Restoring proximal caries lesions conservatively with tunnel restorations

The tunnel restoration has been suggested as a conservative alternative to the conventional box preparation for treating proximal caries. The main advantage of tunnel restoration over the conventional box or slot preparation includes being more conservative and increasing tooth integrity and strength by preserving the marginal ridge. However, tunnel restoration is technique-sensitive and can be particularly challenging for inexperienced restorative dentists. Recent advances in technology, such as the contemporary design of dental handpieces with advanced light-emitting diode (LED) and handheld comfort, offer operative dentists better vision, illumination, and maneuverability. The use of magnifying loupes also enhances the visibility of the preparation. The advent of digital radiographic imaging has improved dental imaging and reduced radiation. The new generation of restorative materials has improved mechanical properties. Tunnel restoration can be an option to restore proximal caries if the dentist performs proper case selection and pays attention to the details of the restorative procedures. This paper describes the clinical technique of tunnel restoration and reviews the studies of tunnel restorations.published_or_final_versio

Obesity and atrial fibrillation outcomes and risk: increasing the weight of evidence

Editorial CommentaryChrishan J. Nalliah, Prashanthan Sanders, Jonathan M. Kalma

Obstructive sleep apnea treatment and atrial fibrillation: a need for definitive evidence

Obstructive Sleep Apnea Treatment. Prevalence rates of atrial fibrillation (AF) and obstructive sleep apnea (OSA) are rising on a global scale. Epidemiological data have consistently demonstrated an independent association between the 2 conditions. Investigators pose that pathophysiologic features of OSA enable progression of the AF substrate; these features include abnormalities of gas exchange, autonomic remodeling, atrial stretch, and inflammation. Furthermore, many of the mechanistic perturbations that impact the AF substrate in OSA can be substantially attenuated by effective treatment with continuous positive airway pressure (CPAP). Clear associations of OSA treatment and improved AF control have been observed across multiple clinical contexts. However, the precision and generalizability of these findings are unclear in view of the data’s observational nature. Although risk factor management has emerged as a critical component of AF treatment, effective control of many AF risk factors can be challenging in the longer term. In view of the efficacy and sustainability of CPAP therapy, OSA raises its profile as a prime candidate for intervention. However, translation of this strategy to the broader framework for AF management requires robust data from randomized controlled trials.Chrishan J. Nalliah, Prashanthan Sanders and Jonathan M. Kalma

Surgical weight loss to treat atrial fibrillation risk and progression

Purpose of Review: This review aims to examine the breadth of data associating atrial fibrillation (AF) with obesity at epidemiologic, mechanistic, and clinical levels. We then proceed to place surgical weight loss within that context. Recent Findings: Epidemiologic studies have demonstrated a robust correlation between overweight and AF. Various mechanistic factors including concomitant risk factors, diastolic impairment, inflammation, and pericardial fat have been observed to contribute to the atrial substrate for AF. However, weight loss can institute a process of reverse atrial remodeling improving arrhythmias profile. Thus, weight loss has emerged as an indispensable aspect of effective AF management. Yet, effective weight management is often a challenging and frustrating journey for clinician and patient, raising surgical weight loss as a potential option. However, data on the role of surgical weight loss on AF are limited. Observations indicate that the dramatic and sustained weight loss availed by surgical intervention may be capable of attenuating rates of incident AF. The impact of surgical weight loss on AF populations remains unknown. However, it is likely that most of the antiarrhythmic benefits of non-surgical weight loss would be paralleled in surgical candidates, mediated by similar mechanisms. Surgical weight loss has been associated with reverse structural remodeling, improvement of diastolic function, and modulation of the autonomic profile. Summary: There exists a compelling case for the utilization of surgical weight loss to circumvent the obstacle of treatment failure. However, resort to an invasive procedure with antedant risks for AF management alone would be premature in the absence of robust data. However, it may find a more immediate role in the context of AF ablation, where exposure to procedural risk must be justified by optimizing procedural success. Further data surrounding surgical weight loss and its antiarrhythmic benefits are required to define its role in the battle against the dual and closely linked epidemics of AF and obesity. Surgical weight loss would be a powerful weapon in the clinician’s armamentarium that would further consolidate weight loss as the fourth pillar of AF management.C. J. Nalliah, P. Sanders, Jonathan M. Kalma

The impact of diet and lifestyle on atrial fibrillation

PURPOSE OF REVIEW:Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans, affecting more than 33 million people globally. Its association with complex, resource intensive medical conditions such as stroke, heart failure and dementia have had profound impacts across existing health care structures. The global prevalence of AF has enjoyed significant growth despite significant improvement in our armamentarium for arrhythmia treatment. RECENT FINDINGS:Efforts aimed at curtailing the incidence, prevalence, or progression of AF have prompted re-evaluation of traditional frameworks for understanding and managing this debilitating disease. It is in this context that focus has shifted toward lifestyle-associated factors such as obesity, hypertension, sleep apnoea, exercise, alcohol and diet, as mechanistic drivers and putative targets for therapy. Compelling evidence exists for weight loss and management of associated risk factors to improve outcomes of AF treatment. This review will address the epidemiologic and mechanistic evidence that link lifestyle-associated factors with AF and in light of this analysis evaluate the clinical impacts of their upstream management. Traditional paradigms of AF are shifting in light of emerging evidence, such that risk factor modification has become positioned as the fourth pillar of AF management.Chrishan J. Nalliah, Prashanthan Sanders, Jonathan M. Kalma

Restoring proximal caries lesions conservatively with tunnel restorations

Chun-Hung Chu1, May L Mei,1 Chloe Cheung,1 Romesh P Nalliah2 1Faculty of Dentistry, The University of Hong Kong, Hong Kong, People's Republic of China; 2Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA Abstract: The tunnel restoration has been suggested as a conservative alternative to the conventional box preparation for treating proximal caries. The main advantage of tunnel restoration over the conventional box or slot preparation includes being more conservative and increasing tooth integrity and strength by preserving the marginal ridge. However, tunnel restoration is technique-sensitive and can be particularly challenging for inexperienced restorative dentists. Recent advances in technology, such as the contemporary design of dental handpieces with advanced light-emitting diode (LED) and handheld comfort, offer operative dentists better vision, illumination, and maneuverability. The use of magnifying loupes also enhances the visibility of the preparation. The advent of digital radiographic imaging has improved dental imaging and reduced radiation. The new generation of restorative materials has improved mechanical properties. Tunnel restoration can be an option to restore proximal caries if the dentist performs proper case selection and pays attention to the details of the restorative procedures. This paper describes the clinical technique of tunnel restoration and reviews the studies of tunnel restorations. Keywords: operative, practice, tunnel preparation, composite, amalgam, glass ionome