Diagnosis of Vertical Root Fractures by Cone-beam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis

IntroductionThe purpose of this review was to determine the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in detecting vertical root fractures (VRFs) in root-filled teeth compared with a reference standard (direct visualization).MethodsElectronic searches were performed in Medline, Scopus, Cochrane, and gray literature for English language articles until June 2020. Prospective and retrospective clinical studies using CBCT imaging to diagnose VRFs in root-filled teeth were included. Case reports and in vitro studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias and applicability concerns. Meta-analysis was performed using Stata 16.1 software (StataCorp, College Station, TX) via the MIDAS v.3.0 package and METANDI module. Publication bias was evaluated using Deeks’ funnel plot analysis. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was performed to evaluate the certainty of evidence. This systematic review was registered in the Open Science Framework (10.17605/OSF.IO/7JKE2).ResultsEight articles were included in this systematic review and meta-analysis. Risk of bias assessment showed that 5 articles in the patient selection domain had low risk of bias with low applicability concern. In the index test and reference standard domains, 7 articles had moderate risk of bias with moderate applicability concern. Three articles had high RB in the flow and timing domain. There was no publication bias. CBCT imaging had a pooled sensitivity and specificity of 0.78 (95% confidence interval [CI], 0.64–0.88) and 0.80 (95% CI, 0.63–0.91), respectively, and an accuracy of 0.86 (95% CI, 0.83–0.89). CBCT imaging also had pooled positive and negative likelihood ratios of 4 and 0.2, respectively. In GRADE analysis, the quality of evidence was low for sensitivity and moderate for specificity when CBCT imaging was used for the diagnosis of VRF.ConclusionsThe overall quality assessment of the included articles showed that in the patient selection domain, the risk of bias was low, and it was moderate in the index test and reference standard domains. Evidence from this systematic review and meta-analysis indicates that CBCT imaging is still not a good tool for diagnosing VRFs in root-filled teeth compared with direct visualization.     

Influence of Minimally Invasive Access Cavity Designs on the Fracture Resistance of Endodontically Treated Mandibular Molars Subjected to Thermocycling and Dynamic Loading

IntroductionThe aim of this study was to investigate the fracture resistance of endodontically treated and restored permanent mandibular molars with minimally invasive access cavities subjected to thermocycling and dynamic loading.MethodsForty first and second mandibular molars were randomly assigned to 4 groups (n = 10/group) as follows: group 1, control (intact teeth); group 2, traditional access cavity (TradAC); group 3, conservative access cavity (ConsAC); and group 4, truss access cavity (TrecAC). After endodontic treatment, teeth were restored with SDR core (Dentsply Caulk, Milford, DE) and subjected to thermocycling followed by dynamic and static loading with a multiaxial fatigue testing machine (Instron, Canton, MA). The maximum load to fracture and pattern of failure (restorable/unrestorable) were recorded. Data were evaluated with analysis of variance and the Tukey post hoc test for multiple comparisons.ResultsFracture resistance of the samples in the control group were higher than those in the experimental groups (P < .005). TradAC exhibited the least resistance to fracture (P < .005). There was no statistically significant difference in the fracture resistance of ConsAC and TrecAC (P = .361) Unrestorable fractures were more frequent in the TradAC group compared with all other groups.ConclusionsMandibular molars with ConsAC and TrecAC exhibited superior fracture resistance compared with TradAC. TradAC had the highest number of unrestorable fractures.     

Treatment Outcomes of Permanent Immature Teeth with Crown Fracture: A Retrospective Cohort Study

IntroductionCrown fractures are a common type of traumatic dental injury. Various factors may affect the outcome of crown fractures. This study aimed to evaluate the treatment outcomes of immature teeth with a crown fracture.MethodsThis retrospective cohort study included patients who presented to a dental trauma center from 2008–2018 with a history of a crown fracture of immature teeth and at least 6 months of follow-up. Outcomes of primary endodontic or restorative interventions as well as reinterventions were evaluated. Kaplan-Meier curves were used to compare the unadjusted differences in survival time. Logistic and Cox regression analyses were performed to identify potential predictors for complication and survival time, respectively.ResultsThe success rates of the primary interventions for 99 teeth (72 patients) after a median follow-up of 22 months were as follows: cervical pulpotomy (90.4%), partial pulpotomy (85.2%), mineral trioxide aggregate apical barrier (80.0%), root canal treatment (66.6%), and only restoration (47.2%). Teeth that received vital pulp therapy were less prone to complications (adjusted hazard ratio = 0.21; 95% confidence interval, 0.09–0.53; P < .05), whereas those with concomitant luxation injuries were more susceptible to complications (adjusted odds ratio = 2.90; 95% confidence interval, 1.01–8.29; P < .05).ConclusionsCrown fractures had a relatively high favorable prognosis. Vital pulp therapy (partial or cervical pulpotomy) had the highest success rate, whereas cases that received only restoration had the lowest success rate. Teeth with concomitant luxation injuries had more odds and hazards of complications.     

破骨细胞分化在颞下颌关节骨关节炎发生中的作用

目的 探究破骨细胞分化在颞下颌关节骨关节炎(TMJOA)发生中的作用.方法 构建小鼠TMJOA模型,Micro-CT观察TMJOA发生发展过程中髁突骨质变化,苏木素伊红(HE)染色观察TMJOA关节组织学结构变化,抗酒石酸酸性磷酸酶(TRAP)组织染色观察TMJOA关节组织中破骨细胞的存在情况.收集TMJOA患者滑液,...     

Open Reduction Internal Fixation of Condylar Head/Diacapitular Fracture of Mandible: Case Series

ObjectiveSurgical management of condylar head is largely deferred due to the lack of appropriate armamentarium or instrumentation, restricted surgical access and risk of iatrogenic complications. Here we delineate open reduction internal fixation of condylar head fracture with various fixation modalities using specialized instrumentation for visualization and providing access for reduction with minimal complications.MethodsA total of 21 patients were reported with condylar head fracture of mandible to the Department of Oral and Maxillofacial Surgery from January 2017 to June 2018. Three patients had bilateral condylar head fracture, making it a total of 24 fractures. All patients had clinical symptoms including deranged occlusion, limited mouth opening, jaw deviation and restricted mandibular movements. The radiological findings were dislocated or displaced condylar head medially or laterally. All patients were treated by open reduction internal fixation using lag screws or standard long screws.ResultsAmong condylar head fractures, 19 of the study population were male and 2 were female. Distribution of age among the condylar head fractures ranges from 19 years to 40 years with the mean being 22 years. At the end of three-month follow-up, all patients had satisfactory results, both clinically and radiologically. The functional outcome of this study was found to be superior.ConclusionWe recommend open reduction internal fixation of condylar head for patients with high risk of ankylosis, and it is possible without complications due to the availability of minimally invasive surgical access system.     

髋关节置换术和空心加压螺钉内固定术治疗老年股骨颈骨折的效果比较

目的 对比观察全髋关节置换术与空心加压螺钉内固定术两种不同的手术方式对老年股骨颈骨折的疗效,以指导选择老年股骨颈骨折的治疗方案.方法 选择126例老年股骨颈骨折患者,回顾性对比分析患者行全髋关节置换术（A组,n=64）及内固定术（B组,n=62）两种不同治疗方式的手术时间、术中出血量、扶双拐下地时间、住院时间、并发症情况及术后关节功能的变化.结果 A组平均手术时间比B组明显延长[（72.8±10.1）min vs（55.7±7.8）min,P＜0.05];A组平均术中出血量显著多于B组[（365.5±51.2）mL vs （180.8±25.3） mL,P＜0.01];A组平均扶双拐下地时间显著少于B组[（7.5±1.2）d vs（48.7±6.8）d,P＜0.01];A组平均住院时间与B组比较,差异无统计学意义[（14.5±2.5） d vs （15.2±2.1）d,P＞0.05].A组并发症出现率明显低于B组（3.13％ vs 19.35％,P＜0.01）.A组Harris功能评分优良率明显高于B组（92.19％ vs 75.81％,P＜0.01）;A组无移位组Harris功能评分优良率与B组比较,差异无统计学意义（90.91％ vs 88.89％,P＞0.05）;A组移位组Harris功能评分优良率显著高于B组（92.85％ vs 60.00％,P＜0.01）.结论 全髋关节置换术适合于髋关节本身有骨关节炎、伴有严重骨质疏松症或有其他老年病不宜长期卧床的股骨颈骨折患者;而内固定术可作为受伤前髋关节活动能力好、骨质量好的或有严重内科合并症不能耐受关节置换的老年股骨颈骨折患者的首选治疗方案.     

Musculoskeletal health,frailty and functional decline

Frailty in older people is associated with a vulnerability to adverse events. While ageing is associated with a loss of physiological reserves, identifying those with the syndrome of frailty has the potential to assist clinicians to tailor treatments to those at the risk of future decline into disability with an increased risk of complications, morbidity and mortality. Sarcopenia is a key component of the frailty syndrome and on its own puts older people at risk of fragility fractures; however, the clinical syndrome of frailty affects the musculoskeletal and non-musculoskeletal systems. Hip fractures are becoming a prototype condition in the study of frailty. Following a hip fracture, many of the interventions are focused on limiting mobility disability and restoring independence with activities of daily living, but there are multiple factors to be addressed including osteoporosis, sarcopenia, delirium and weight loss. Established techniques of geriatric evaluation and management allow systematic assessment and intervention on multiple components by multidisciplinary teams and deliver the best outcomes. Using the concept of frailty to identify older people with musculoskeletal problems as being at the risk of a poor outcome assists in treatment planning and is likely to become more important as effective pharmacological treatments for sarcopenia emerge.This review will focus on the concept of frailty and its relationship with functional decline, as well as describing its causes, prevalence, risk factors, potential clinical applications and treatment strategies.     

数字化设计与3D打印在自体牙移植术的应用

目的探讨术前数字化设计结合3D打印供体牙模型及受区牙槽窝模型辅助自体牙移植术的效果。方法收集12例因牙折或牙槽骨广泛吸收而无法保留的第一或第二磨牙,将其锥形束CT数据导入Mimics数字化设计软件中,选取匹配度最高的第三磨牙作为供体牙,3D打印出供体牙及受区牙槽窝模型进行术前模拟移植术。术中在供体牙模型引导下进行受区牙槽窝及供体牙的预备,将供体牙移植于受区。术后3、6、12个月复查锥形束CT评估骨重建及牙周膜状况。结果 12例患者均选择根尖孔已完全闭合的第三磨牙作为供体牙即刻移植于磨牙区。7例受区牙槽窝术前存在感染,其中1例因受区患牙感染致牙槽骨广泛吸收。12例手术短期恢复良好,均完成12个月以上随访,其中11例移植牙成功,能正常行使咀嚼功能,1例在术后14个月时出现牙根吸收。结论数字化设计结合3D打印技术能够辅助匹配最合适的供体牙,术前完成受区牙槽窝精准预备,减少供体牙在体外的暴露时间和移植到牙槽窝内的试放次数,有助于自体牙移植成功。     

老年髋部骨折患者肌肉减少症与骨密度的关系

目的探讨老年髋部骨折患者肌肉减少症(sarcopenia)及与骨密度下降的关系。方法 113例65岁的老年髋部骨折患者(骨折组)纳入本研究,男性67例,女性46例;同期非髋部骨折老年患者1 321例作为对照组,男性654例,女性667例。所有患者均用双能X线骨密度仪(DXA)检测全身身体组成成分(骨量、肌肉含量,脂肪含量)。肌肉减少症的诊断标准:骨骼肌重量指数(SMI)(肢体骨骼肌重量/身高平方,kg/m2)低于同人种健康成年人1个标准差为1级肌肉减少症(class 1),低于2个标准差为2级肌肉减少症(class 2)。根据以上标准将受试者分为肌量正常组:男性SMI7.01 kg/m2,女性SMI5.42 kg/m2;class 1组:男性SMI 6.09~7.01 kg/m2,女性SMI 4.80~5.42 kg/m2;class2组:男性SMI≤6.08 kg/m2,女性SMI≤4.79 kg/m2。分析不同组老年髋部骨折患者肌肉减少症的检出率。结果老年髋部骨折患者肌肉减少症检出率明显高于同性别类似年龄人群:骨折组男性肌肉减少症检出率(62.6%)与对照组男性肌肉减少症检出率(12.8%)比较差异有统计学意义(P0.001),骨折组女性肌肉减少症检出率(13.0%)与非骨折组女性肌肉减少症检出率(4.1%)比较差异有统计学意义(P0.001);老年女性髋部骨折患者中肌量正常者24例(52.1%),Class 1级者16例(34.7%),Class 2级者6例(13.0%);骨骼肌重量指数与股骨颈骨密度和全身骨密度呈正相关。老年男性髋部骨折患者中肌量正常者9例(13.4%),Class 1级者16例(23.8%),Class 2级者42例(62.6%),骨骼肌重量指数与BMI呈正相关,与年龄呈负相关。结论老年髋部骨折患者肌肉减少症检出率明显高于同龄非骨折者,男性肌少症检出率高于女性。老年女性髋部骨折患者的骨骼肌重量指数与股骨颈和全身骨密度呈正相关,老年男性髋部骨折患者骨骼肌重量指数则与骨密度无明显相关性。应关注骨折患者肌肉减少症的防治。     

宁波地区515例老年髋部骨折患者的临床特征

目的回顾性分析宁波地区515例老年髋部骨折患者的临床特点,为防治骨质疏松性骨折提供依据。方法 2010年1月至2012年12月在宁波市第一医院、宁波市第二医院治疗的515例老年髋部骨折患者(男158例,女357例,年龄60岁~96岁)纳入本研究。按5岁为1个年龄段进行分组,分析患者性别、年龄、致伤原因、骨折类型,受伤时间、治疗方式、伴随疾病、住院费用、住院时间等情况。结果冬季(10月至1月)是老年人髋部骨折高发时期,老年女性髋部骨折病例数为男性的2.25倍,显著高于男性,男性患者髋部骨折发病的年龄高峰为70~80岁,女性发病高峰在75~85岁。515例老年髋部骨折患者中股骨粗隆间骨折236例,占45.8%;股骨颈骨折279例,占54.2%。跌倒是骨折主要原因,占89.3%。515例老年髋部骨折患者手术治疗率为78.3%,1年死亡率为3.2%。手术组1年死亡率低于保守治疗组的9.9%(P=0.004)。骨密度检测率为58.8%,其中T值-2.5SD者占48.5%。结论跌倒是老年人髋部骨折的主要原因;骨质疏松是老年人髋部骨折的内在因素。