Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction

This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.     

Quantitative evaluation of background parenchymal enhancement (BPE) on breast MRI. A feasibility study with a semi-automatic and automatic software compared to observer-based scores

Objective:

To evaluate quantitative measurements of background parenchymal enhancement (BPE) on breast MRI and compare them with observer-based scores.

Methods:

BPE of 48 patients (mean age: 48 years; age range: 36–66 years) referred to 3.0-T breast MRI between 2012 and 2014 was evaluated independently and blindly to each other by two radiologists. BPE was estimated qualitatively with the standard Breast Imaging Reporting and Data System (BI-RADS) scale and quantitatively with a semi-automatic and an automatic software interface. To assess intrareader agreement, MRIs were re-read after a 4-month interval by the same two readers. The Pearson correlation coefficient (r) and the Bland–Altman method were used to compare the methods used to estimate BPE. p-value <0.05 was considered significant.

Results:

The mean value of BPE with the semi-automatic software evaluated by each reader was 14% (range: 2–79%) for Reader 1 and 16% (range: 1–61%) for Reader 2 (p > 0.05). Mean values of BPE percentages for the automatic software were 17.5 ± 13.1 (p > 0.05 vs semi-automatic). The automatic software was unable to produce BPE values for 2 of 48 (4%) patients. With BI-RADS, interreader and intrareader values were κ = 0.70 [95% confidence interval (CI) 0.49–0.91] and κ = 0.69 (95% CI 0.46–0.93), respectively. With semi-automated software, interreader and intrareader values were κ = 0.81 (95% CI 0.59–0.99) and κ = 0.85 (95% CI 0.43–0.99), respectively. BI-RADS scores correlated with the automatic (r = 0.55, p < 0.001) and semi-automatic scores (r = 0.60, p < 0.001). Automatic scores correlated with the semi-automatic scores (r = 0.77, p < 0.001). The mean percentage difference between automatic and semi-automatic scores was 3.5% (95% CI 1.5–5.2).

Conclusion:

BPE quantitative evaluation is feasible with both semi-automatic and automatic software and correlates with radiologists'' estimation.

Advances in knowledge:

Computerized BPE quantitative evaluation is feasible with both semi-automatic and automatic software. Computerized BPE quantitative scores correlate with radiologists'' estimation.     

The NUGGET study: NIR ultra gold-gilded equivalency trial.

This study should clarify whether the gold-coated NIROYAL stent is equivalent to the stainless steel NIR stent. Patients were randomized to either NIR stent (n = 298) or a NIROYAL stent (n = 305). The primary endpoint was the minimum lumen diameter of the target lesion at 6 months postprocedure. Secondary endpoints focused on clinical events. At 30 days, adverse events were similar in both groups. At 6 months, the minimal lumen diameter was 1.83/1.64 mm (P < 0.001; 95% CI = 0.08-0.30) and the angiographic restenosis rate was 20.6%/37.7% (P < 0.001; 95% CI = -24.7 to -9.3) for NIR/NIROYAL. The 6-month MACE rates were NIR 7.4% and NIROYAL 10.5% (95% CI = -7.7 to 1.4). Compared to stainless steel stent, the NIROYAL stent demonstrated a smaller minimal lumen diameter, a higher late loss (i.e., higher neointimal hyperplasia in spite of a significantly better initial gain), with higher restenosis and similar MACE rates at 6 months.     

Does clinical experience affect the reproducibility of cervical vertebrae maturation method?

Objective:To assess interobserver and intraobserver reproducibility of the cervical vertebrae maturation method (CVMM) among three panels of judges with different levels of orthodontic experience (OE).Materials and Methods:Fifty individual lateral cephalograms of good quality with complete visualization of cervical vertebrae 1 to 4 were selected. Thirty clinicians, divided according to their OE into three groups (junior group, JU, OE ≤ 1 year; postgraduate group, PG, 2 ≤ OE ≤ 4 years; specialist group, SP, OE ≥ 7 years), evaluated the cephalograms in two sessions (T₁ and T₂) at 3 weeks apart. Kendall''s W and weighted Cohen''s kappa (κ) coefficients were performed to assess interobserver and intraobserver agreement. The level of significance was set as P < .05. For both the interobserver and the intraobserver datasets, the percentage of perfect agreement (PPA) and the number of stages apart for each disagreement were calculated.Results:Kendall''s W at T₁ was SP  =  0.61, PG  =  0.70, and JU  =  0.87; at T₂ it was SP  =  0.78, PG  =  0.85, and JU  =  0.86. The percentage of total interobserver perfect agreement (Inter-PPA) was 42.3% at T₁ and 46.3% at T₂. The JU group had the highest Cohen''s κ coefficient at 0.78, while the PG and SP had coefficients of 0.64 each. The percentage of total intraobserver perfect agreement (Intra-PPA) was 54.2%.Conclusions:The reproducibility of the method was not improved by the level of orthodontic experience. The group with the lowest level of orthodontic experience had the best performance.