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Davey MG, Kerin EP, McLaughlin RP, Barry MK, Malone CM, Elwahab SA, Lowery AJ, Kerin MJ. Evaluating the Necessity for Routine Sentinel Lymph Node Biopsy in Postmenopausal Patients Being Treated for Clinically Node Negative Breast Cancer the Era of RxPONDER. Clin Breast Cancer 2023:S1526-8209(23)00080-0. [PMID: 37076364 DOI: 10.1016/j.clbc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Traditionally, sentinel lymph node biopsy (SLNB) was performed to inform adjuvant chemotherapy prescription and prognosis in breast cancer. Following RxPONDER, the OncotypeDX Recurrence Score (RS) guides adjuvant chemotherapy prescription for all postmenopausal patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative (ER+/HER2-) breast cancer with 0 to 3 positive lymph nodes (0-3 + LN). AIMS To establish the oncological safety of omitting SLNB in postmenopausal patients with ER+/HER2- breast cancer indicated to undergo SLNB and to evaluate the primary determinants of chemotherapy prescription for these patients. PATIENTS AND METHODS A retrospective cohort study was undertaken. Cox regression and Kaplan-Meier analyses were performed. Data analytics was performed using SPSS v26.0. RESULTS Five hundred and seventy five consecutive patients were included (mean age: 66.5 years, range: 45-96). The median follow-up was 97.2 months (range: 3.0-181.6). Of the 575 patients, just 12 patients had positive SLNB (SLNB+) (2.1%). Using Kaplan-Meier analyses, SLNB+ failed to impact recurrence (P = .766) or mortality (P = .310). However, using Cox regression analyses, SLNB+ independently predicted poorer disease-free survival (hazard ratio: 1.001, 95% confidence interval (95% CI): 1.000-1.001, P = .029). Logistic regression analysis identified RS as the sole predictor of chemotherapy prescription (odds ratio: 1.171, 95% CI: 1.097-1.250, P < .001). CONCLUSION Omitting SLNB may be safe and justifiable in postmenopausal patients with ER+/HER2- breast cancer with clinically negative axillae. Following RxPONDER, RS is the most important guide of chemotherapy use in these patients and SLNB may be less important than previously perceived. Prospective, randomized clinical trials are required to fully establish the oncological safety of omitting SLNB in this setting.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland.
| | - Eoin P Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Ray P McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Sami Abd Elwahab
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
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Kerin EP, Davey MG, McLaughlin RP, Sweeney KJ, Barry MK, Malone CM, Elwahab SA, Lowery AJ, Kerin MJ. Comparison of the Nottingham Prognostic Index and OncotypeDX© recurrence score in predicting outcome in estrogen receptor positive breast cancer. Breast 2022; 66:227-235. [PMID: 36335747 PMCID: PMC9647009 DOI: 10.1016/j.breast.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Traditionally, Nottingham prognostic index (NPI) informed prognosis in patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative, node negative (ER+/HER2-/LN-) breast cancer. At present, OncotypeDX© Recurrence Score (RS) predicts prognosis and response to adjuvant chemotherapy (AC). AIMS To compare NPI and RS for estimating prognosis in ER + breast cancer. METHODS Consecutive patients with ER+/HER2-/LN- disease were included. Disease-free (DFS) and overall survival (OS) were determined using Kaplan-Meier and Cox regression analyses. RESULTS 1471 patients met inclusion criteria. The mean follow-up was 110.7months. NPI was calculable for 1382 patients: 19.8% had NPI≤2.4 (291/1471), 33.0% had NPI 2.41-3.4 (486/1471), 30.0% had NPI 3.41-4.4 (441/1471), 10.9% had NPI 4.41-5.4 (160/1471), and 0.3% had NPI>5.4 (4/1471). In total, 329 patients underwent RS (mean RS: 18.7) and 82.1% had RS < 25 (270/329) and 17.9% had RS ≥ 25 (59/329). Using multivariable Cox regression analyses (n = 1382), NPI independently predicted DFS (Hazard ratio (HR): 1.357, 95% confidence interval (CI): 1.140-1.616, P < 0.001) and OS (HR: 1.003, 95% CI: 1.001-1.006, P = 0.024). When performing a focused analysis of those who underwent both NPI and RS (n = 329), neither biomarker predicted DFS or OS. Using Kaplan Meier analyses, NPI category predicted DFS (P = 0.008) and (P = 0.026) OS. Conversely, 21-gene RS group failed to predict DFS (P = 0.187) and OS (P = 0.296). CONCLUSION In our focused analysis, neither NPI nor RS predicted survival outcomes. However, in the entire series, NPI independently predicted both DFS and OS. On the 40th anniversary since its derivation, NPI continues to provide accurate prognostication in breast cancer, outperforming RS in the current study.
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Affiliation(s)
- Eoin P. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Matthew G. Davey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Corresponding author. Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.
| | | | - Karl J. Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K. Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M. Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Sami Abd Elwahab
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J. Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
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Courtney D, Davey MG, Moloney BM, Barry MK, Sweeney K, McLaughlin RP, Malone CM, Lowery AJ, Kerin MJ. Breast cancer recurrence: factors impacting occurrence and survival. Ir J Med Sci 2022; 191:2501-2510. [PMID: 35076871 DOI: 10.1007/s11845-022-02926-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Breast cancer mortality has decreased due to improved screening and treatment options. Nevertheless, 25-30% of patients develop disease recurrence and die from the disease dissemination. Patients who develop metastatic disease represent a heterogeneous group and management plans are dependent on molecular subtype, disease burden and metastatic site. AIM To determine predictive clinicopathological factors of disease recurrence and their impact on survival in the molecular era. METHODS Consecutive patients who breast cancer developed recurrence at our tertiary referral centre between 2000 and 2015 were included. Clinicopathological and treatment data were assessed using descriptive statistics. Oncological outcome was assessed using Cox regression and Kaplan Meier analyses. RESULTS Two hundred sixty-five consecutive patients who developed breast cancer recurrence were included; median age at metastasis was 59.3 years (range 27-87 years), and median time to recurrence (TTR) was 47.7 ± 38.5 months (range 3.0-194.3 months). Survival was 24.2% (64/265) 53.2% were luminal A (LABC) (141/265), 18.5% were luminal B (LBBC) (49/265), 18.5% were triple negative (TNBC) (49/265), and 9.8% were human epidermal growth factor receptor-2 overexpressing (HER2 +) (26/265). TTR for patients with LABC was 56.0 ± 41.3 months, LBBC was 48.4 ± 41.1 months, TNBC was 26.9 ± 28.5 months and HER2 + was 34.3 ± 21.8 months. Increased grade (P < 0.001), Nottingham Prognostic Indices (P < 0.001), TNBC (P < 0.001), HER2 + subtype (P < 0.001) and receiving targeted therapy (P = 0.006) predicted shorted TTR. Estrogen receptor positivity (P < 0.001), progesterone receptor positivity (P = 0.010), invasive lobular carcinoma (P = 0.009) and receiving endocrine therapy (P = 0.001) predicted longer TTR. CONCLUSION Readily available clinicopathological factors predict risk of metastatic dissemination. Developing a tailored program to identify patients at risk of recurrence is crucial in controlling metastatic dissemination of breast cancer.
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Affiliation(s)
- Donald Courtney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Matthew G Davey
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland.
| | - Brian M Moloney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Michael K Barry
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Karl Sweeney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Ray P McLaughlin
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Carmel M Malone
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Aoife J Lowery
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
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Davey MG, Kerin E, O'Flaherty C, Maher E, Richard V, McAnena P, McLaughlin RP, Sweeney KJ, Barry MK, Malone CM, Wyns W, Soliman O, Miller N, Keane MM, Lowery AJ, Kerin MJ. Clinicopathological response to neoadjuvant therapies and pathological complete response as a biomarker of survival in human epidermal growth factor receptor-2 enriched breast cancer - A retrospective cohort study. Breast 2021; 59:67-75. [PMID: 34171619 PMCID: PMC8234352 DOI: 10.1016/j.breast.2021.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human epidermal growth factor receptor-2 (HER2) is overexpressed in 20-25% of breast cancers. Complete eradication of disease following neoadjuvant therapies and chemotherapy has been referred to as pathological complete response (pCR). AIMS To determine clinicopathological predictors of pCR to neoadjuvant therapies and to evaluate pCR as a surrogate to enhanced survival. METHODS Consecutive female patients with HER2 positive (HER+) breast cancer managed surgically in a single institution between 2005 and 2015 were included. Descriptive statistics and binary logistic regression were used to determine predictors of pCR. Appraisal of pCR as a predictor of survival was performed using Kaplan-Meier curves and Cox regression analysis. RESULTS 451 patients were included with a mean age of 56.6 ± 13.4 years (range 23-95). Disease-free (DFS) and overall survival (OS) was 82.3% (371/451) and 82.6% (376/451) respectively with a median follow-up of 108.0 months (range 3-184.0). 118 were treated in the neoadjuvant setting (26.2%): tumour size <50 mm (Odds Ratio (OR): 12.156, P = 0.023) and progesterone receptor negativity (OR: 2.762, P = 0.008) independently predicted breast pCR, while ductal carcinoma (OR: 3.203, P = 0.030) and grade 3 disease (OR: 2.788, P = 0.018) predicted axillary pCR. Both breast and axillary pCR predicted enhanced DFS (Hazard Ratio (HR): 0.470 & HR: 0.449) and OS (HR: 0.383 & HR: 0.307). Axillary pCR independently predicted improved OS (HR: 0.326). CONCLUSION pCR is sensitive biomarker and surrogate to survival outcomes in HER2+ breast cancer. Patients likely to achieve pCR may be predicted from traditional clinicopathological characteristics and molecular parameters.
