Different subtypes of chronic fatigue in childhood cancer survivors: A DCCSS LATER study

INTRODUCTION

The aim of the current study was to investigate whether subtypes of chronic fatigue (CF) can be identified in childhood cancer survivors (CCS), and if so, to determine the characteristics of participants with a specific subtype.

METHODS

Participants were included from the nationwide DCCSS LATER cohort. The Checklist Individual Strength (CIS) was completed to assess fatigue. Participants with CF (scored ≥35 on the fatigue severity subscale and indicated to suffer from fatigue for ≥6 months) were divided into subgroups using two-step cluster analysis based on the CIS concentration, motivation, and physical activity subscales. Differences between groups on demographics, psychosocial, lifestyle, and treatment-related variables were determined using ANOVA and chi-square analyses (univariable) and multinomial regression analysis (multivariable).

RESULTS

A total of 1910 participants participated in the current study (n = 450 with CF; n = 1460 without CF). Three CF subgroups were identified: Subgroup 1 (n = 133, 29% of participants) had CF with problems in physical activity; Subgroup 2 (n = 111, 25% of participants) had CF with difficulty concentrating; and Subgroup 3 (n = 206, 46% of participants) had multi-dimensional CF. Compared to Subgroup 1, Subgroup 2 more often reported sleep problems, limitations in social functioning, and less often have more than two comorbidities. Subgroup 3 more often reported depression, sleep problems, a lower self-esteem, and limitations in social functioning and a lower educational level compared to Subgroup 1.

CONCLUSION

Different subgroups of CCS with CF can be identified based on fatigue dimensions physical activity, motivation and concentration. Results suggest that different intervention strategies, tailored for each subgroup, might be beneficial.

5.5-year-survival of CAD/CAM resin-based composite restorations in severe tooth wear patients

OBJECTIVES

Aim of this prospective study was to assess full mouth rehabilitation of severe tooth wear patients using minimally invasive CAD/CAM resin-based composite (RBC) restorations and direct veneers by evaluating restoration survival up to 5.5-years.

METHODS

Twenty-two patients with generalized severe tooth wear with functional and/or esthetic problems were included. Following minimally invasive preparation, CAD/CAM RBC restorations (LAVA Ultimate,3M) were adhesively luted, direct RBC veneers (Filtek Supreme XTE, 3M) were applied in the aesthetic region. Patients were recalled after 1m,1y,3y,5y and seen in between recalls by their general dentists or at the clinical study center if complaints occurred. Failures were categorized as F1 (severe deficiencies requiring replacement/extraction), F2 (localized deficiencies requiring re-cementation/repair) and F3 (small chippings requiring refurbishment/monitoring). Survival of indirect restorations was evaluated using lifetables and Kaplan-Meier-graphs, distinguishing between failure categories and tooth type (front teeth=FT, premolars=PM, molars=M). F1 + F2 and F1 + F2 + F3 failures were analyzed using Cox regression on the variables tooth type/ location, age, gender and VDO increase (p < 0.05).

RESULTS

568 indirect restorations and 200 direct veneers in 21 patients evaluated for up to 5.5-years. For indirect restorations, 96 failures were recorded (F1:6;F2:41;F3:49) and annual failure rates were 0.29%(FT), 1.56%(PM), 2.93%(M) for F1 +F2 and 0.53%(FT), 2.42%(PM), 6.11%(M) for F1 + F2 + F3. Reasons for failure were chipping fracture (48), adhesive fracture (32), complete debonding (7), caries (4), endodontic treatment (1) and reasons unknown (documentation general dentists, 4). Molar tooth type had a statistically significantly increased probability of failure compared with front teeth and premolars for F1 + F2 + F3 (p < 0.006). Direct veneer restorations showed 18 failures (F1:2;F2:9;F3:7).

SIGNIFICANCE

Minimally invasive CAD/CAM RBC restorations combined with direct RBC veneers showed an acceptable clinical mid-term survival for restorative rehabilitation of severely worn dentitions.

Chronic fatigue in childhood cancer survivors is associated with lifestyle and psychosocial factors; a DCCSS LATER study

BACKGROUND

The purpose of this study was to determine factors associated with chronic fatigue (CF) in childhood cancer survivors (CCS).

PATIENTS AND METHODS

Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS (≥5 years after diagnosis) and siblings as controls. Fatigue severity was assessed with the 'fatigue severity subscale' of the Checklist Individual Strength ('CIS-fatigue'). CF was defined as scoring ≥35 on the 'CIS-fatigue' and having fatigue symptoms for ≥6 months. Twenty-four parameters were assessed, categorized into assumed fatigue triggering, maintaining and moderating factors. Multivariable logistic regression analyses were carried out to investigate the association of these factors with CF.

RESULTS

A total of 1927 CCS participated in the study (40.7% of invited cohort), of whom 23.6% reported CF (compared with 15.6% in sibling controls, P < 0.001). The following factors were associated with CF: obesity [versus healthy weight, odds ratio (OR) 1.93; 95% confidence interval (CI) 1.30-2.87], moderate physical inactivity (versus physical active, OR 2.36; 95% CI 1.67-3.34), poor sleep (yes versus no, OR 2.03; 95% CI 1.54-2.68), (sub)clinical anxiety (yes versus no, OR 1.55; 95% CI 1.10-2.19), (sub)clinical depression (yes versus no, OR 2.07; 95% CI 1.20-3.59), pain (continuous, OR 1.49; 95% CI 1.33-1.66), self-esteem (continuous, OR 0.95; 95% CI 0.92-0.98), helplessness (continuous, OR 1.13; 95% CI 1.08-1.19), social functioning (continuous, OR 0.98; 95% CI 0.97-0.99) and female sex (versus male sex, OR 1.79; 95% CI 1.36-2.37).

CONCLUSION

CF is a prevalent symptom in CCS that is associated with several assumed maintaining factors, with lifestyle and psychosocial factors being the most prominent. These are modifiable factors and may therefore be beneficial to prevent or reduce CF in CCS.

Translation and Validation of the Dutch Version of the Sun Exposure and Protection Index

INTRODUCTION

Skin cancer is currently the most common cancer type worldwide, and numbers are rapidly increasing. To improve primary prevention, individualised prevention strategies may be of interest as this enhances the chance of long-term behavioural change. The Sun Exposure and Protection Index (SEPI), previously validated in multiple languages, is a tool that could help identify individuals with risky behaviour and tailor interventions to the person's propensity to change. The aim of the present study was to investigate the reliability and validity of a Dutch version of the SEPI for both usage in daily clinical practice and research.

METHODS

Patients were included at primary care settings and dermatology outpatient settings in a 1:1 ratio. Participants were asked to fill out the SEPI together with some baseline characteristics and the previously validated FACE-Q Skin Cancer - Sun Protection module. Construct validity was tested by comparing SEPI part I and the FACE-Q module using Spearman's Rho. Internal consistency was assessed with Cronbach's Alpha for both SEPI parts separately. To assess test-retest reliability, the SEPI was again filled out 3 weeks later, and scores were compared with Cohen's weighted Kappa.

RESULTS

Of the 171 participants completing the first questionnaire, 147 (86.0%) participants also completed the follow-up questionnaire. Comparison between the corresponding SEPI part I and FACE-Q module questions showed good correlations regarding sun exposure habits (correlation coefficients ranging from 0.61 to 0.85). Internal consistency of SEPI part I was 0.63 and SEPI part II was 0.65. The test-retest analysis indicated reproducibility over time (weighted Kappa ranging from 0.38 to 0.76).

CONCLUSION

In conclusion, the Dutch version of the SEPI is shown to be a valid and reliable tool for both usages in daily clinical practice and research to evaluate individual ultraviolet exposure and measure a person's propensity to limit it.

Inter- and intra-variability in tooth wear progression at surface-, tooth- and patient-level over a period of three years: A cohort study: Inter- and intra-variation in tooth wear progression

OBJECTIVE

To explore the variability of tooth wear progression at the surface-, tooth- and patient-level over a period of three years three years using in vivo 3D-measurements of full dentitions amongst patients with moderate to severe tooth wear and without demand for restorative rehabilitation.

METHODS

Fifty-five eligible patients with moderate to severe tooth wear had intra-oral scans taken using either the 3 M True Definition Intraoral Scanner or the 3 M Lava Chairside Oral Scanner. The maximum height loss (µm) per cusp/incisal/palatal surface at unrestored surfaces was measured using the 3D Wear Analysis (3DWA)-protocol with Geomagic Qualify, resulting in sixty-four measurements per dentition. Data was visualized using box plots. Correlation was calculated between tooth wear progression rates of different tooth types and surfaces.

RESULTS

Thirty patients with scans at intake and after three years were included (38 ± 8 years, 77% M, 23% F). Mean observation time was 3.1 ± 0.2 years. Surface measurements (N = 1,615) showed a high deviation and a high number of outliers at all surfaces, indicating large variability amongst the surfaces, tooth types and patients with tooth wear progression rates. Correlations between regions were very low: anterior-molar region -0.219, anterior-premolar region 0.116 and premolar-molar region 0.113. Correlations between the surfaces of molars were also low (between 0.190 and 0.565).

CONCLUSIONS

In a group of patients with moderate to severe tooth wear, large differences in wear progression were found within and amongst patients. Tooth wear progression is therefore highly individualized and can be very localized.

CLINICAL SIGNIFICANCE

This study confirms the necessity of individual management of patients with moderate to severe tooth wear. Effective monitoring of tooth wear is important when deciding the timing and need for restorative intervention.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04790110.

Fatigue behaviour of a self-healing dental composite

OBJECTIVE

Novel self-healing resin-based composites containing microcapsules have been developed to improve the mechanical performance of dental restorations. However, the long-term fatigue behaviour of these self-healing composites has still been hardly investigated. Therefore, this manuscript studied the fatigue behaviour of self-healing composites containing microcapsules by subjecting the specimens to traditional staircase tests and ageing in a custom-designed chewing simulator (Rub&Roll) to simulate oral ageing physiologically relevant conditions.

METHODS

To prepare self-healing composite, poly(urea-formaldehyde) microcapsules containing acrylic self-healing liquids were synthesized. Subsequently, these microcapsules (10 wt%) and initiator (benzoyl peroxide, BPO, 2 wt%) were incorporated into a commercial flowable resin-based composite. Microcapsule-free resin-based composites with and without BPO were also prepared as control specimens. A three-point flexural test was used to measure the initial flexural strength (Sinitial). Subsequently, half of the specimens were used for fatigue testing using a common staircase approach to measure the fatigue strengths (FS). In addition, the other specimens were aged in the Rub&Roll machine for four weeks where after the final flexural strength (Sfinal) was measured.

RESULTS

Compared to Sinitial, FS of all tested specimens significantly decreased as measured through staircase testing. After 4 weeks of ageing in the Rub&Roll machine, Sfinal was significantly reduced compared to Sinitial for microcapsule-free resin-based composites, but not for the self-healing composites (p = 0.3658). However, the self-healing composites are still in the experimental phase characterized by a low mechanical strength, which still impedes further clinical translation.

SIGNIFICANCE

Self-healing composites containing microcapsules exhibit improved fatigue resistance compared to microcapsule-free non-self-healing composites.

Five years clinical outcome of maxillary mini dental implant overdenture treatment: A prospective multicenter clinical cohort study

BACKGROUND

The long-term clinical outcome of mini dental implants (MDIs) to support an overdenture is underreported especially in severely atrophic maxillae and when installed flaplessly.

PURPOSE

The current report is a 5-years follow-up of the previously published 2- and 3-years clinical outcome of MDIs supporting a maxillary overdenture in narrow alveolar ridges. MDI survival, marginal bone level, peri-implant health, technical complications, and oral health related quality of life (OHIP) and respective changes over time are reported.

MATERIALS AND METHODS

Subjects aged 50 years or older, in need of improvement of maxillary denture retention, were included. The MDIs were 2.4 mm diameter one-piece tapered implants, Class 4 pure Titanium, and lengths 10 or 11.5 mm. Under local anesthesia, 5-6 MDIs were placed in atrophic maxillae with a free-handed flapless approach. One week postoperative the denture was adapted with a retentive soft reliner. The final prosthetic connection was established after 6 months with a metal-reinforced horse-shoe denture. Clinical outcome after 5 years was assessed with probing pocket depts (PPD), bleeding on probing (BoP), and additional cone beam computed tomography (CBCT) MDI bone level measurements were performed. Oral Health-Related Quality of Life (OHRQoL) investigated with OHIP-14 was assessed preoperative, during provisional loading, and after final prosthetic connection up to 5 years.

RESULTS

Initially, 31 patients (14 females and 17 males) with mean age 62.30 underwent treatment. In the provisional loading interval, 16 patients encountered 32/185 MDIs failures, resulting in a failure of 17.3%; 170 MDIs were functionally loaded in 29 patients. Additionally, 14 implants were lost in three patients, all of whom had had already previous failures. Reimplantation of 17 MDIs were performed during the provisional loading and 2 MDI after functional loading. After 5 years, the absolute implant failure rate was 46/204 (22.5%), corresponding to a cumulative failure rate of 23.2%. Prosthetic failure was observed in four patients due to implant loss and in two patients related to excessive one-piece implant ball attachment wear, making the 5-years prosthetic success 80.0%. The mean PPD and absence/presence of BoP for 149 implants at 5 years was 4.3 and 0.2 mm, respectively. Average mesial-distal-vestibular-palatal bone loss in the interval 2-5 years was 0.08 mm. No statistically significant difference in marginal MDI bone loss between male or female (p = 0.835), smoking and nonsmoking (p = 0.666) was observed. The five-years total measured CBCT interdental bone level (mesial and distal) correlates with the 5-years PPD (Pearson 0.434; p = 0.01). After 5 years, OHRQoL with the treatment procedure was assessed in 27/31 participants. Decreasing mean total OHIP-14 scores with improved OHRQoL, was observed in 27/31 participants, with values of 21.3 at baseline to 15.6 at the time of provisional loading which significantly (p = 0.006) decrease to 7.3 at the final prosthetic connection. The next 3-5 years further decrease was observed with 6.5 and 4.96, respectively.

CONCLUSIONS

Maxillary MDIs for overdentures are an accessible and acceptable treatment option. Although after 5 years between one fifth and one fourth of the MDIs were lost, prosthetic success remains 80.0% and high OHRQoL could be achieved.

Perception of oral health related quality of life and orofacial aesthetics following restorative treatment of tooth wear: A five-year follow-up

OBJECTIVES

Non-carious tooth wear often has a multifactorial etiology and may lead to functional or aesthetically related problems. The most common complaints associated with tooth wear are dissatisfaction with dental appearance and a negative impact on the experienced Oral Health Related Quality of Life (OHRQoL). The aim of this study was to investigate the change in OHRQoL and the perception of aesthetics, following restorative treatment of moderate to severe tooth wear patients, with a five-year follow-up.

METHODS

An explorative study, based on prospective data, was performed. OHRQoL and the perception of aesthetics were measured with the OHIP-NL and OES-NL. These questionnaires were completed before treatment, one month after treatment, and at 1-, 3- and 5-years post-treatment. Treatment involved full mouth reconstruction with composite resin restorations. The data was analysed as repeated measures by using a linear mixed-effects model.

RESULTS

One hundred and twenty-three tooth wear patients that received restorative rehabilitation were included (97 males, 26 females, 37.5 ± 8.8 years-old). Data showed a statistically significant increase in both experienced OHRQoL and orofacial appearance after restorative treatment. The OHIP-scores remained stable over time, while the OES-scores slightly decreased during the years after treatment. Regarding the seven domains of the OHIP, the largest difference in OHIP-score was found in the domain of 'Psychological Discomfort'. The mean overall OHIP-score was 1.8 at baseline and 1.3 at the 5-years recall. The mean OES score increased from 41.8 at baseline to 66.1 at the 5-years follow-up.

CONCLUSIONS

Tooth wear patients reported significant improvements in their OHRQoL and their perception of orofacial aesthetics after restorative treatment. This increase remained at least five years post-treatment.

CLINICAL SIGNIFICANCE

The clinical impact of restorative treatment for tooth wear patients is considerable. This paper emphasizes the need to include a discussion of the patient related outcome measures when planning care.

Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa

BACKGROUND

Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors.

METHODS

An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital.

RESULTS

The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities.

CONCLUSION

The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.

Wear behaviour of direct composite restorations in tooth wear patients: a 5-year clinical study

OBJECTIVE

This study aimed to investigate the wear behaviour of direct composite restorations after 5 years and associated patient factors.

METHODS

38 patients (6 females, 32 males; 35.2 ± 7.6y) from the Radboud Tooth Wear Project with generalized moderate to severe tooth wear were treated with direct composite restorations on all teeth. Ethical approval was sought and granted before the study was undertaken. Intraoral 3D scans were recorded at 1 month (baseline) and 5 years (recall) after treatment. The amount of height loss was measured at six index teeth (first molars and upper central incisors). Patient factors (age, vertical dimension of occlusion increase, bite force, aetiology score, jaw position and bearing/ non-bearing cusps) were included in the analysis. Multilevel multiple regression with bootstrapping was used to analyse the influence of these factors on wear behaviour of restorations. Observer reliability was tested by paired t-tests and Band-Altman plots (p<0.05) RESULTS: After 5 years, the mean height loss was 0.23± 0.19 mm for incisors and 0.43± 0.24 mm for molars (p≤0.001). Patient factors did not show any significant influence on height loss of the composite restorations, while bearing cusps showed significant more wear compared to non-bearing cusps (p≤0.001). The observer reliability tests confirmed the repeatability (correlation of 0.809, DME 0.103).

CONCLUSIONS

Wear of composite restorations is a significant and relevant factor over time in patients treated with severe tooth wear. Within the limitations of this clinical study, patient factors were found not to have a significant effect on wear behaviour of direct composite restorations.

Effect of Sinus Perforation with Flaplessly Placed Mini Dental Implants for Oral Rehabilitation: A 5-Year Clinical and Radiological Follow-Up

Background: Flaplessly placed one-piece mini dental implants (MDI) are an option to support maxillary overdentures. Evenly distribution of the implants over the atrophic alveolar process implies a risk of accidental sinus perforation in the posterior area which could induce sinus-related pathology. Methods: Thirty-one patients received 5–6 maxillary MDIs. Schneiderian membrane swelling was assessed with CBCT at the deepest point of the sinus in the mid-sagittal plane prior to surgery (baseline), after 2 and 5 years. Additionally, subjective patient-reported rhinosinusitis complaints, the effect of smoking, and gender differences were investigated. Results: Mean thickness of the Schneiderian membrane was 2.87 mm at baseline, 3.15 mm at 2 years, and 4.30 mm at 5 years in 27 of 31 initially treated patients. MDI perforation was detected in 21/54 sinuses. At 2 years, perforation length does not affect membrane thickness whereas baseline swelling does. In smokers, each perforated mm induced 0.87 mm additional swelling. After 5 years, the effect of baseline swelling becomes smaller whereas perforation length became statistically significant, with 0.53 mm increase for every perforated mm. The effect of smoking lost its significance. No relations between gender, membrane thickness changes, or subjective clinical sinus complaints and MDI perforation were found. Conclusion: Accidental MDI sinus perforation induces Schneiderian membrane swelling but does not interfere with clinical sinusal outcome after 5 years.

The Impact of Cancer-Related Fatigue on HRQOL in Survivors of Childhood Cancer: A DCCSS LATER Study

Simple Summary

Survivors of childhood cancer have an increased risk to experience symptoms of severe and persistent fatigue. We studied how fatigue might affect the health-related quality of life of these survivors. Questionnaire items asking about a broad range of daily life aspects were compared between fatigued survivors, survivors without fatigue and the general Dutch population. A total of eleven aspects were studied which were all negatively affected by fatigue, with the largest impact seen for Vitality (how much energy does a person have), General Health (perception of current and future health) and Role Limitations (work-related activities). Results show the negative impact fatigue can have on the daily lives of survivors and why it is important to treat fatigue adequately.

Abstract

Background: Early detection and management of late effects of treatment and their impact on health-related quality of life (HRQOL) has become a key goal of childhood cancer survivorship care. One of the most prevalent late effects is chronic fatigue (CF). The current study aimed to investigate the association between CF and HRQOL in a nationwide cohort of CCS. Methods: Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS. Participants completed the Checklist Individual Strength (CIS) to indicate CF (CIS fatigue severity subscale ≥ 35 and duration of symptoms ≥6 months) and the Short Form-36 (SF-36) and TNO (Netherlands Organization for Applied Scientific Research) and AZL (Leiden University Medical Centre) Adult’s Health-Related Quality of Life questionnaire (TAAQOL) as measures for HRQOL. Differences in mean HRQOL domain scores between CF and non-CF participants were investigated using independent samples t-tests and ANCOVA to adjust for age and sex. The association between CF and impaired HRQOL (scoring ≥ 2 SD below the population norm) was investigated using logistic regression analyses, adjusting for confounders. Results: A total of 1695 participants were included in the study. Mean HRQOL domain scores were significantly lower in participants with CF. In addition, CF was associated with impaired HRQOL on all of the domains (except physical functioning) with adjusted odds ratios ranging from 2.1 (95% CI 1.3–3.4; sexuality domain) to 30.4 (95% CI 16.4–56.2; vitality domain). Conclusions: CF is associated with impaired HRQOL, urging for the screening and regular monitoring of fatigue, and developing possible preventative programs and interventions.

Effect of niche components on masseter satellite cell differentiation on fibrin coatings

In skeletal muscles, niche factors stimulate satellite cells to activate and induce muscle regeneration after injury. In vitro, matrigel is widely used for myoblast differentiation, however, is unsuitable for clinical applications. Therefore, this study aimed to analyze attachment and differentiation of satellite cells into myotubes on fibrin coatings with selected niche components. The attachment of satellite cells to fibrin alone and fibrin with niche components (laminin, collagen‐IV, laminin‐entactin complex [LEC]) were compared to matrigel. Only on matrigel and fibrin with LEC, Pax7‐positive cells attached well. Then, LEC was selected to analyze proliferation, differentiation, and fusion indices. The proliferation index at day 1 on fibrin‐LEC (22.5%, SD 9.1%) was similar to that on matrigel (30.8% [SD 11.1%]). The differentiation index on fibrin‐LEC (28.7% [SD 6.1%] at day 5 and 32.8% [SD 6.7%] at day 7) was similar to that on matrigel (40.1% [5.1%] at day 5 and 27.1% [SD 4.3%] at day 7). On fibrin‐LEC, the fusion index at day 9 (26.9% [SD 11.5%]) was similar to that on matrigel (25.5% [SD 4.7%]). Our results showed that the addition of LEC enhances the formation of myotubes on fibrin. Fibrin with LEC might be suitable to enhance muscle regeneration after surgery such as cleft palate repair and other muscle defects.

Does initial buccal crest thickness affect final buccal crest thickness after flapless immediate implant placement and provisionalization: A prospective cone beam computed tomogram cohort study

BACKGROUND

Flapless immediate implant placement and provisionalization (FIIPP) in the aesthetic zone is still controversial. Especially, an initial buccal crest thickness (BCT) of ≤1 mm is thought to be disruptive for the final buccal crest stability jeopardizing the aesthetic outcome.

PURPOSE

To radiographically assess the BCT and buccal crest height (BCH) after 1 year and to calculate the correlation between initial and final achieved BCT.

MATERIALS AND METHODS

The study was designed as a prospective study on FIIPP. Only patients were included in whom one maxillary incisor was considered as lost. In six centers, 100 consecutive patients received FIIPP. Implants were placed in a maximal palatal position of the socket, thereby creating a buccal space of at least 2 mm, which was subsequently filled with a bovine bone substitute. Files of preoperative (T0), peroperative (T1) and 1-year postoperative (T3) cone beam computed tomogram (CBCT) scans were imported into the Maxillim™ software to analyze the changes in BCT-BCH over time.

RESULTS

Preoperatively, 85% of the cases showed a BCT ≤1 mm, in 25% of the patients also a small buccal defect (≤5 mm) was present. Mean BCT at the level of the implant-shoulder increased from 0.6 mm at baseline to 3.3 mm immediate postoperatively and compacted to 2.4 mm after 1 year. Mean BCH improved from 0.7 to 3.1 mm peroperatively, and resorbed to 1.7 mm after 1 year. The Pearson correlation of 0.38 between initial and final BCT was significant (p = 0.01) and therefore is valued as moderate. If only patients (75%) with an intact alveolus were included in the analysis, still a "moderate correlation" of 0.32 (p = 0.01) was calculated.

CONCLUSIONS

A "moderate correlation" was shown for the hypothesis that "thinner preoperative BCT's deliver thinner BCT's" 1 year after performing FIIPP.

Assessing fatigue in childhood cancer survivors: Psychometric properties of the Checklist Individual Strength and the Short Fatigue Questionnaire--a DCCSS LATER study

Background

Fatigue is often reported by patients with childhood cancer both during and after cancer treatment. Several instruments to measure fatigue exist, although none are specifically validated for use in childhood cancer survivors (CCS). The aim of the current study was to present norm values and psychometric properties of the Checklist Individual Strength (CIS) and Short Fatigue Questionnaire (SFQ) in a nationwide cohort of CCS.

Methods

In total, 2073 participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort. Normative data, construct validity, structural validity, and internal consistency were calculated for the CIS and SFQ. In addition, reliability and a cutoff score to indicate severe fatigue were determined for the SFQ.

Results

Correlations between CIS/SFQ and vitality measures asking about fatigue were high (>0.8). Correlations between CIS/SFQ and measures of different constructs (sleep, depressive emotions, and role functioning emotional) were moderate (0.4–0.6). Confirmatory factor analysis resulted in a four‐factor solution for the CIS and a one‐factor solution for the SFQ with Cronbach's alpha for each (sub)scale showing good to excellent values (>0.8). Test–retest reliability of the SFQ was adequate (Pearson's correlation = 0.88; ICC = 0.946; weighted Cohen's kappa item scores ranged 0.31–0.50) and a cut‐off score of 18 showed good sensitivity and specificity scores (92.6% and 91.3%, respectively).

Conclusion

The current study shows that the SFQ is a good instrument to screen for severe fatigue in CCS. The CIS can be used as a tool to assess the multiple fatigue dimensions in CCS.

Prevalence and risk factors of cancer-related fatigue in childhood cancer survivors: A DCCSS LATER study

Background

Cancer‐related fatigue is a debilitating late effect after treatment for childhood cancer. The prevalence of fatigue in childhood cancer survivors (CCSs) and associated factors for fatigue has varied widely in previous studies. Two important aspects of cancer‐related fatigue, its severity and chronicity, are often not assessed. This study investigated the prevalence of, and risk factors for, severe chronic fatigue (CF) in a national cohort of Dutch CCSs.

Methods

In this study, 2810 CCSs (5‐year survivors of all childhood malignancies diagnosed between 1963 and 2001 with a current age of 12‐65 years) and 1040 sibling controls were included. CF was assessed with the Short Fatigue Questionnaire and was defined as a score ≥ 18 and persistence of fatigue for ≥6 months. Cancer‐ and treatment‐related characteristics, current health problems, and demographic and lifestyle variables were assessed as potential risk factors for CF via multivariable logistic regression analyses.

Results

In adult CCSs and sibling controls (≥18 years old), the prevalence of CF was 26.1% and 14.1%, respectively (P < .001). In adolescent CCSs and sibling controls (<18 years old), the prevalence of CF was 10.9% and 3.2%, respectively. Female gender (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.73‐2.62), unemployment (OR, 2.18; 95% CI, 1.67‐2.85), having 1 or more health problems (OR for 1‐2, 1.48; 95% CI, 1.18‐1.87; OR for >2, 2.20; 95% CI, 1.50‐3.21), and a central nervous system diagnosis (OR, 1.74; 95% CI, 1.17‐2.60) were significantly associated with CF in adult CCSs.

Conclusions

This study shows that CCSs, regardless of their cancer diagnosis, report CF more often than sibling controls. This study provides new evidence for the prevalence of fatigue in CCSs.

One in 4 childhood cancer survivors reports chronic fatigue. Current health problems increase the risk of reporting chronic fatigue.

Wear behavior of a microhybrid composite vs. a nanocomposite in the treatment of severe tooth wear patients: A 5-year clinical study

OBJECTIVE

This study aimed to compare the wear behavior of a microhybrid composite vs. a nanocomposite in patients suffering from severe tooth wear.

METHODS

A convenience sample of 16 severe tooth wear patients from the Radboud Tooth Wear Project was included. Eight of them were treated with a microhybrid composite (Clearfil APX, Kuraray) and the other eight with a nanocomposite (Filtek Supreme XTE, 3M). The Direct Shaping by Occlusion (DSO) technique was used for all patients. Clinical records were collected after 1 month (baseline) as well as 1, 3 and 5 years post-treatment. The maximum height loss at specific areas per tooth was measured with Geomagic Qualify software. Intra-observer reliability was tested with paired t-tests, while multilevel logistic regression analyses were used to compare odds ratios (OR) of "large amount of wear".

RESULTS

Intra-observer reliability tests confirmed that two repeated measurements agreed well (p > 0.136). For anterior mandibular teeth, Filtek Supreme showed significantly less wear than Clearfil APX; in maxillary anterior teeth, Clearfil APX showed significantly less wear (OR _material = 0.28, OR _{jaw position} = 0.079, p < 0.001). For premolar and molar teeth, Filtek Supreme showed less wear in bearing cusps, whereas Clearfil APX showed less wear in non-bearing cusps (premolar: OR _material = 0.42, OR _{bearing condition} = 0.18, p = 0.001; molar: OR _material = 0.50, OR _{bearing condition} = 0.14, p < 0.001).

SIGNIFICANCE

Nanocomposite restorations showed significantly less wear at bearing cusps, whereas microhybrid composite restorations showed less wear at non-bearing cusps and anterior maxillary teeth.

Four-implant-supported overdenture treatment in the maxilla. Part I: A randomized controlled split mouth trial assessing the effect of microthreads and abutment connection type on 4 years peri-implant health

BACKGROUND

According to literature, peri-implant bone loss is minimized on implants with microthreaded neck design and internal type of abutment connection. However, most clinical studies may be biased due to confounding factors.

PURPOSE

This nonblinded RCT assessed the effect of implant neck (microthreaded vs non-microthreaded) as well as the type of abutment connection (internal conical vs external flat-to-flat) on peri-implant bone stability and peri-implant health after at least 36 months.

MATERIALS AND METHODS

Twenty-five patients were treated with a maxillary implant-supported bar-retained overdenture on four different implant types: internal connection with microthreads (I-MT), internal connection without microthreads (I-NMT), external connection with microthreads (E-MT), and external connection without microthreads (E-NMT). To control confounding factors, all other design features were similar. A linear mixed-model analysis or mixed-model logistic regression analysis was used to determine the effect of implant type on bone level, probing pocket depth, bleeding on probing, and plaque.

RESULTS

Four out of 98 implants (4.1%) placed in 25 patients failed during provisionalization and were replaced. Mean overall bone loss after 6 months was 0.39 mm (SD 0.62, range 0.00-3.48) with limited additional bone loss of 0.04 mm (SD 0.54, range -1.80-1.63) after at least 3 years. Microthreads or connection type had no effect on the bone level, probing pocket depth, bleeding on probing, nor plaque.

CONCLUSIONS

With 96% of implant survival, the maxillary overdenture supported with a bar on four implants yield a predictable outcome and the implant-abutment connection type (internal vs external) and implant neck design (microthreaded vs non-microthreaded) have no influence on peri-implant bone remodeling after initial bone remodeling nor up to 4 years of function. Peri-implant bone levels are within international success standards and peri-implant health is indicative of absence of peri-implantitis.

Methodology of the DCCSS later fatigue study: a model to investigate chronic fatigue in long-term survivors of childhood cancer

BACKGROUND

A debilitating late effect for childhood cancer survivors (CCS) is cancer-related fatigue (CRF). Little is known about the prevalence and risk factors of fatigue in this population. Here we describe the methodology of the Dutch Childhood Cancer Survivor Late Effect Study on fatigue (DCCSS LATER fatigue study). The aim of the DCCSS LATER fatigue study is to examine the prevalence of and factors associated with CRF, proposing a model which discerns predisposing, triggering, maintaining and moderating factors. Triggering factors are related to the cancer diagnosis and treatment during childhood and are thought to trigger fatigue symptoms. Maintaining factors are daily life- and psychosocial factors which may perpetuate fatigue once triggered. Moderating factors might influence the way fatigue symptoms express in individuals. Predisposing factors already existed before the diagnosis, such as genetic factors, and are thought to increase the vulnerability to develop fatigue. Methodology of the participant inclusion, data collection and planned analyses of the DCCSS LATER fatigue study are presented.

RESULTS

Data of 1955 CCS and 455 siblings was collected. Analysis of the data is planned and we aim to start reporting the first results in 2022.

CONCLUSION

The DCCSS LATER fatigue study will provide information on the epidemiology of CRF and investigate the role of a broad range of associated factors in CCS. Insight in associated factors for fatigue in survivors experiencing severe and persistent fatigue may help identify individuals at risk for developing CRF and may aid in the development of interventions.

"Longitudinal Oral Health-Related Quality of Life in maxillary mini dental implant overdentures after 3 years in function"

OBJECTIVES

Longitudinal evaluation of Oral Health-Related Quality of Life (OHRQoL) during treatment of flaplessly placed, one-piece mini-dental-implants (MDIs) for maxillary overdentures is rarely investigated, nor is the impact of MDI failures.

MATERIAL AND METHODS

This multicenter prospective cohort study evaluated the 3-year outcome of 5-6 MDIs in the edentulous maxilla in patients above 50 years with dentate mandible. Provisional dentures were provided before final prosthetic connection was established at 6 months. Postoperative discomfort was assessed using a visual analogue score (VAS). OHRQoL was investigated using the Oral Health Impact Profile (OHIP)-14 at baseline (preoperatively), postoperatively, post-prosthetic connection and after 3 years in function.

RESULTS

164 (78.4%) of the 204 placed MDIs were still in situ after 3 years, in 29/31 patients. Two patients lost 5/6 MDIs resulting in two prosthetic failures (6.45%). With regard to pain, a score of 4.1/10 (SD 2.8) was recorded on day 1, and 1.1/10 (SD 1.7) on day 7. A decrease in total OHIP-14 scores was observed postoperatively (15.6; SD 12.8) as compared to baseline (21.3; SD 13.1), with improvement of OHRQoL. Furthermore, this was statistically significant at connection of the final prosthesis (7.3; SD 6.7) (p = .006). The OHIP-14 improved less (p = .011) when experiencing one or more implant losses (9.5; SD: 9.85), in comparison with no implant loss (20.7; SD: 13.97). A failure of one MDI did not affect OHIP-14 score (p = .658); however, multiple failures did (p = .007).

CONCLUSION

Maxillary MDI overdenture treatment yields significant OHRQoL improvement when at least 5 MDIs survive, preserving functional comfort.

Short fatigue questionnaire: Screening for severe fatigue

OBJECTIVE

To determine psychometric properties, a cut-off score for severe fatigue and normative data for the 4-item Short Fatigue Questionnaire (SFQ) derived from the multi-dimensional fatigue questionnaire Checklist Individual Strength (CIS).

METHODS

Data of previous studies investigating the prevalence of fatigue in ten chronic conditions (n = 2985) and the general population (n = 2288) was used to determine the internal consistency (Cronbach's alpha) of the SFQ, its relation with other fatigue measures (EORTC QLQ-30 fatigue subscale and digital fatigue diary), a cut-off score for severe fatigue (ROC analysis) and to examine whether the four SFQ items truly measure the same construct. Norms were calculated for ten patient groups and the Dutch general population.

RESULTS

Cronbach's alpha of the SFQ were excellent in almost all groups. Pearson's correlations between the SFQ and the EORTC-QLQ-C30 fatigue subscale and a fatigue diary were respectively 0.76 and 0.68. ROC analysis showed an area under the curve of 0.982 (95% CI: 0.979-0.985) and cut-off score of 18 was suggested which showed a good sensitivity (0.984) and specificity (0.826) as well as excellent values for the positive and negative prediction values within all groups using the CIS as golden standard. Factor analysis showed a one factor solution (Eigenvalue: 3.095) with factor loadings of all items on the factor being greater than 0.87.

CONCLUSION

The SFQ is an easy to use, reliable and valid instrument to screen for severe fatigue in clinical routine and research.

Three-dimensional characterization of mandibular asymmetry in craniofacial microsomia

Objectives

This study aimed to investigate the three-dimensional (3D) mandibular asymmetry in craniofacial microsomia (CFM) and its association with the Pruzansky–Kaban classification system.

Materials and methods

Cone-beam computed tomography images of 48 adult CFM cases were collected. The asymmetry of the mandibular body and ramus was analyzed with 3D landmarks. The mirrored mandibular model was registered on the original model, yielding a color-coded distance map and an average distance (i.e., asymmetry score) to quantify the overall mandibular asymmetry.

Results

The lengths of the mandibular body and ramus were significantly shorter on the affected than the contralateral side (p < 0.001). The ANB (p = 0.009), body and ramal lengths (both p < 0.001), and body and ramal length asymmetry (both p < 0.05) were significantly different between mild (types I/IIA) and severe (types IIB/III) cases. The mandibular asymmetry score correlated with mandibular body length asymmetry (r = 0.296, p = 0.046). CFM mandibles showed high variability in shape asymmetry.

Conclusions

CFM patients showed distinct body and ramal length asymmetries. In severe cases, mandibles were smaller, more retruded, and more asymmetric in length. The mandibular shape asymmetry was highly variable regardless of the Pruzansky–Kaban types, being a determinant in the extent of overall mandibular asymmetry.

Clinical relevance

The 3D morphologic analysis provides better insights into real mandibular asymmetry. Although the Pruzansky–Kaban classification was applied, high individual variability of the mandibular morphology still existed within the types. Therefore, individualized analyses and treatment plans for CFM patients are highly recommended.

Immediate implant placement and provisionalization: Aesthetic outcome 1 year after implant placement. A prospective clinical multicenter study

BACKGROUND

Prospective aesthetic outcomes on a high number of patients after immediate implant placement and provisionalization (IIPP) are lacking.

PURPOSE

To analyze the aesthetic outcome after IIPP.

MATERIALS AND METHODS

One hundred consecutive patients with a failing maxillary incisor were provided with an immediately placed and provisionalized nonloaded implant using a flapless procedure and palatal implant positioning. The remaining gap buccally was filled with a bone substitute. Preoperatively (T0), 2 weeks postoperatively (T1), direct after placement of the permanent crown (T2), and 1 year after IIPP (T3), standardized light photographs were made. Change in aesthetic score was the primary outcome measure. Both the white aesthetic score (WES) and pink aesthetic score (PES) were used.

RESULTS

In the first year postsurgery, the mean total-WES and total-PES scores raised from 4.5 to 8.2, and from 9.9 to 12.1, respectively. The mean PES scores for mesial and distal papilla, soft tissue marginal level, contour, color, and texture, raised significantly (P < .05), while the alveolar process contour, on average, remained stable from T0 to T3.

CONCLUSIONS

Within the limitations of this 1-year research, it may be concluded that, following this minimal invasive IIPP procedure, a high aesthetic outcome was achieved.

Cost-Effectiveness Analysis of Peripheral Nerve Field Stimulation as Add-On Therapy to Spinal Cord Stimulation in the Treatment of Chronic Low Back Pain in Failed Back Surgery Syndrome Patients

OBJECTIVE

Presently, there is only limited evidence about the cost-effectiveness of peripheral nerve field stimulation (PNFS) and no evidence to date on the cost-effectiveness of PNFS as an add-on therapy to spinal cord stimulation (SCS). In a multicenter randomized controlled trial, PNFS as add-on therapy to SCS demonstrated clinical effectiveness in treating chronic low back pain in failed back surgery syndrome (FBSS) patients. We report here the cost-effectiveness of PNFS as additional therapy.

MATERIALS AND METHODS

Cost-effectiveness analysis was performed from a health-care perspective using the general principles of cost-utility analysis, using empirical data from our multicenter randomized controlled trial on the effectiveness of hybrid SCS + PNFS on low back pain in FBSS patients, who were back pain non-responders to initial SCS-therapy, over a time-horizon of three months. Outcome measures were costs and quality-adjusted life-years (QALYs). Cost and QALYs were integrated using the net monetary benefit (NMB). Differences in costs, effects, and NMB were analyzed using multilevel regression. Uncertainty surrounding the NMB was presented by cost-effectiveness acceptability curves.

RESULTS

A total of 52 patients implanted with both SCS and PNFS, randomly assigned to a group with PNFS either activated or inactive, completed the controlled part of the study. With mean total costs for the SCS + active PNFS group of €1813.86 (SD €109.78) versus €1103.64 (SD €123.43) for the SCS + inactive PNFS group at three months, we found an incremental cost-utility ratio of €25.311 per QALY gained and a probability being cost-effective of more than 80% given a willingness to pay for a QALY of about €40.000.

CONCLUSIONS

From a Dutch national health-care context, when the willingness to pay threshold is up to 60.000 Euros per QALY, PNFS as an add-on therapy to SCS for the treatment of low back pain in FBSS patients has a high probability of being cost-effective.

Improvement of Quality of Life with Implant-Supported Mandibular Overdentures and the Effect of Implant Type and Surgical Procedure on Bone and Soft Tissue Stability: A Three-Year Prospective Split-Mouth Trial

In fully edentulous patients, the support of a lower dental prosthesis by two implants could improve the chewing ability, retention, and stability of the prosthesis. Despite high success rates of dental implants, complications, such as peri-implantitis, do occur. The latter is a consequence of crestal bone loss and might be related to the implant surface and peri-implant soft tissue thickness. The aim of this paper is to describe the effect of implant surface roughness and soft tissue thickness on crestal bone remodeling, peri-implant health, and patient-centered outcomes. The mandibular overdenture supported by two implants is used as a split-mouth model to scrutinize these aims. The first study compared implants placed equicrestal to implants placed biologically (i.e., dependent on site-specific soft tissue thickness). The second clinical trial compared implants with a minimally to a moderately rough implant neck. Both studies reported an improvement in oral health-related quality of life and a stable peri-implant health after three years follow-up. Only equicrestal implant placement yielded significantly higher implant surface exposure, due to the establishment of the biologic width. Within the limitations of this study, it can be concluded that an implant supported mandibular overdenture significantly improves the quality of life, with limited biologic complications and high survival rates of the implants.

A new segmentation algorithm for measuring CBCT images of nasal airway: a pilot study

Background

Three-dimensional (3D) modeling of the nasal airway space is becoming increasingly important for assessment in breathing disorders. Processing cone beam computed tomography (CBCT) scans of this region is complicated, however, by the intricate anatomy of the sinuses compared to the simpler nasopharynx. A gold standard for these measures also is lacking. Previous work has shown that software programs can vary in accuracy and reproducibility outcomes of these measurements. This study reports the reproducibility and accuracy of an algorithm, airway segmentor (AS), designed for nasal airway space analysis using a 3D printed anthropomorphic nasal airway model.

Methods

To test reproducibility, two examiners independently used AS to edit and segment 10 nasal airway CBCT scans. The intra- and inter-examiner reproducibility of the nasal airway volume was evaluated using paired t-tests and intraclass correlation coefficients. For accuracy testing, the CBCT data for pairs of nasal cavities were 3D printed to form hollow shell models. The water-equivalent method was used to calculate the inner volume as the gold standard, and the models were then embedded into a dry human skull as a phantom and subjected to CBCT. AS, along with the software programs MIMICS 19.0 and INVIVO 5, was applied to calculate the inner volume of the models from the CBCT scan of the phantom. The accuracy was reported as a percentage of the gold standard.

Results

The intra-examiner reproducibility was high, and the inter-examiner reproducibility was clinically acceptable. AS and MIMICS presented accurate volume calculations, while INVIVO 5 significantly overestimated the mockup of the nasal airway volume.

Conclusion

With the aid of a 3D printing technique, the new algorithm AS was found to be a clinically reliable and accurate tool for the segmentation and reconstruction of the nasal airway space.

Fluoroquinolone-resistant Salmonella typhi infection: a report of two cases in South Africa

Typhoid and paratyphoid fever are acute, life-threatening febrile illnesses caused by systemic infection with the bacterium Salmonella enterica. Nineteen cases were reported in South Africa in 2016. We report on two cases of bacteraemic invasive S. typhi with fluoroquinolone resistance.

SASOCP position statement on the pharmacist’s role in antibiotic stewardship 2018

Antibiotics are the most commonly prescribed medicines in global healthcare practice today. Their effectiveness is crucial and often life-saving in humanity’s battle against pathogens and infectious diseases. Antibiotic/antimicrobial stewardship strategies and programmes have become vital to the preservation of effective antibiotics and the optimisation of their use. The South African Society of Clinical Pharmacy (SASOCP) has written this guideline to outline the importance, role and purpose of pharmacists in such stewardship programmes, both in the public, as well as the private hospital sectors in South Africa. It also provides an overview of various approaches to antibiotic preservation, behavioural change, stewardship measures, and monitoring strategies.

Immediate implant placement: the fate of the buccal crest. A retrospective cone beam computed tomography study

This retrospective study aimed to analyse the fate of the buccal crest after immediate implant placement (IIP) through the use of cone beam computed tomography (CBCT). In 16 consecutive patients, an implant was placed in a more palatal position after extraction, thereby creating a gap of at least 2mm between the implant and the buccal crest. Subsequently, this gap was filled with a bone substitute. Preoperatively, immediate postoperatively, and late postoperatively, a CBCT was made to measure the thickness of the buccal crest. After application of the bone substitute, the buccal crest increased in thickness from 0.9mm to 2.4mm (mean). At a mean of 103 weeks after IIP, late postoperative CBCT scans showed that the thickness of the buccal crest was compacted to 1.8mm. In the same period, the height of the buccal crest increased by 1.6mm (mean) to, on average, 1.2mm above the implant shoulder. The aesthetic outcome was analysed using the White and Pink Esthetic Score (WES and PES). Both scored high: 8.4 and 11.8, respectively. Within the limitations of this study, the results of this IIP protocol are promising. Long-term prospective research on this topic on a large number of patients is necessary.

Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery

Background

Clinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships.

Methods

A cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient’s opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses’ observation of patient’s performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients’ performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO.

Results

15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0–4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power.

Conclusions

Our results suggest pain management should be guided by the many dimensions of the patient’s pain experience, not solely by NRS cut-off points. Future research should evaluate the impact of such multidimensional pain assessment on patients’ functional outcome.

Comparison of Three Methods of Rating Nasolabial Appearance in Cleft Lip and Palate

OBJECTIVE

To investigate which of three methods of rating nasolabial appearance-esthetic index, visual analogue scale (VAS), or numerical scale with reference photographs-is optimal.

DESIGN

Experimental study.

SETTING

Radboud University Medical Centre, The Netherlands and University of Bern, Switzerland.

SUBJECTS AND METHODS

Cropped photographs of 60 patients with complete unilateral cleft lip and palate (mean age = 10.8 years) were used for rating. A panel of eight raters rated four components of nasolabial morphology (nasal shape, nose deviation, vermillion border, and profile view) using three methods: 5-point esthetic index, 100 mm VAS, and 0 to 200 numerical scale with reference photographs (reference scores method). Method reliability was assessed by re-evaluation of 20 images after >1 month. Intraclass correlation coefficients were calculated to evaluate consistency of each method.

RESULTS

Overall reference scores method always produced more reproducible results (i.e., higher ICCs) than did VAS or the esthetic index. However, statistically significant differences were found between reference scores and esthetic index in rating nasal shape, nose deviation, and vermillion border only (P < 0.001, <0.001, and 0.012, respectively) and between reference scores and VAS in rating nose deviation and vermillion border (P < 0.001 and 0.017, respectively).

CONCLUSION

We recommend the use of reference photographs along with the VAS or numerical (from 0 to 200) semi-continuous scale. The esthetic index, based on a Likert-type scale, seems to produce the most variable results and, therefore, is not preferred.

A retrospective survey of the causes of bracket- and tube-bonding failures

OBJECTIVE

To investigate the causes of bonding failures of orthodontic brackets and tubes and the effect of premedicating for saliva reduction.

MATERIALS AND METHODS

Premedication with atropine sulfate was administered randomly. Failure rate of brackets and tubes placed in a group of 158 consecutive patients was evaluated after a mean period of 67 weeks after bonding.

RESULTS

The failure rate in the group without atropine sulfate premedication was 2.4%. In the group with premedication, the failure rate was 2.7%. The Cox regression analysis of these groups showed that atropine application did not lead to a reduction in bond failures. Statistically significant differences in the hazard ratio were found for the bracket regions and for the dental assistants who prepared for the bonding procedure.

CONCLUSIONS

Premedication did not lead to fewer bracket failures. The roles of the dental assistant and patient in preventing failures was relevant. A significantly higher failure rate for orthodontic appliances was found in the posterior regions.

A survey of general dentists regarding orthodontic retention procedures

AIM

To explore 1. how Swiss general dentists deal with complications associated with fixed orthodontic retainers, 2. collaboration between general dentists and orthodontists with regards to the organization and responsibility for long-term follow-up of orthodontic retainers, and 3. the need for standardized clinical guidelines regarding orthodontic retention.

METHODS

A structured questionnaire was sent to 201 randomly selected dentists. They were asked about their experience with retainers, opinions regarding the advantages and disadvantages of different types of retainers, responsibility for patients wearing bonded retention and the communication between orthodontists and general dentists. Statistical analysis was carried out using SPSS software.

RESULTS

The response rate was 61 per cent. About 55 per cent of the respondents had had experience with bonding fixed retainers and even more were familiar with their follow-up and repair. In case of complications, dentists usually contacted orthodontists according to the following rule: the more severe the complication, the more intense the communication. Most dentists hesitated to remove retainers when requested to do so by the patient and attempted to convince them to continue wearing them. Retainers bonded to all six anterior teeth were considered more efficient than those bonded to canines only; however, possible side effects (e.g. unwanted changes of the torque) were not well known. 66.4 per cent respondents were willing to take responsibility for patients in retention as early as 6 months after retainer placement. 93.2 per cent respondents would welcome the establishment of standardized guidelines.

CONCLUSIONS

Swiss general dentists have good knowledge of orthodontic retention and follow-up procedures. Nevertheless, introduction of clinical guidelines including information on the possible side-effects of bonded retention is justified.

Effect of Remaining Cavity Wall, Cervical Dentin, and Post on Fracture Resistance of Endodontically Treated, Composite Restored Premolars

PURPOSE

The aim of this study was to examine the effect of remaining buccal cavity wall, remaining cervical tissue, and post on the fracture strength of endodontically treated restored premolars.

MATERIALS AND METHODS

Teeth were randomly allocated to 10 experimental groups (n=10) according to cavity design and presence or absence of post or to a control group. After thermal and mechanical aging, ramped loading until fracture was performed.

