Malocclusion and Temporomandibular Disorders: Verification of the Controversy

Aims: To investigate the dental and skeletal aspects of malocclusion in the anteroposterior and vertical dimensions in a sample of temporomandibular disorders (TMD) patients and to correlate these aspects with the signs and symptoms of TMD. Methods: A total of 150 TMD patients were divided into five groups according to the Diagnostic Criteria for TMD: Group 1 = myalgia (M); Group 2 = disc displacement with reduction (DDWR); Group 3 = disc displacement without reduction (DDWOR); Group 4 = degenerative disorders (D); and Group 5 = subluxation (S). Molar and canine relations, overjet, overbite, occlusal guidance, occlusal interferences, and centric slides were recorded for each patient, and the skeletal craniofacial patterns were analyzed for each patient using cone beam computed tomography. One-way analysis of variance was used to compare the variable means of the different groups. Pearson correlation coefficient was used to assess the correlations of quantitative continuous variables. Significance level was considered at P < .05. Results: No significant difference was found among the groups regarding any aspects of dental occlusion except for mediotrusive interferences, which were significantly higher in Group 3 (DDWOR) (P = .02). Regarding skeletal craniofacial pattern, Group 4 (D) had significantly smaller mean ± standard deviation sella-nasion-B (SNB) point angle (74.31 ± 3.04 degrees) than Group 3 (DDWOR) (78.04 ± 4.88 degrees), and Group 1 (M) showed the greatest SNB angle (79.87 ± 3.73 degrees) (P = .03). Group 3 (DDWOR) showed significantly greater mean mandibular plane/SN angle (39.56 ± 6.19 degrees) than Group 1 (M) (34.73 ± 5.65 degrees) (P = .04). Relations between occlusal variables and TMD parameters were nonsignificant. Conclusion: This study provides robust evidence to diminish the TMD-malocclusion association, especially in myogenic types of TMD. © 2019 by Quintessence Publishing Co Inc

Effectiveness of low frequency vibration on the rate of canine retraction: a randomized controlled clinical trial

Abstract To investigate the effectiveness of AcceleDent Aura vibrating device on the rate of canine retraction. Thirty-two patients requiring extraction of upper first premolars and canine retraction were randomly allocated with a 1:1 ratio into either no-appliance group or the AcceleDent Aura appliance group. Canine retraction was done applying 150gm of retraction force using NiTi coil springs on 16 × 22 stainless steel archwires. The duration of the study was 4 months. Models were collected and digitized directly after extraction of upper first premolars and at monthly intervals during canine retraction for recording the monthly as well as the total distance moved by the canine. Digitized models were superimposed on the initial model and data were statistically analyzed. Anchorage loss, rotation, tipping, torque and root condition were evaluated using cone beam computed tomography imaging. Pain was evaluated by visual analog scale. No patients were dropped-out during this study. There was no statistically significant difference between both groups regarding the total distance travelled by the canine (P = 0.436), as well as the rate of canine retraction per month (P = 0.17). Root condition was the same for the two groups. Regarding the pain level, there was no statistically significant difference between the two groups at day 0 (P = 0.721), after 24 h (P = 0.882), after 72 h (P = 0.378) and after 7 days (P = 0.964). AcceleDent Aura was not able to accelerate orthodontic tooth movement. Pain level couldn’t be reduced by vibrational force with an AcceleDent device during orthodontic treatment. Root condition was not affected by the vibrational forces

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)