRT war Ziel dieser vorliegenden Studie. Material und Methode: An 43 randomisiert ausgewählten MRT-Bilder adulter Patienten der bevölkerungs-bezogene Kohortenstudie SHIP-2 wurden T1-gewichtete 3D-Sequenz hergestellt. Fünf unabhängige Unter-sucher markierten drei Referenz-punkte der FH. Die Markierung der Referenzpunkte wurde mittels intra-examiner reproducibility, inter-examiner reliability, Korrelationskoeffizient (ICC) und Variabilitätskoeffizient im Bland-Altman Plots geprüft. Die räumliche Lage der Referenzpunkte und Ebenen-angulation der FH wurden ebenfalls mittels intra-examiner reproducibility und inter-examiner reliability bewertet. Results: intra-examiner reproducibility und inter-examiner reliability der X-, Y-und Z-Koordinaten aller drei Referenz punkte mit ICC-Werten im Bereich von 0,914 bis 0,998 waren exzellent. Die Unterschiede zwischen den Untersuchern waren vornehmlich in X- und Z-Koordinten als in Y-Koordinaten zu finden. Die Bland-Altman-Analyse zeigte eine ausgezeichnete Übereinstimmung (intra-examiner reproducibility sowie inter-examiner reliability) zwischen den Untersuchern für alle Referenzpunkte in allen drei Koordinatenebenen. intra-examiner reproducibility und inter-examiner reliability der drei Referenzpunkte bezüglich der dargestellten Distanzen / Entfernungen zeigte hingegen deutliche Unterschiede zwischen 1,3 - 2,9 mm, die mittelwertige Differenz in der Angulation der FH Ebene lag zwischen 1,0 ° bis 1,5 °. Fazit: Diese Studie zeigt eine ausgezeichnete Genauigkeit und Zuverlässigkeit zwischen Untersuchern (intra-examiner reproducibility und inter-examiner reliability) bei der Bestimmung der Referenzpunkte der Ebene der FH in der 3D-Sequenz im MRT. Die Referenzpunkte der FH könnten somit als Bezugsebene für verschiedene Therapien und Studien verwendet werden

Clinical performance during 48 months of two current glass ionomer restorative systems with coatings: a randomized clinical trial in the field

Background: This study was carried out as a prospective clinical field study with the aim of evaluating the clinical performance of Equia Fil (R) with a nanofilled resin coating and the conventional Fuji IX GP (R) fast with an LC coating according to the World Dental Federation (FDI) restoration material evaluation criteria. Methods: The clinical performance of Equia Fil (R) and Fuji IX GP (R) fast was evaluated on permanent posterior teeth of 643 adult patients aged between 20 to 80 years old in randomly selected clinics across Germany. Occlusal cavities in posterior permanent teeth were restored with Equia Fil (R) with a nanofilled, light-cured resin coating (n = 515) and Fuji IX GP (R) fast with an LC coating (n = 486). Direct clinical assessment as well as photographic assessment and assessment of stone casts of the restorations were made at 1 year, 2 years, 3 years, and 4 years. Results: In 4 years, a total of 1001 fillings from both materials were placed by 111 dentists in 643 patients. Random slope models showed that the Equia filling system had overall lower odds of obtaining a delta event (material needs replacement) in comparison to Fuji IX GP (R) fast with an LC coating within all models. In both materials, filling size/surface was the most important component affecting the clinical performance of the materials. When measuring the odds of obtaining a delta event (material needs replacement), the odds ratios jumped to approximately 43 and 296 times for class II (two surfaces) and class II mesial-occlusal-distal (three surfaces) respectively in comparison to class I fillings. Conclusion: Both materials showed similar good overall performance in class I cavities;however, when including numbers from both class I and II fillings, the Equia system with a nanofilled resin coating showed better overall performance with fewer failures in all the follow-up intervals. Nonetheless, the percentage of unsatisfactory to poor fillings according to the FDI criteria was relatively high in two-surface class II fillings and higher in three-surface class II fillings for both materials

Procrustes-based geometric morphometrics on MRI images: An example of inter-operator bias in 3D landmarks and its impact on big datasets.

Using 3D anatomical landmarks from adult human head MRIs, we assessed the magnitude of inter-operator differences in Procrustes-based geometric morphometric analyses. An in depth analysis of both absolute and relative error was performed in a subsample of individuals with replicated digitization by three different operators. The effect of inter-operator differences was also explored in a large sample of more than 900 individuals. Although absolute error was not unusual for MRI measurements, including bone landmarks, shape was particularly affected by differences among operators, with up to more than 30% of sample variation accounted for by this type of error. The magnitude of the bias was such that it dominated the main pattern of bone and total (all landmarks included) shape variation, largely surpassing the effect of sex differences between hundreds of men and women. In contrast, however, we found higher reproducibility in soft-tissue nasal landmarks, despite relatively larger errors in estimates of nasal size. Our study exemplifies the assessment of measurement error using geometric morphometrics on landmarks from MRIs and stresses the importance of relating it to total sample variance within the specific methodological framework being used. In summary, precise landmarks may not necessarily imply negligible errors, especially in shape data; indeed, size and shape may be differentially impacted by measurement error and different types of landmarks may have relatively larger or smaller errors. Importantly, and consistently with other recent studies using geometric morphometrics on digital images (which, however, were not specific to MRI data), this study showed that inter-operator biases can be a major source of error in the analysis of large samples, as those that are becoming increasingly common in the 'era of big data'

Basketball conditioning training workout

Title: Basketball conditioning training workout Objectives: The aim of this thesis is based on a survey to determine importance of fitness training in basketball, whether basketball players are using service of a conditioning coach or not, frequency, focus on fitness, equipment, additional sports etc. Methods: Data needed to process this thesis came out of a non-standardized anonymous questionnaire, which was created for professional basketball players and players of different performance levels. The reason is a opinion comparison of players of different skill levels. After obtaining the necessary data I evaluate the general characteristics and selected indicators. Results: The results of the thesis is confirmed by the survey (n = 55 male respondents). Fitness trainer representation is at more than 80% responces. Almost all respondents follow some kind of a fitness training plan, either directly led by a fitness trainer or a basketball coach. Keywords: Fitness training, basketball, power, speed, coordination, enduranc

A deep learning framework for efficient analysis of breast volume and fibroglandular tissue using MR data with strong artifacts

The main purpose of this work is to develop, apply, and evaluate an efficient approach for breast density estimation in magnetic resonance imaging data, which contain strong artifacts including intensity inhomogeneities

A deep cascaded segmentation of obstructive sleep apnea-relevant organs from sagittal spine MRI

Purpose!#!The main purpose of this work was to develop an efficient approach for segmentation of structures that are relevant for diagnosis and treatment of obstructive sleep apnea syndrome (OSAS), namely pharynx, tongue, and soft palate, from mid-sagittal magnetic resonance imaging (MR) data. This framework will be applied to big data acquired within an on-going epidemiological study from a general population.!##!Methods!#!A deep cascaded framework for subsequent segmentation of pharynx, tongue, and soft palate is presented. The pharyngeal structure was segmented first, since the airway was clearly visible in the T1-weighted sequence. Thereafter, it was used as an anatomical landmark for tongue location. Finally, the soft palate region was extracted using segmented tongue and pharynx structures and used as input for a deep network. In each segmentation step, a UNet-like architecture was applied.!##!Results!#!The result assessment was performed qualitatively by comparing the region boundaries obtained from the expert to the framework results and quantitatively using the standard Dice coefficient metric. Additionally, cross-validation was applied to ensure that the framework performance did not depend on the specific selection of the validation set. The average Dice coefficients on the test set were [Formula: see text], [Formula: see text], and [Formula: see text] for tongue, pharynx, and soft palate tissues, respectively. The results were similar to other approaches and consistent with expert readings.!##!Conclusion!#!Due to high speed and efficiency, the framework will be applied for big epidemiological data with thousands of participants acquired within the Study of Health in Pomerania as well as other epidemiological studies to provide information on the anatomical structures and aspects that constitute important risk factors to the OSAS development

Association between coronal caries and malocclusion in an adult population

Purpose!#!Only a few but conflicting results have been reported on the association between malocclusions and caries. We investigated this association using data from the population-based cross-sectional Study of Health in Pomerania (SHIP).!##!Methods!#!Sagittal, vertical and transversal intermaxillary relationship, space conditions and sociodemographic parameters of 1210 dentate subjects (median age 30 years, interquartile range 25-35 years) were collected. Caries was assessed with the Decayed-Missing-Filled Surfaces index but analyzed as ordered outcome (four levels: sound, enamel caries, caries, tooth loss) in ordinal multilevel models, taking into account subject, jaw, and tooth level simultaneously.!##!Results!#!Anterior open bite ≤3 mm (odds ratio [OR] = 2.08, 95% confidence interval [CI]: 1.19-3.61), increased sagittal overjet of 4-6 mm (OR = 1.31, CI: 1.05-1.64), distal occlusion of ½ premolar width (OR = 1.27, CI: 1.05-1.53) and distal 1 premolar width (OR = 1.31, CI: 1.06-1.63) were associated with adjusted increased odds for a higher outcome level (caries). Anterior spacing (OR = 0.24, CI: 0.17-0.33), posterior spacing, (OR = 0.69, CI: 0.5-0.95), posterior crowding (OR = 0.57, CI: 0.49-0.66) and buccal nonocclusion (OR = 0.54, CI: 0.33-0.87) were associated with a lower outcome level (caries).!##!Conclusion!#!The results from this population-based study suggest that a connection between caries and malocclusion exists to a limited extent in young adults. The associations with caries are contradictory for several malocclusion variables. Distal occlusion (OR = 1.31, CI: 1.06-1.63) and related skeletal anomalies displayed positive associations with caries whereas crowding did not. Orthodontic treatment of anterior crowding would probably not interfere with caries experience. These aspects should be considered for patient information and in treatment decisions