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Affiliation(s)
- Matthew G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Eoin Kerin
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - C O'Flaherty
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Elizabeth Maher
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Vinitha Richard
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Peter McAnena
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Ray P McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Karl J Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - William Wyns
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Nicola Miller
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J Kerin
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
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McLaughlin RP, Mason GS, Miller AL, Stipe CB, Kearns JD, Prier MW, Rarick JD. Note: A portable laser induced breakdown spectroscopy instrument for rapid sampling and analysis of silicon-containing aerosols. Rev Sci Instrum 2016; 87:056103. [PMID: 27250478 PMCID: PMC5441304 DOI: 10.1063/1.4949506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A portable instrument has been developed for measuring silicon-containing aerosols in near real-time using laser-induced breakdown spectroscopy (LIBS). The instrument uses a vacuum system to collect and deposit airborne particulate matter onto a translatable reel of filter tape. LIBS is used to analyze the deposited material, determining the amount of silicon-containing compounds present. In laboratory testing with pure silica (SiO2), the correlation between LIBS intensity for a characteristic silicon emission and the concentration of silica in a model aerosol was determined for a range of concentrations, demonstrating the instrument's plausibility for identifying hazardous levels of silicon-containing compounds.
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Affiliation(s)
- R P McLaughlin
- Department of Chemistry, Seattle University, Seattle, Washington 98122, USA
| | - G S Mason
- Department of Mechanical Engineering, Seattle University, Seattle, Washington 98122, USA
| | - A L Miller
- National Institute for Occupational Health and Safety (NIOSH), Spokane, Washington 99207, USA
| | - C B Stipe
- TSI, Inc., Great Falls, Montana 59405, USA
| | - J D Kearns
- Department of Mechanical Engineering, Seattle University, Seattle, Washington 98122, USA
| | - M W Prier
- Department of Mechanical Engineering, Seattle University, Seattle, Washington 98122, USA
| | - J D Rarick
- Department of Chemistry, Seattle University, Seattle, Washington 98122, USA
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Abstract
The purpose of this study was to clarify morphological differences between Caucasian and Japanese mandibular clinical arch forms in Class I, II, and III malocclusions. The study included 60 Class I, 50 Class II, and 50 Class III cases from each ethnic group. The most facial portion of 13 proximal contact areas was digitized from photocopied images of the mandibular dental arches. Clinical bracket points were calculated for each tooth based on mandibular tooth thickness data. Four linear and 2 proportional measurements were taken. The dental arches were classified into square, ovoid, and tapered forms to determine and compare the frequency distributions between the 2 ethnic groups. The Caucasian population had a statistically significant decreased arch width and increased arch depth compared with the Japanese population. When the subjects were regrouped by arch form, no statistically significant difference in arch dimension was observed between the 2 ethnic groups in any of the arch form samples. Our results suggest that there is no single arch form specific to any of the Angle classifications or ethnic groups. It appears to be the frequency of a particular arch form that varies among Angle classifications or ethnic groups.
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Affiliation(s)
- K Nojima
- Department of Orthodontics, Tokyo Dental College, Chiba, Japan.