RESULTS

A high cervical outline (417 N) and the presence of a post (189 N) increased fracture strength, but both factors together had an antagonistic effect of -218 N, resulting in a higher strength of not 606 N (417+189) but 388 N. The risk of catastrophic failure increased (OR=3.17) when a post was present.

Validation of a Dutch version of the Geriatric Oral Health Assessment Index (GOHAI-NL) in care-dependent and care-independent older people

BACKGROUND

The GOHAI is a frequently used instrument to measure oral health-related quality of life (OHRQoL) of adults, in particular older people. The aim of this study was to translate the original English version of the GOHAI into a Dutch version (GOHAI-NL), and to test the validity and reliability of the GOHAI-NL in care-independent and care-dependent older people.

METHODS

The GOHAI questionnaire was translated into Dutch, discussed by an expert panel, back-translated to the original, pilot-tested and assessed for cognitive and conceptual equivalence. The resulting GOHAI-NL was tested in a groups of care-independent (Group A, n = 109, mean age 73.1 ± 5.4 years) and care-dependent (Group B, n = 118, mean age 85.6 ± 7.0. years) cognitively alert people of 65 years and over. Psychometric properties including reliability (internal consistency, item-total, item-dimension, dimension-total, inter-item correlation, and test-retest stability), and validity (convergent, discriminant, known-group), and floor and ceiling effects were assessed.

RESULTS

Internal consistency was confirmed by Cronbach's alphas of 0.86 (group A) and 0.80 (group B). Item-total score correlations were between 0.4 and 0.7 except for item 3 in group A (0.34) and B (0.08) and for item 12 in group A (0.20). Item-dimension and dimension-total correlations were between 0.30 and 0.78 and around 0.7 respectively for the dimensions 'physical functioning' and 'psychosocial functioning', but lower for the dimension 'pain and discomfort' with item-dimension correlations between 0.13 and 0.44. Average inter-item correlations were 0.34 ± 0.11 (group A) and 0.33 ± 0.08 (group B). Test-retest correlation of the total score (GOHAI-ADD) was 0.88 in group A (ICCs: 0.62 - 0.88) and 0.93 in group B (ICCs: 0.64 - 0.91). Significant correlations in the expected direction were found between GOHAI and most oral health-related variables except for presence of caries in group A, and perceived general health, prosthodontic status and number of natural teeth in group B. No floor or ceiling effects were detected at GOHAI-ADD level; however ceiling effects did occur at dimension level.

CONCLUSION

The GOHAI-NL has satisfactory reliability and validity and can be used to measure OHRQoL in Dutch care-dependent and care-independent older people.

The role of proprotein convertase subtilisin/kexin type 9 inhibitors in managing cardiovascular risk

Hypercholesterolaemia and dyslipidaemia, marked by decreased levels of high-density lipoprotein and elevated levels of lowdensity lipoprotein (LDL), increase the risk of cardiovascular disease. Familial hypercholesterolaemia (FH), diagnosed based on the clinical features seen in patients with a positive family history, constitutes a heritable disorder involving a single gene. FH can exist in either the heterozygous or homozygous form, and may be differentiated based on clinical features and genetic studies. A novel drug target, proprotein convertase subtilisin/kexin type 9 (PCSK9), has resulted in the development and subsequent approval of new, targeted monoclonal antibodies in the treatment of FH. Targeting PCSK9 with monoclonal antibodies, i.e. evolocumab and alirocumab, inhibits the degradation of LDL receptors, and against a background of optimised statin therapy, increases the life expectancy of patients with hypercholesterolaemia by reducing the incidence and severity of coronary artery disease.

Rating nasolabial appearance on three-dimensional images in cleft lip and palate: a comparison with standard photographs

BACKGROUND/OBJECTIVE

Judgement of nasolabial aesthetics in cleft lip and palate (CLP) is a vital component of assessment of treatment outcome. It is usually performed based on two-dimensional (2D) facial photographs. An increasing use of three-dimensional (3D) imaging warrants an assessment if 3D images can substitute 2D photographs during aesthetic evaluation. The aim of this study was to compare reliability of rating nasolabial appearance on 3D images and standard 2D photographs in prepubertal children.

METHODS

Forty subjects (age: 8.8-12) with unilateral CLP treated according to a standardized protocol, who had 2D and 3D facial images were selected. Eight lay raters assessed nasal form, nasal deviation, vermilion border, and nasolabial profile on cropped 2D and 3D images using a 100-mm visual analogue scale (VAS). Additionally, raters answer two questions: 1. Do 2D or 3D images provide more information on nasolabial aesthetics? and 2. Is aesthetic evaluation easier on 2D or 3D images?

RESULTS

Intrarater agreement demonstrated a better reliability of ratings performed on 3D images than 2D images (correlation coefficients for 3D images ranged from 0.733 to 0.857; for 2D images from 0.151 to 0.611). The mean scores showed, however, no difference between 2D and 3D formats (>0.05). 3D images were regarded more informative than 2D images (P = 0.001) but probably more difficult to evaluate (P = 0.06).

LIMITATIONS

Basal view of the nose was not assessed.

CONCLUSIONS

3D images seem better than 2D images for rating nasolabial aesthetics but raters should familiarize themselves with them prior to rating.

Distribution of permanent canine agenesis in Down syndrome: 15 cases from a Centre for Special Care Dentistry

The purpose of this study was to investigate the distribution of permanent canine agenesis in subjects with Down syndrome (DS). Subjects with canine agenesis were determined by means of panoramic radiographs from 150 DS subjects attending a center for special care dentistry. Our results confirm the high prevalence of agenetic canines in DS (21 canines, 14%). We found specific effects on the distribution both of phenotype and of location (jaw). In subjects with a mild expression of hypodontia (phenotype nonoligodontia) agenetic canines primarily occurred in the mandibula, whereas in subjects with severe hypodontia (phenotype oligodontia) agenetic canines virtually only occurred in the maxilla. In both phenotypes cooccurrence of an agenetic lateral incisor with an agenetic canine was observed in the maxilla. It was striking that canine agenesis in the mandibula did not cooccur with agenesis of other teeth. These results can be important for treatment planning.

Longevity of posterior composite restorations: a systematic review and meta-analysis

The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.

Sealant retention is better assessed through colour photographs than through the replica and the visual examination methods

The aim of this study was to test the hypothesis that the colour photograph method has a higher level of validity for assessing sealant retention than the visual clinical examination and replica methods. Sealed molars were assessed by two evaluators. The scores for the three methods were compared against consensus scores derived through assessing retention from scanning electron microscopy images (reference standard). The presence/absence (survival) of retained sealants on occlusal surfaces was determined according to the traditional and modified categorizations of retention. Sensitivity, specificity, and Youden-index scores were calculated. Sealant retention assessment scores for visual clinical examinations and for colour photographs were compared with those of the reference standard on 95 surfaces, and sealant retention assessment scores for replicas were compared with those of the reference standard on 33 surfaces. The highest mean Youden-index score for the presence/absence of sealant material was observed for the colour photograph method, followed by that for the replica method; the visual clinical examination method scored lowest. The mean Youden-index score for the survival of retained sealants was highest for the colour photograph method for both the traditional (0.882) and the modified (0.768) categories of sealant retention, whilst the visual clinical examination method had the lowest Youden-index score for these categories (0.745 and 0.063, respectively). The colour photograph method had a higher validity than the replica and the visual examination methods for assessing sealant retention.