Effect of Operator Experience on Ability to Place Sequential, 2-mm-thick Increments of Composite

Because an operator has only about one chance out of three to place a composite increment within this clinically acceptable range, clinicians are advised to use an instrument (e.g., a periodontal probe with a 2-mm mark) to estimate the thickness of each increment of composite they place.

SUMMARY

Objective: To measure and compare the effect of operator experience in their ability to place composite in increments that are 2 mm thick.Methods and Materials: Fifteen volunteers from each class of freshmen, sophomores, juniors, and senior dental students and 15 clinical faculty (total number of volunteers = 75) were asked to restore a Class I preparation that was 5 mm in diameter and 8 mm deep from the cusp tips using three increments of composite that were each to be 2 mm thick. Once completed, the models were sectioned, and the thickness of each increment was measured. A repeated-measures analysis of variance (pre-set α=0.05) was used to compare the mean increment thickness with respect to operator experience level and increment sequence number. In addition, the proportion of operators placing clinically acceptable increments (between 1.75 and 2.25 mm thick), as well as the proportions from each group who placed increments that either were thinner or thicker than this range, was determined using nonparametric analyses.Results: Overall, there was an increasing trend for groups with a higher experience level to provide mean incremental thickness values close to 2 mm. However, the likelihood of placing an increment that was thicker or thinner than the manufacturer-recommended thickness was not significantly different. Regardless of the increment value, only about one-third of the increments placed fell within the desired range of 1.75 to 2.25 mm.Conclusions: Operator experience had no overwhelming significant influence on the ability to place increments of composite that were between 1.75 and 2.25 mm thick. An operator has only about one chance out of three to place a composite increment within this clinically acceptable range when using no external measurement system.

Amniotic fluid index curves in the obese gravida

OBJECTIVE

To determine whether amniotic fluid volume as measured by amniotic fluid index (AFI) is influenced by maternal pre-gestational obesity as measured by body mass index (BMI).

METHODS

This was a retrospective cohort study of pregnant women between 20 and 43 weeks gestation receiving ultrasounds with AFI measurements at Augusta University Medical Center between 2003 and 2017. A subset of 500 charts that met inclusion and exclusion criteria were reviewed to obtain maternal clinical data. The study cohort was subdivided by maternal BMI at initial obstetric visit into three groups: normal weight (18.5 kg/m2-24.9 kg/m2), overweight (25.0 kg/m2-29.9 kg/m2), and obese (≥ 30 kg/m2). Chi-square analysis was used to compare BMI groups in terms of categorical clinical characteristics and outcome variables, and analysis of variance (ANOVA) was used for continuous variables. Mixed effects regression models (MRMs) were used to evaluate AFI throughout gestation separately in each group, and MRM-based analysis of covariance was used to compare AFI throughout gestation among groups. AFI curves were constructed for the 5th, 50th, and 95th percentiles for all study subjects combined and separately for normal weight, overweight, and obese subjects.

RESULTS

Fitted curves relating AFI percentiles to estimated gestational age (EGA) showed statistically significant differences among BMI groups. There was also a significant difference in AFI over gestation across the obesity groups.

CONCLUSION

Fitted curves for AFI throughout pregnancy showed statistically significant differences among BMI groups.

Application of radiopaque micro-particle fillers for 3-D imaging of periodontal pocket analogues using cone beam CT

BACKGROUND

Periodontitis is an infectious/inflammatory disease most often diagnosed by deepening of the gingival sulcus, which leads to periodontal pockets (PPs) conventional manual periodontal probing does not provide detailed information on the three-dimensional (3-D) nature of PPs.

OBJECTIVES

To determine whether accurate 3-D analyses of the depths and volumes of calibrated PP analogues (PPAs) can be obtained by conventional cone beam computed tomography (CBCT) coupled with novel radiopaque micro-particle fillers (described in the companion paper) injected into the PPAs.

METHODS

Two PPA models were employed: (1) a human skull model with artificial gingiva applied to teeth with alveolar bone loss and calibrated PPAs, and (2) a pig jaw model with alveolar bone loss and surgically-induced PPAs The PPAs were filled with controlled amounts of radiopaque micro-particle filler using volumetric pipetting Inter-method and intra-method agreement tests were then used to compare the PPA depths and volumes obtained from CBCT images with values obtained by masked examiners using calibrated manual methods.

RESULTS

Significant inter-method agreement (0.938-0.991) and intra-method agreement (0.94-0.99) were obtained when comparing analog manual data to digital CBCT measurements enabled by the radiopaque filler.

SIGNIFICANCE

CBCT imaging with radiopaque micro-particle fillers is a plausible means of visualizing and digitally assessing the depths, volumes, and 3-D shapes of PPs This approach could transform the diagnosis and treatment planning of periodontal disease, with particular initial utility in complex cases Efforts to confirm the clinical practicality of these fillers are currently in progress.

Abstract PD09-07: Breast Cancer Patients with WHO Class II Obesity or Greater (BMI ≥35) Have Poorer Overall Survival after Receiving Chemotherapy Compared to Similar Patients with Lower Body Mass Index

Background: Breast cancer (BCa) is the most common non-cutaneous malignancy and the second leading cause of cancer-related mortality among US women. Obesity has commonly been associated with increased risk for malignancy. There have been few studies looking at the effect of obesity on prognosis in BCa patients receiving chemotherapy (ctx). This retrospective study, conducted at the Medical College of Georgia utilizing tumor registry data, assesses the correlation between body mass index (BMI) and overall survival (OS) in BCa patients receiving ctx.

Methods: Data were obtained from the MCG Tumor Registry (Augusta, GA). Inclusion criteria were all BCa patients receiving ctx between 1997 and 2006. The estimated hazard ratio (HR) from Cox regression was used to measure the association between BMI and OS among these patients. Race, age at diagnosis, stage at diagnosis, and body surface area were considered for inclusion as covariates in the regression model. Results: Data on height and weight from the first day of ctx were collected for a sample of 259 women who received ctx for breast cancer. BMI values were calculated based on these data and categorized using WHO BMI classification parameters. The initial analysis examined women with BMI ≥25 (WHO criteria of overweight or more), which classified 186 women (71.8%) as overweight or more and 73 women (28.2%) as under/normal weight. This analysis did not yield a significant association with OS (unadjusted HR, 1.12; 95% CI, 0.69-1.82; p = 0.652). The next analysis examined women with BMI ≥30 (WHO criteria of class I obesity or more), which classified 115 women (44.4%) as class I obese or more and 144 (55.6%) as non-obese. This cut off demonstrated a decreased

OS for the obese patients, but the results were not statistically significant (unadjusted HR, 1.10; 95% CI, 0.72-1.69; p = 0.650). The final analysis examined women with BMI ≥35 (WHO criteria of class II obesity or more); this yielded 67 women (25.9%) classified as class II obese or more and 192 women (74.1%) classified as less than class II obese. This analysis demonstrated a decreased OS for class II obese or more patients (unadjusted HR, 1.56; 95% CI, 1.00-2.43; p = 0.049). The only other factor that was significantly associated with OS was stage at diagnosis. When the HR for class II obese or more patients was adjusted for stage, statistical significance was retained (HR, 1.57; 95% CI, 1.00-2.44; p = 0.048). Discussion: Women with BCa treated with ctx who are WHO class II obese (BMI ≥35) or more have significantly lower overall survival than women with BMI < 35 regardless of race or age at diagnosis. The statistical significance for OS was also retained when adjusted for stage. A primary limitation of our study was a small sample size. Adjustments to ctx dosing in patients with BMI ≥35 may also affect survival outcomes. Future studies will examine the effect of the type and dosing of ctx regimens used, comorbidities, and actual cause of death in this cohort of patients.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD09-07.

Breast Conservation Therapy for Invasive Lobular Carcinoma: The Impact of Lobular Carcinoma in Situ in the Surgical Specimen on Local Recurrence and Axillary Node Status

Forty patients undergoing breast-conserving therapy for invasive lobular carcinoma were studied for the volume of lobular carcinoma in situ (LCIS) in the surgical specimen and its relationship to the surgical margins. The pathology of all cases was reviewed for margin status as well as the volume of LCIS in the surgical specimen. Mean follow-up time was 67 months. There were no local recurrences despite the fact that 38 per cent of patients had close or involved margins. There was one cancer-related death. Increasing tumor size and moderate or extensive involvement of the surgical specimen with LCIS were found to be independent predictors of axillary node metastases. The volume of LCIS in the surgical did not appear to have an impact on local recurrence. This paper adds to the growing body of literature suggesting that in patients undergoing breast-conserving therapy, LCIS in the surgical margin does not impact the risk of local recurrence and therefore may not require reexcision for close or involved surgical margins.

Breast conservation therapy for invasive lobular carcinoma: the impact of lobular carcinoma in situ in the surgical specimen on local recurrence and axillary node status

Forty patients undergoing breast-conserving therapy for invasive lobular carcinoma were studied for the volume of lobular carcinoma in situ (LCIS) in the surgical specimen and its relationship to the surgical margins. The pathology of all cases was reviewed for margin status as well as the volume of LCIS in the surgical specimen. Mean follow-up time was 67 months. There were no local recurrences despite the fact that 38 per cent of patients had close or involved margins. There was one cancer-related death. Increasing tumor size and moderate or extensive involvement of the surgical specimen with LCIS were found to be independent predictors of axillary node metastases. The volume of LCIS in the surgical did not appear to have an impact on local recurrence. This paper adds to the growing body of literature suggesting that in patients undergoing breast-conserving therapy, LCIS in the surgical margin does not impact the risk of local recurrence and therefore may not require reexcision for close or involved surgical margins.

Depression among nursing home elders: testing an intervention strategy

This study focused on the assessment of depression among nursing home elders, and on determining the efficacy of an intervention strategy for depression using a geropsychiatric nurse in conjunction with trained older adult volunteers in the role of mental health paraprofessionals. Nursing home residents (n = 139) were assessed for depression using the Geriatric Depression Scale (GDS); 94 (68%) were found to have depressive symptomatology. Among those receiving the intervention, depressive symptomatology was significantly reduced, but no significant decline was evident in the control group. The ability of the minimum data set (MDS) to detect depression as compared to the GDS was evaluated. Relationships between depression and health status, life satisfaction, and social support were also examined.