Endodontic Retreatment of Teeth With Uncertain Endodontic Prognosis Versus Dental Implants: 5-year Results From a Randomised Controlled Trial

PURPOSE. To ascertain whether it is better to endodontically retreat a previously endo-dontically treated tooth with periapical pathology and/or symptoms and an uncertain prognosis, or to replace the tooth with a single implant-supported crown. MATERIALS AND METHODS. Twenty patients requiring treatment of a previously endodon-tically treated tooth with periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigator, were randomly allocated to endodontic retreatment (endo group; 10 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 10 patients) according to a paral-lel-group design at a single centre. Patients were followed up to 5 years after treatment completion. Outcome measures were: procedure failure; complications; marginal bone level changes at both teeth and implants; radiographic endodontic success (teeth only); number of patient visits and days to complete treatment; chairside time; costs; and ae-sthetics, as assessed using the pink aesthetic score (PES) for the soft tissues and the white aesthetic score (WES) for the tooth/crown by independent assessors. RESULTS. One patient from the endo group dropped out. One endodontically retreated tooth fractured. There were no statistically significant differences in treatment failure between groups (difference in proportions = 0.1; 95% CI-0.18 to 0.35; P = 1.00). Three endo group patients had one complication each versus one complication in the implant group, the difference not being statistically significant (difference in proportions = 0.2; 95% CI-0.17 to 0.51; P = 0.582). The mean marginal bone levels at endo retreatment/implant insertion were 2.10 ± 0.66 mm for the endo and 0.05 ± 0.15 mm for the implant group. Five years after treatment completion, teeth lost on average 0.60 ± 0.96 mm and implants 0.56 ± 0.77 mm, the difference not being statistically significant (mean difference =-0.05 mm; 95% CI:-0.95 to 0.86; P = 0.914). Of the four teeth that originally showed periapical radiolucency, one was lost, two displayed complete healing, and one showed radiographic improvement. There were no statistically significant differences in the number of patient visits (endo = 6.7 ± 0.7; implant = 6.1 ± 0.7; mean difference = 0.6; 95% CI:-0.1 to 1.3 P = 0.106). However, it took significantly more days (endo = 61 ± 13.0; implant = 191.4 ± 75.0; mean difference =-130.4; 95% CI:-184.5 to-76.4; P < 0.001) but less chairside time (endo = 628 ± 41.4 min; implant = 328.5 ± 196.4 min; mean difference =-299.5; 95% CI:-441.3 to 1.0; P = < 0.001) to complete the rehabilitation. Implant treatment was significantly more expensive (endo = 1440 ± 549.7; implant = 2099 ± 170.3; mean difference = 659; 95% CI: 257.2 to 1060.8; P = 0.004). Five years after treatment completion, mean PES were 12.3 ± (1.3) and 8.9 ± 2.2 and mean WES were 8.1 ± 1.4 and 7.1 ± 1.7 in the endo group and implant group, respectively. Soft tissues aesthetics (PES) was significantly better at endodontically retreated teeth (mean difference-3.4; 95% CI-5.1 to-1.6; P (t-test) = 0.001), whereas no significant differences were observed between treatments in tooth aesthetics (WES) (mean difference =-1.0; 95% CI-2.6 to 0.5; P (t-test) = 0.178)

To Splint or Not to Splint Short Dental Implants Under the Same Partial Fixed Prosthesis? One-year Post-loading Data From a Multicentre Randomised Controlled Trial

PURPOSE. To compare the clinical outcomes of two adjacent 6-mm-long dental implants splinted under the same prosthesis (control group) versus two identical implants sup-porting single crowns (test group). MATERIALS AND METHODS. Forty-seven patients with edentulous posterior (premolars and/or molars) jaws received two adjacent 6-mm-long dental implants, which were sub-merged. Four months later, at impression taking, patients were randomised to receive splinted or unsplinted definitive cemented metal-composite prostheses. Unfortunately, four patients died before randomisation and three patients lost five implants, so only 40 patients were randomised, according to a parallel-group design, to have both implants splinted under the same partial fixed prosthesis (19 patients) or with two single crowns (21 patients). Outcome measures were: prosthesis and implant failures, any complica-tions, peri-implant marginal bone level changes and patient satisfaction. Patients were followed-up to 1 year after loading. RESULTS. One patient from the splinted group dropped out. No implant failures occurred after randomisation. One complication occurred in the unsplinted group versus no complications at splinted implants, the difference not being statistically different (Fisher’s exact test P = 1.000; difference in proportions =-0.04; 95% CI-0.16 to 0.09). Both groups presented significant peri-implant marginal bone loss at 1 year after loading (P<0.05), respectively-0.36 (0.45) mm at splinted implants and-0.17 (0.31) mm at unsplinted implan-ts, but there were no statistically significant differences between the two groups (mean difference 0.19 mm; 95% CI-0.10 to 0.48; P = 0.194). All patients were fully or reasonably satisfied with the treatment, with the exception of two patients, both from the splinted group: one patient was not sure about the aesthetics, and another would not undergo the same treatment again. CONCLUSIONS. The present data seems to suggest that up to 1 year after loading the prognosis of short implants, mostly placed in mandibles characterised by dense bone quality, may not be influenced by splinting or not under the same fixed prostheses. Howe-ver, these preliminary results need to be confirmed by larger trials with follow-ups of at least 5 years