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McLaughlin RP, Bennett JC. The dental VTO: an analysis of orthodontic tooth movement. J Clin Orthod 1999; 33:394-403. [PMID: 10535022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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McLaughlin RP. H. pylori eradication therapy. Ala Med 1996; 65:20-2. [PMID: 8871512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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McLaughlin RP, Bennett JC. Bracket placement with the preadjusted appliance. J Clin Orthod 1995; 29:302-11. [PMID: 8617853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Extraction has been a controversial subject for as long as the specialty of orthodontics has existed. Some authors believe that the extraction of premolars leads to temporomandibular disorders. This occurs, they say, because the vertical dimension collapses. Concomitantly, over-retraction and retroclination of the incisors cause the facial profile to flatten, bring about premature anterior contacts, and distally displace the mandible and mandibular condyle. Numerous correlation studies in the dental literature do not support this contention. There appears to be no higher incidence of temporomandibular disorders in patients treated with the extraction of premolars than in nontreated patients or those treated without extractions. Analysis of premolar extraction cases reveals that there is no collapse of the vertical dimension; on the contrary, the vertical dimension is either maintained or slightly opened. Similarly, there is no evidence that premolar extraction causes undesirable flattening of the facial profile. The facial profile established during treatment is primarily the result of diagnosis and treatment mechanics. Excessive anterior interferences resulting in possible posterior condyle displacement are the result of treatment mechanics. When arches are leveled properly and space closure and overjet reduction are adequately controlled, there is no reason that such interferences should occur.
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Cusimano C, McLaughlin RP, Zernik JH. Effects of first bicuspid extractions on facial height in high-angle cases. J Clin Orthod 1993; 27:594-8. [PMID: 8056862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- C Cusimano
- Department of Orthodontics, School of Dentistry, University of Southern California, Los Angeles 90089
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Bennett JC, McLaughlin RP. Overjet reduction with a preadjusted appliance system. J Clin Orthod 1992; 26:293-309. [PMID: 1430180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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McLaughlin RP, Bennett JC. Anchorage control during leveling and aligning with a preadjusted appliance system. J Clin Orthod 1991; 25:687-96. [PMID: 1814949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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McLaughlin RP, Bennett JC. Finishing and detailing with a preadjusted appliance system. J Clin Orthod 1991; 25:251-64. [PMID: 1939626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Bennett JC, McLaughlin RP. Management of deep overbite with a preadjusted appliance system. J Clin Orthod 1990; 24:684-96. [PMID: 2084157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bennett JC, McLaughlin RP. Controlled space closure with a preadjusted appliance system. J Clin Orthod 1990; 24:251-60. [PMID: 2094736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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McLaughlin RP, Bennett JC. The transition from standard edgewise to preadjusted appliance systems. J Clin Orthod 1989; 23:142-53. [PMID: 2606968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
A review of changing attitudes and information on temporomandibular joint disorders, with a compilation of clinical conditions that can contribute to such problems.
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Tieszen RL, McLaughlin RP. Carraway Methodist Medical Center's true story, or how to assure professional goals and exchange ideas on patient care through audit. QRB Qual Rev Bull 1976; 2:3-6, 27-8. [PMID: 823500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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McLaughlin RP, Scholz DA, McConahey WM, Childs DS. Metastatic thyroid carcinoma with hyperthyroidism: two cases with functioning metastatic follicular thyroid carcinoma. Mayo Clin Proc 1970; 45:328-35. [PMID: 5439138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Extraction has been a controversial subject for as long as the specialty of orthodontics has existed. Some authors believe that the extraction of premolars leads to temporomandibular disorders. This occurs, they say, because the vertical dimension collapses. Concomitantly, over-retraction and retroclination of the incisors cause the facial profile to flatten, bring about premature anterior contacts, and distally displace the mandible and mandibular condyle. Numerous correlation studies in the dental literature do not support this contention. There appears to be no higher incidence of temporomandibular disorders in patients treated with the extraction of premolars than in nontreated patients or those treated without extractions. Analysis of premolar extraction cases reveals that there is no collapse of the vertical dimension; on the contrary, the vertical dimension is either maintained or slightly opened. Similarly, there is no evidence that premolar extraction causes undesirable flattening of the facial profile. The facial profile established during treatment is primarily the result of diagnosis and treatment mechanics. Excessive anterior interferences resulting in possible posterior condyle displacement are the result of treatment mechanics. When arches are leveled properly and space closure and overjet reduction are adequately controlled, there is no reason that such interferences should occur.
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