Quality assessment of instructions for authors in dental, oral and maxillofacial journals

Objective: to develop and test inter-observer reproducibility of instructions for authors quality rating (IAQR) tool measuring the quality of instructions for authors at journal level for a possible improvement of editorial guidelines.Material and methods: instructions for authors of 75 dental and maxillofacial surgery journals were assessed by two independent observers using assessment tool inspired from AGREE with 16 questions and 1 to 4 points scale per answer. Two observers evaluated the instructions of authors independently and blind to impact factor of a given journal. Scores obtained from our tool were compared with “journal impact factor 2013”. Results: IAQR presented with an excellent interobserver reproducibility (κ= 0.81) despite a difference in data distribution between observers. There existed a weak positive correlation between IAQR and “journal impact factor 2013”. Conclusions: The IAQR is a reproducible quality assessment tool at the journal level. The IAQR assess the quality of instruction for authors and it is a goodstarting point for possible improvements of the instructions for authors, especially when it comes to their completeness. Nemesis relevance: 28% of dental and maxillofacial journals might revise their instructions for authors to provide more up-to-date version.Objective: to develop and test inter-observer reproducibility of instructions for authors quality rating (IAQR) tool measuring the quality of instructions for authors at journal level for a possible improvement of editorial guidelines.Material and methods: instructions for authors of 75 dental and maxillofacial surgery journals were assessed by two independent observers using assessment tool inspired from AGREE with 16 questions and 1 to 4 points scale per answer. Two observers evaluated the instructions of authors independently and blind to impact factor of a given journal. Scores obtained from our tool were compared with “journal impact factor 2013”. Results: IAQR presented with an excellent interobserver reproducibility (κ= 0.81) despite a difference in data distribution between observers. There existed a weak positive correlation between IAQR and “journal impact factor 2013”. Conclusions: The IAQR is a reproducible quality assessment tool at the journal level. The IAQR assess the quality of instruction for authors and it is a goodstarting point for possible improvements of the instructions for authors, especially when it comes to their completeness. Nemesis relevance: 28% of dental and maxillofacial journals might revise their instructions for authors to provide more up-to-date version

Accuracy of Patient-Specific Instrumentation for Bone Tumor Resection within the pelvis: 1st study of 11 patients

Introduction Pelvic bone tumor resection is challenging due to complex geometry, limited visibility and restricted working space of the pelvis. Accurate resection in safe margin is required to reduce the risk of local recurrence. Computer-assisted preoperative planning and intraoperative navigation technologies have been developed for pelvic bone tumor surgeries, and clinical studies have already demonstrated the feasibility of achieving clinically adequate (tumor-free) resection margins [1]. Patient-specific instrumentation (PSI) technology has been developed and adapted to bone tumor surgery as a cheaper and less time-consuming alternative to intraoperative navigation. A recent experimental study has assessed an equivalent value-added of both PSI and navigation technologies in terms of the achieved surgical margins during simulated bone tumor resections of the pelvis [2]. The present study reports a series of 11 clinical cases of PSI-assisted bone tumor surgery within the pelvis, and assesses how accurately a preoperative resection strategy can be replicated intraoperatively with the PSI. Materials and methods The patient series consisted in 11 patients eligible for curative surgical resection of primary bone tumor of the pelvis. Eight patients had a bone sarcoma of iliac bone involving the acetabulum, two patients had a sacral tumor, and one patient had a chondrosarcoma of proximal femur with intra-articular hip extension. For all cases, magnetic resonance imaging (MRI) and computerized tomography (CT) were acquired preoperatively for diagnosis. The tumor volume was first delineated on the MRI. The set of MRI and CT images were fused to produce 3D models of bone and tumor volume (Figure (a)). Resection planning consisted in desired cut planes positioned close to the boundary of the tumor (from 1 up to 6 planes) defining the desired bone cutting with a safe margin defined by the surgeon from 3 up to 15 mm. PSI were designed in computer-aided design software according to the desired resection strategy and produced by additive manufacturing technology. PSI were designed to have bone-specific surfaces to fit in unique position on the bony structure of the patient. PSI were equipped with cylindric guides for 2-mm diameter Kirschner wires to be pinned on the bony structure and flat surfaces to materialize the desired cut planes. Intraoperatively, PSI were positioned freehand by the surgeon and fixed on the bone surface using the K-wires. Once the resection was achieved, both K-wires and PSI were taken off. The standard surgical approach has been used for each patient. Dissection of soft tissue for bone exposure was in accordance with the routine technique. There was no additional bone exposure to position the PSI. Histopathological analysis of the resected tumor specimens was performed to evaluate the safety of the achieved resection margins. Postoperative CT were acquired to assess the local control of the tumor. 3D bone models were reconstructed from the postoperative CT of the patient and registered with the corresponding preoperative bone model (Figure (b)). Two parameters were measured: achieved resection margin (RM) and location accuracy (L). RM was defined as the minimum distance (mm) between the achieved cut plane and the boundary of the tumor. Consequently, the error in the desired safe margin (ESM) was defined as the difference (mm) between RM and the desired safe margin. L was used in accordance with the ISO1101 standard [2] to evaluate accuracy between achieved and desired cut planes. L was defined as the maximum distance (mm) between the achieved cut plane and the desired cut plane. Results PSI were quick and easy to use with a positioning onto the bone surface in less than 5 minutes for all cases. The positioning of the PSI was considered unambiguous for all patients. Histopathological analysis classified all achieved resection margins as R0 (tumor-free), except for two patients. Patient #8 had an urgent morcelize