Comparison Between Single Early-loaded Implants With Sandblasted Acidetched (Sa) Surface Versus Sa Surface Modified With Ph Buffering Agent (Soi): Four-month Data From a Split-mouth, Multicentre Randomized Controlled Trial

PURPOSE. To compare implant survival and success rates and implant stability quotient (ISQ) values of early-loaded single implants with sandblasted acid-etched (SA, control group) surface versus implants with SA surface modified with pH buffering agent (SOI, test group). MATERIALS AND METHODS. This study was designed as multicentre, split-mouth, randomized controlled trial to evaluate implant and prosthesis survival rates, complications, and implant stability quotient (ISQ) in any partially edentulous subject requiring at least two single implant-supported crowns. A one-stage implant placement procedure was used, and implants were randomized after implant site preparation. ISQ values were eva-luated for each implant, at baseline and then every week up to 8 weeks after surgery, and finally at definitive crown delivery (12 weeks after implant placement). RESULTS. Overall, 62 patients from 9 centres were enrolled in this study. One patient dropped out from the study at 8 weeks. In the first 12 weeks of observation, 2 implants failed, both in the SA group, the difference not being statistically significant (P = 0.5). No prosthesis failure occurred up to 4 months after fitting. Five complications were expe-rienced, 3 in the SA group and 2 in the SOI group. The difference between groups was not statistically significant (OR = 0.66, 95% CI: 0.11 to 4.07; P = 0.650). Of these complications, loss of stability without rotation was observed in 2 implants from the SOI group and 2 implants from the SA group, all in the third and fourth weeks of measurements. All the implants were submerged and successfully osseointegrated at the twelfth week. The last complication was an SA implant screw loosening, which was resolved chair-side. The baseline mean ISQ values were 76.57 ± 7.54 (95% CI 74.69 to 78.44) in the SA group and 75.92 ± 7.69 (95% CI 73.89 to 77.73) in the SOI group. The mean ISQ values at 12 weeks were 79.17 ± 7.83 (95% CI 77.03 to 81.29) and 78.82 ± 8.80 (95% CI 76.42 to 81.21) in the SA and SOI groups, respectively. Mixed-effects modelling revealed a statistically significant difference between groups over time, with slightly lower ISQ values for the SOI group (-0.65; 95% CI-1.14 to-0.15). Statistically significant differences were also estimated among centres (P <0.001). CONCLUSIONS. Within the limitations of the present preliminary report, it is possible to conclude that both implants can be successfully loaded early

The nuclear receptors of Biomphalaria glabrata and Lottia gigantea: Implications for developing new model organisms

© 2015 Kaur et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedNuclear receptors (NRs) are transcription regulators involved in an array of diverse physiological functions including key roles in endocrine and metabolic function. The aim of this study was to identify nuclear receptors in the fully sequenced genome of the gastropod snail, Biomphalaria glabrata, intermediate host for Schistosoma mansoni and compare these to known vertebrate NRs, with a view to assessing the snail's potential as a invertebrate model organism for endocrine function, both as a prospective new test organism and to elucidate the fundamental genetic and mechanistic causes of disease. For comparative purposes, the genome of a second gastropod, the owl limpet, Lottia gigantea was also investigated for nuclear receptors. Thirty-nine and thirty-three putative NRs were identified from the B. glabrata and L. gigantea genomes respectively, based on the presence of a conserved DNA-binding domain and/or ligand-binding domain. Nuclear receptor transcript expression was confirmed and sequences were subjected to a comparative phylogenetic analysis, which demonstrated that these molluscs have representatives of all the major NR subfamilies (1-6). Many of the identified NRs are conserved between vertebrates and invertebrates, however differences exist, most notably, the absence of receptors of Group 3C, which includes some of the vertebrate endocrine hormone targets. The mollusc genomes also contain NR homologues that are present in insects and nematodes but not in vertebrates, such as Group 1J (HR48/DAF12/HR96). The identification of many shared receptors between humans and molluscs indicates the potential for molluscs as model organisms; however the absence of several steroid hormone receptors indicates snail endocrine systems are fundamentally different.The National Centre for the Replacement, Refinement and Reduction of Animals in Research, Grant Ref:G0900802 to CSJ, LRN, SJ & EJR [www.nc3rs.org.uk]

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Older women, breast cancer, and social support

One in ten women over the age of 65 will develop breast cancer. Despite this high incidence of breast cancer among older women, social support for them is often inadequate. This paper describes a qualitative study of the impact of a breast cancer diagnosis on older women from racially/ethnically diverse populations and their subsequent need for social support. Forty-seven older African American, Asian American, Caucasian and Latina women between the ages of 65 to 83 participated in a larger study examining the impact of breast cancer on women from racially/ethnically diverse populations and the meaning and nature of social support. The women completed an in-depth qualitative interview on the psychosocial impact of breast cancer and the meaning and nature of social support. The results indicate that there are variations in reactions to a breast cancer diagnosis among older women, and that these reactions impact their experiences with seeking social support at diagnosis and during treatment. Respondents were concerned about their aging bodies, potential dependency on others, and loss of autonomy. At the same time, the severity of cancer treatment and existing co-morbidities often meant they needed to learn to receive support, and to reach out if they had no support. The implications of these findings underscore the older cancer patient’s need to strengthen her supportive networks at the time of diagnosis, during treatment, and post-treatment

Frailty and Adherence to Adjuvant Hormonal Therapy in Older Women With Breast Cancer: CALGB Protocol 369901

Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation