Canine substitution of a missing maxillary lateral incisor in an orthodontic re-treatment case: Long term follow up

Abstract Introduction: This case report describes the orthodontic re-treatment of a case with a severely compromised maxillary lateral incisor requiring removal and canine substitution. The treatment included creative asymmetric treatment mechanics and a careful management of anchorage. Case Presentation: Pre-treatment, post treatment and 5 years follow-up records are shown. The treatment outcomes proved to be stable at the follow-up with acceptable aesthetic and functional results. Conclusion: Through careful management of anchorage it was possible to successfully use asymmetric treatment mechanics to achieve a good functional occlusion

A retrospective cephalometric study on pharyngeal airway space changes after rapid palatal expansion and herbst appliance with or without skeletal anchorage

Background: The aim of this study is to investigate the pharyngeal airway space changes in patients treated with rapid palatal expansion (RPE) and Herbst appliance with or without skeletal anchorage. Methods: A 40-patient study group treated with the Herbst RME combination was included; moreover, a comparison between two subgroups based on whether miniscrews were used was evaluated. A subgroup 1 included 20 patients who were treated with RPE and an acrylic splint Herbst with miniscrews, and subgroup 2 included 20 patients who were treated with RPE and an acrylic splint Herbst. A cephalometric analysis was performed before (T1) and after (T2) treatment. The skeletal parameters of the sagittal occlusion analysis of Pancherz were utilized together with some extra measurements to evaluate the airways. Results: An increased nasopharyngeal airway space was observed in group 1 (p < 0.05) from T1 to T2. Furthermore, the increase in nasopharyngeal airway space was significantly higher in subgroup 1 (p < 0.05) in comparison to the subgroup 2. Oropharyngeal (OA) and laryngopharyngeal (LA) dimensions were significantly increased in the subgroup 1 at the end of the treatment. In the subgroup 1, a significant decrease in SNA, a significant increase in SNB, and a significant decrease in ANB were observed from T1 to T2. In the subgroup 2, the treatment resulted in a significant decrease in ANB. In both groups, Pogonion increased significantly from T1 to T2. Conclusions: The results suggest that the RPE and the Herbst appliance allow a slight improvement of the sagittal dimensions of the airways. The oropharyngeal dimension increased significantly more in the skeletal anchorage group

Unusual extraction treatment in Class II division 1 using C-orthodontic mini-implants.

AbstractThis paper describes the treatment of a female patient, aged 23 years and 5 months, with a Class II division 1 malocclusion, who showed severe anterior protrusion and lower anterior crowding. Specially-designed orthodontic mini-implants were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. Both lower first molars showed severe apical lesions. Therefore, the treatment plan consisted of extraction of both upper first premolars and lower first molars, en masse retraction of the upper six anterior teeth, lower anterior alignment, and protraction of all the lower molars. C-implants® were used as substitutes for maxillary posterior anchorage teeth during anterior retraction and as hooks for mandibular molar protraction. The correct overbite and overjet were obtained by intruding and retracting the upper six anterior teeth into their proper positions. The dentition was detailed using conventional orthodontic appliances. The upper C-implants contributed to an improvement in facial balance, and the lower C-implants made it possible to protract the lower second and third molars with less effect on the axis of the lower anterior teeth. The active treatment period was 29 months and the patient's teeth continued to be stable 11 months after debonding

Maxillary premolars extraction or molar distalization with or without TADs: cephalometric evaluation of soft tissue changes in Class II treatment

Introduction: Problem solving in Class II malocclusion treatment performed with premolars extractions or distalizing techniques in relation to the profile modification. Aim: To cephalometrically compare soft tissue changes produced either by maxillary premolar extraction, tooth-borne Pendulum appliance or bone-borne MGBM appliance. Materials and Methods: Both pre- (T1) and post-treatment (T2) lateral cephalograms of 89 skeletal Class II patients (36 M, 53 F), treated during pubertal growth spurt, were retrospectively selected. Three groups were formed based on the therapy performed: 30 patients had been treated with maxillary first premolars extraction (U4), 31 patients with a conventional tooth-borne distalizing with Pendulum appliance (PA), and 28 patients with a skeletally anchored distalizing appliance (MGBM). Soft tissue was analyzed comparing upper (UL) and lower (LL) lip’s points with regard to True Vertical Line (TVL) and Esthetic plane (E-plane). Skeletal and dental values have been recorded in order to cephalometrically compare ΔT2-T1 changes among groups and to correlate dental and skeletal changes to profile modifications. One-way ANOVA was employed to compare groups at T1. Paired sample t-tests were employed to assess significant intra- and intergroup differences between T2 and T1. Significance level was set at 0.05 Results: UL and LL showed a slight but not significant retrusion relative to TVL in all three groups. UL and LL distances to E-plane were not statistically significant among U4, PA, and MGBM groups. Independently of the treatment, UL was tangent to TVL in all groups. No statistically significant differences have been shown in skeletal records. Significant differences were recorded in Overjet among U4 than PA and MGBM groups. Conclusions: Class II malocclusion treatment with maxillary first premolar extraction, conventional or skeletal distalization did not significantly affect the profile producing similar changes in the soft tissue

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

The action of cyclooxygenase and its steady state mRNA levels

PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact [email protected] (M.Sc.D.)--Boston University. Henry M. Goldman School of Graduate Dentistry, 1990.Bibliography: leaves 76-87

Macrodontic maxillary incisor in alagille syndrome

This case report describes the surgical-orthodontic guided-eruption of a deeply impacted macrodontic maxillary central incisor in a 10-year-old patient with Alagille syndrome (ALGS). In the first stage, orthodontic treatment with fixed appliance on deciduous teeth allowed to create enough space for the eruption of the maxillary right central incisor. The second stage included closed surgical exposure and vertical traction. After impacted tooth erupted in the proper position, accessory periodontal treatment and dental reshaping procedures may be indicated to camouflage macrodontic incisor with the adjacent teeth. This is the first report that presents a patient with ALGS undergoing orthodontic and surgical treatment