Three-dimensional analysis of airway space and mandibular morphology in Pierre Robin sequence using cone beam computed tomography.

Objectives: The Pierre Robin sequence (PRS) is defined by retromicrognathia, glossoptosis, and sleep apnea and can also be associated with cleft palate. Diagnosis, management and mandibular catch-up growth are still controversial issues in PRS patients. The aim of our retrospective study was to evaluate in three dimensions (3D) the airway space and mandibular morphology in PRS compared to a normal control group patients in the pre-orthodontic period of life. The null hypothesis was that we would not find a significant difference between the PRS and control group patients in oropharyngeal airway volume measurements. Material and methods: We analyzed 9 PRS patients (mean age: 8 years-old) who underwent cleft palate surgery in the first four months of life, performed by the same surgeon using the same technique. Cone-beam computed tomography (CBCT) was performed in these patients after local ethical committee approval. The control group consisted of 15 patients (mean age: 9 years-old) with CBCT already performed for other reasons. 3D Slicer was used in both groups for semi-automatic segmentation of the airway space. Two independent observers performed semi-automatic segmentations twice in each patient with a one- week interval between the two series of measurements. Airway volume was automatically measured using 3D Slicer. We also developed a 3D cephalometric analysis with Maxilim software in order to define a 3D mandibular morphology which consisted of 25 landmarks, 4 planes, and 23 distances. Two independent observers performed the 3D cephalometric analysis twice for each patient, with a one- week interval between the two series of measurements. Results: There was no significant difference in the intra- and inter-observer measurements between the PRS and control groups for airway space volume (p<0.05). However, there was a significant difference in the shape of the mandible between the PRS group and the control group (p<0.05). Conclusions: Vertical ramus width and mandibular global anteroposterior length were significantly lower in the PRS group. Mandibular hypoplasia could be found in PRS patients not only in the horizontal dimension. Nemesis relevance: the null hypothesis was confirmed. Moreover we failed to find exactly the same control group under 9 years-old due to radioprotection restrictions of application of cone beam CT in children.Objectives: The Pierre Robin sequence (PRS) is defined by retromicrognathia, glossoptosis, and sleep apnea and can also be associated with cleft palate. Diagnosis, management and mandibular catch-up growth are still controversial issues in PRS patients. The aim of our retrospective study was to evaluate in three dimensions (3D) the airway space and mandibular morphology in PRS compared to a normal control group patients in the pre-orthodontic period of life. The null hypothesis was that we would not find a significant difference between the PRS and control group patients in oropharyngeal airway volume measurements. Material and methods: We analyzed 9 PRS patients (mean age: 8 years-old) who underwent cleft palate surgery in the first four months of life, performed by the same surgeon using the same technique. Cone-beam computed tomography (CBCT) was performed in these patients after local ethical committee approval. The control group consisted of 15 patients (mean age: 9 years-old) with CBCT already performed for other reasons. 3D Slicer was used in both groups for semi-automatic segmentation of the airway space. Two independent observers performed semi-automatic segmentations twice in each patient with a one- week interval between the two series of measurements. Airway volume was automatically measured using 3D Slicer. We also developed a 3D cephalometric analysis with Maxilim software in order to define a 3D mandibular morphology which consisted of 25 landmarks, 4 planes, and 23 distances. Two independent observers performed the 3D cephalometric analysis twice for each patient, with a one- week interval between the two series of measurements. Results: There was no significant difference in the intra- and inter-observer measurements between the PRS and control groups for airway space volume (p<0.05). However, there was a significant difference in the shape of the mandible between the PRS group and the control group (p<0.05). Conclusions: Vertical ramus width and mandibular global anteroposterior length were significantly lower in the PRS group. Mandibular hypoplasia could be found in PRS patients not only in the horizontal dimension. Nemesis relevance: the null hypothesis was confirmed. Moreover we failed to find exactly the same control group under 9 years-old due to radioprotection restrictions of application of cone beam CT in children

Drugs targeting the bone microenvironment: new therapeutic tools in Ewing's sarcoma?

Introduction: Ewing's sarcoma (ES) is the second most frequent malignant primary bone tumour in children, adolescents and young adults. The overall survival is 60 – 70% at 5 years but still very poor for patients with metastases, disease relapse or for those not responding to chemotherapy. For these high risk patients, new therapeutic approaches are needed beyond conventional therapies (chemotherapy, surgery and radiation) such as targeted therapies. Areas covered: Transcriptomic and genomic analyses in ES have revealed alterations in genes that control signalling pathways involved in many other cancer types. To set up more specific approaches, it is reasonable to think that the particular microenvironment of these bone tumours is essential for their initiation and progression, including in ES. To support this hypothesis, preclinical studies using drugs targeting bone cells (bisphosphonate zoledronate, anti-receptor activator of NF-κB ligand strategies) showed promising results in animal models. This review will discuss the new targeted therapeutic options in ES, focusing more particularly on the ones modulating the bone microenvironment. Expert opinion: Targeting the microenvironment represents a new option for patients with ES. The proof-of-concept has been demonstrated in preclinical studies using relevant animal models, especially for zoledronate, which induced a strong inhibition of tumour progression in an orthotopic bone model

Radiographie standard dans le conflit fémoro-acétabulaire (description d'un nouveau profil et intérêt diagnostique)

Le conflit fémoro-acétabulaire est dû à un contact anormal entre le rebord acétabulaire et le col fémoral antéro-supérieur lors de la mobilisation de la hanche. Il est à l'origine de douleurs de hanche, de lésions du labrum acétabulaire, et est responsable d'une grande proportion des coxarthroses dites primitives . Des anomalies anatomiques fémorales et acétabulaires responsables de ce conflit ont été récemment décrites. L'angle alpha qui mesure l'asphéricité de la tête fémoral, bien étudié en arthro-IRM et en arthro-scanner, a été peu étudié sur des radiographies standard. L'angle de couverture antérieur (VCA), mesuré sur le faux profil de Lequesne, mesure la couverture acétabulaire antérieur et n'a jamais été mesuré dans le conflit fémoro-acétabulaire. Dans cette étude, nous avons mis au point un nouveau cliché radiographique permettant de mesurer l'angle alpha et l angle VCA sur le même cliché.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

A New Classification of the Morphology of Complete Ponticulus Posticus on Cone Beam Computed Tomography

The objectives of this retrospective study were to measure the prevalence of complete ponticulus posticus (CPP), to propose a new classification based on two different shapes of CPP, to compare these shapes with age and gender, and to test two different methods of measurements of the diameters of CPP on cone beam computed tomography (CBCT). Material and methods: We used 2012 CBCT scans from Planmeca Promax 3D Mid and Romexis 5.1 software tools to measure the height and width of the CPP, and we measured the surface of the CPP using an ellipse tool. We classified the CPP into “thin” and “thick” shape. Results: the prevalence of CPP was 9.49% with 97 male and 94 female patients. The unilateral type was found in 131 patients, while the bilateral type was found in 60 patients. Intra-observer reliability was evaluated using the intraclass correlation coefficient (ICC). The ICC was 0.875 for height, 0.872 for width, and 0.885 for the ellipse area. Both methods present very good intra-observer reproducibility. The “thin” group tended to be older and significantly more related to female patients. The “thick” group was associated with younger male patients. Conclusions: the proposed classification of CPP may be used when reporting the CBCT large field of view. There is still a need to increase the knowledge on the atlas and on its main variant, such as complete PP

Computer-Assisted Planning and Patient-Specific Instruments for Bone Tumor Resection within the Pelvis: A Series of 11 Patients

Pelvic bone tumor resection is challenging due to complex geometry, limited visibility, and restricted workspace. Accurate resection including a safe margin is required to decrease the risk of local recurrence. This clinical study reports 11 cases of pelvic bone tumor resected by using patient-specific instruments. Magnetic resonance imaging was used to delineate the tumor and computerized tomography to localize it in 3D. Resection planning consisted in desired cutting planes around the tumor including a safe margin. The instruments were designed to fit into unique position on the bony structure and to indicate the desired resection planes. Intraoperatively, instruments were positioned freehand by the surgeon and bone cutting was performed with an oscillating saw. Histopathological analysis of resected specimens showed tumor-free bone resection margins for all cases. Available postoperative computed tomography was registered to preoperative computed tomography to measure location accuracy (minimal distance between an achieved and desired cut planes) and errors on safe margin (minimal distance between the achieved cut planes and the tumor boundary). The location accuracy averaged 2.5 mm. Errors in safe margin averaged −0.8 mm. Instruments described in this study may improve bone tumor surgery within the pelvis by providing good cutting accuracy and clinically acceptable margins

Three-Dimensional Evaluation of Implant Positioning in the Maxillary Sinus Septum: A Retrospective Study.

BACKGROUND The aim of this study was to simulate implant placement in the maxillary sinus septum, as a potential alternative site to avoid sinus grafting. MATERIAL AND METHODS One hundred partially or completely edentulous patients, with their maxillary sinus septum present in the edentulous region, were selected from the database of the Department of Maxillofacial Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium. Three-dimensional (3D) reconstructions were created using 3D planning software. 3D reconstructions were performed for each maxillary sinus. Using the software implant library, the implants that presented the best fit with the maxillary sinus septum and that followed the established inclusion criteria were selected. RESULTS All of the implants were inserted in premolar and molar regions. Most implants were inserted in the position of the second molar (21 of 55) or in the position of the first molar (17 of 55). In all sites the most frequently used implant was 4 mm in diameter and 7 mm in height. The mean coronal angle for the implant was 80.19±17.13 degrees and the mean sagittal angle was 94.83±9.94 degrees. The septal height represents 38.13% of the total available bone height (ABH). The mean percentage of the septum used to insert the implants was 47.33±2.47%. The septum increased the available bone height by a mean value of 2.18±1.47 mm. In 45 cases, the septa did not permit implant placement. CONCLUSIONS In completely edentulous patients, inserting implants in sinus septa does not exclude the need for sinus grafting, but in partially edentulous patients, this minimally invasive technique is an alternative to subantral augmentation

Percutaneous restoration of bone continuity with screws and PMMA cement in an extensive destruction of the pelvis

We report a case of combined percutaneous screw placement and cementoplasty guided by CT and fluoroscopy in a 66-year-old man with extensive osteolytic destruction of the right iliac bone and sacral wing due to metastasic infiltrative vesical carcinoma. The medical condition was responsible for very limited and painful walking. Two perpendicular screws were inserted into the iliac bone and sacroiliac joint, and bone cement injection was used to anchor the screws and restore the mechanical continuity of the pelvis ring. This minimally invasive procedure allowed for significant and rapid resumption of painless walking

Three-Dimensional Evaluation of Maxillary Sinus Septa for Implant Placement.

BACKGROUND: The aim of our study was to investigate, in 3 dimensions, the maxillary sinus septa as an alternative site for dental implant placement to avoid sinus lift procedures. MATERIAL AND METHODS: We selected 100 dentate and 100 edentate patients with the presence of a maxillary sinus septum by reviewing a larger cone beam computer tomography (CBCT) database from the Department of Oral and Maxillofacial Surgery at Cliniques Universitaires Saint Luc in Bruxelles, Belgium. Three-dimensional reconstructions of 200 maxillary sinus septa were performed using Maxilim software. Ten measurements (length, lateral height, and thickness of the middle and medial region of the septum) were performed by 1 observer, 2 times, with an interval of 1 week between measurements. The angle between the septum and the maxillary plane was also measured. Finally, localization and orientation were assessed for each septum. RESULTS: There was no statistically significant difference between the 2 intraobserver measurements (p>0.05). Student's t-test was used to compare means. Middle height was the only measurement for which there was a difference between edentate and dentate patients (p=0.0095, edentate mean < dentate mean). The location of the septa observed in our study groups demonstrated greater prevalence in the posterior region than in the anterior and middle regions. For the spatial orientation of the septum, we found that most septa (81.2% in dentate patients, 53% in edentate patients) were oblique. CONCLUSIONS: Three-dimensional evaluation of maxillary sinus septa using 3D CBCT imaging showed that the sinus septum could offer an alternative site for implant placement in the maxillary sinus