Impacted First and Second Permanent Molars: Overview

Impaction of a permanent tooth is a relatively common clinical occurrence in the human dentition. First mandibular molars and maxillary second molars are rarely impacted with a reported prevalence of 0–2.3% for second molars, 0.02% for the maxillary first molar, and of less than 0.01% for the mandibular first molar. The failures in their eruption mechanism may occur due to an obstacle such as the presence of a supernumerary tooth or an odontoma, lack of adequate space in the arch, an abnormal eruption path, or with idiopathic etiology. It is an asymptomatic pathology which is usually a casual discovery. Early diagnosis and treatment of permanent molars eruption disturbances contributes to optimal outcomes and favorable long-term prognosis by reduction of complication. The purpose of this is chapter is (1) to define prevalence and etiopathogeny of impacted first and second permanent molars, (2) to pinpoint the needs of earlier diagnosis, and finally (3) to highlight the treatment options

Impact of cavotricuspid isthmus ablation for typical atrial flutter and heart failure in the elderly—results of a retrospective multi-center study

IntroductionWhile in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare.MethodsWe included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes.ResultsPatients with CTIA showed a significant increase in LVEF after 1 (p < 0.001) and 2 years (p < 0.001) in contrast to baseline LVEF. Improvement of LVEF in the CTIA group was associated with significantly lower 2-year mortality (p = 0.003). In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044–7.755; p = 0.041). Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization (p = 0.042) and mortality rate after 2 years (p = 0.013).ConclusionsCTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization