Autotransplantation of teeth to the anterior maxilla: A systematic review of survival and success,aesthetic presentation and patient‐reported outcome

Background/Aim

Autotransplantation of teeth to the anterior maxilla may be indicated after trauma or in patients with congenitally missing teeth. The aim of this systematic review was to report the current evidence concerning survival and success rate, aesthetic outcome, and patient‐reported outcome of autotransplanted teeth to the anterior maxilla.

Materials and Methods

A MEDLINE search followed by an additional hand search was performed to identify relevant literature. All levels of evidence except case reports were considered. Any publication reporting on 10 or more autotransplanted teeth to the anterior maxilla, and written in English were eligible for this systematic review.

Results

The systematic search identified 95 abstracts. Thirty‐seven full‐text articles were evaluated of which 17 could finally be included. Data on survival and success rate of the transplants could be extracted from 11 studies. Survival rates ranged between 93% and 100% (weighted mean: 96.7%, median: 100%) after 9 months to 22 years of observation (median: 8.75 years). No consensus regarding definition of success criteria of the transplants could be found in the literature. Two and four studies contained data on aesthetic and patient‐reported outcomes, respectively. In general, they reported favourable aesthetic results and high patient satisfaction.

Conclusion

The current available evidence suggests a high survival rate after autotransplantation of teeth to the anterior maxilla. However, the level of evidence is low. Limited data on aesthetic and patient‐reported outcomes warrant additional research in this field.     

Wound repair during arm regeneration in the red starfish Echinaster sepositus

Starfish can regenerate entire arms following their loss by both autotomic and traumatic amputation. Although the overall regenerative process has been studied several times in different asteroid species, there is still a considerable gap of knowledge as far as the detailed aspects of the repair phase at tissue and cellular level are concerned, particularly in post‐traumatic regeneration. The present work is focused on the arm regeneration model in the Mediterranean red starfish Echinaster sepositus; to describe the early cellular mechanisms of arm regeneration following traumatic amputation, different microscopy techniques were employed. In E. sepositus, the repair phase was characterized by prompt wound healing by a syncytial network of phagocytes and re‐epithelialisation followed by a localized subepidermal oedematous area formation. Scattered and apparently undifferentiated cells, intermixed with numerous phagocytes, were frequently found in the wound area during these first stages of regeneration and extensive dedifferentiation phenomena were seen at the level of the stump, particularly in the muscle bundles. A true localized blastema did not form. Our results confirm that regeneration in asteroids mainly relies on morphallactic processes, consisting in extensive rearrangement of the existing tissues which contribute to the new tissues through cell dedifferentiation, redifferentiation, and/or migration.     

Bone density in Moroccan women with systemic scleroderma and its relationships with disease-related parameters and vitamin D status

In this case-control study, our first aim was to evaluate the bone mineral density (BMD) in women with systemic sclerosis (SSc) and its correlates. Secondarily, we aimed to evaluate 25-hydroxyvitamin D3 status and its relationships with disease parameters and BMD. Sixty patients with SSc and 60 age-and gender-matched controls were included in the absence of confounding factors that interfere with bone metabolism. Body mass index, menopausal status, familial history of osteoporosis and/or fractures; personal fracture history; exercise activity and laboratory parameters of bone metabolism were assessed in patients and controls. BMD was measured by using a dual-energy X-ray absorptiometry in lumbar spine (L1-L4) and femoral neck. The 25-hydroxyvitamin D3 was measured in a subgroup of 30 patients and in a subgroup of 30 matched controls. Systemic manifestations of SSc, biological inflammatory parameters, functional disability (scleroderma health assessment questionnaire (S-HAQ)) and immunological status of disease were collected in patients' group. The mean age of patients was 49.44?±?13.07?years versus 49.55?±?12.11 in controls. The mean disease duration was 9.63?±?5.9?years. SSc patients had a significantly earlier age and longer duration of menopause than controls (P?=?0.003). Phosphocalcic metabolism parameters were within normal ranges in both groups. BMD was significantly lower in SSc patients than in controls both in lumbar spine (-2.97?±?0.25 in patients vs. 0.46?±?0.11 in controls) and femoral neck (-1.93?±?0.32 in patients vs. -0.81?±?0.69 in controls) (P?相似文献   

Rheumatoid factor and antibodies against citrullinated peptides in Moroccan patients with rheumatoid arthritis: association with disease parameters and quality of life

We aimed to evaluate the immunological status and its relationships with disease-related parameters of activity, severity and quality of life in Moroccan patients with rheumatoid arthritis (RA). Two hundred forty-five consecutive patients with RA were recruited. The following data were collected: demographic characteristics, disease duration (years), disease activity (evaluated by the disease activity score, DAS28), structural damage (evaluated by Sharp's method as modified by van der Heijde), functional disability (assessed by using the Moroccan version of the Health Assessment Questionnaire, HAQ) and quality of life (by using the Arabic version of the Medical Outcomes Study Short Form 36 Health Survey: the SF-36). Immunological status (rheumatoid factor rate, RF) and antibodies against citrullinated peptides rate (ACPAs) by the Elisa method were examined. ACPAs were detected in 75.1% of patients with a mean rate of 79.2 ± 43.8 UI. RF was detected in 80.8% of patients with a mean rate of 80.1 ± 50.6 UI. Patients with positive RF and ACPAs had higher disease activity, impaired functional ability, severe structural damage, more ocular symptoms and altered aspects of quality of life. In univariate analysis, higher levels of ACPAs were significantly correlated with the age at onset (r = 0.307), disease duration (r = 0.520), disease activity (DAS28) (r = 0.531), Sharp score (r = 0.431), and with the deterioration of all domains of SF-36 (for all p ≤ 0.01). RF levels were correlated with disease duration (r = 0.517), disease activity (r = 0.470), functional disability (r = 0.521), and the alteration of physical domains of SF-36 (for all p ≤ 0.01). In multivariate analysis, the main factors associated to ACPAs and RF levels were functional disability, structural damage and impaired QoL. Furthermore, using the SF-36 scores as dependent variables, the impairment of physical domains and the domain of vitality were significantly associated with ACPA levels while the decrease of the domain of physical function was associated with the level of RF. Our study suggests that the presence and the levels of ACPAs and RF in our RA patients are associated with more active disease, more severe joint damage, worst functional disability and altered aspects of quality of life.     

Incorporation of potassium halides in the mechanosynthesis of inorganic perovskites: feasibility and limitations of ion-replacement and trap passivation

Potassium halides (KX; X = I, Br, or Cl) were incorporated as partial replacements of CsBr in the mechanosynthesis of CsPbBr₃. This led to partial substitution of both monovalent ions forming mixed Cs_1−xK_xPbBr_3−yX_y perovskites. Longer photoluminescence lifetimes were also observed, possibly linked to the formation of a non-perovskite KPb₂X₅ passivating layer.

Potassium halides are used for cation-exchange, anion-exchange and trap passivation of mechanosynthesized perovskites.

In the past few years, organic metal halide perovskites (OHPs) have drawn considerable attention as promising materials for optoelectronic devices.^1–5 However, it is generally known that these materials make the development of stable solar cells and light emitting diodes rather difficult, due to their environmental instability related with the use of organic compounds.^6–8 Thus, fully inorganic halide perovskites, such as cesium-based perovskites are sought after for their increased stability.^9–13 The known poor solubility of cesium halides in common solvents may be bypassed by synthesizing inorganic perovskites in an all-dry manner such as by mechanosynthesis (e.g., grinding or ball-milling)^14–18 and/or thermal vacuum deposition.¹⁹ Recently, halide perovskites with an increasing complexity in formulation containing up to 6 or 7 different ions have proven to be beneficial for device performance.^20–24 In this context, mechanosynthesis by ball-milling represents an ideal platform to test different precursors or additives in a simple manner. Multi-cation perovskites enable tuning of the bandgap of the material²³ as well as its Goldschmidt tolerance factor (t),^25,26 which is calculated as follows:where r_A, r_B and r_X respectively stand for the ionic radiuses of the cation A, metal B and the anion X in the ABX₃ perovskite.To obtain a stable cubic ABX₃ perovskite, it is generally accepted that the Goldschmidt tolerance factor should not be lower than 0.8 nor exceed a value of 1. A t-value outside of this range usually results in non-perovskite structures. Examples of such crystalline structures are orthorhombic (so-called “yellow phase”) cesium lead iodide (CsPbI₃) and formamidinium lead iodide (FAPbI₃). In the case of CsPbI₃, the tolerance factor is too small whereas in the case of FAPbI₃ the tolerance factor is too large to result in a stable cubic phase at room temperature. However, the multi-cation cesium formamidinium lead iodide perovskite ((Cs:FA)PbI₃) was shown to be stable.^23,27 This is only an example of the interest of multi-cation perovskites. Among other cations, potassium has been recently used as an additive in perovskites, with different conclusions.^22,28–33 Some reports show a benefit from the presence of potassium in mixed (KCs)PbI₃, where the guest cation is capable of stabilizing the perovskite structure.²⁹ Others, based on the small tolerance factor of such structure, have concluded that incorporating potassium halides in the synthesis does not lead to the effective incorporation of potassium as replacement of the “A” cation within the perovskite structure. As a result, potassium stays at the grain boundaries and indirectly contributes to surface passivation by providing additional halides (bound to K⁺), partially compensating the halide vacancies. The halide vacancies are believed to be one of the main quenching traps which need to be passivated to improve the optoelectronic properties of the perovskite.^28,34 On the contrary, other reports have concluded that addition of potassium halides leads to the formation of different separate phases.^30,31 These discrepancies might originate from the different perovskite crystallization processes used, which can result in different morphology, phase purity or stoichiometry of the final compound. Therefore, dry mechanosynthesis is an ideal preparation method, as it does not involve solvents, it avoids the formation of intermediate species, and eliminates the need of thermal treatments to foster the perovskite crystallization.In this work we synthesized halide perovskites by ball milling equimolar mixtures of PbBr₂ and ABr, where A = K_0.2Cs_0.8 and compared the resulting powders with the pure cesium reference (A = Cs). High resolution X-ray diffraction (XRD) patterns as well as optical characterization are presented in Fig. 1. The main diffraction peaks from the resulting powder are presented in Fig. 1b, c and e. These peaks correspond to the orthorhombic APbBr₃ perovskite (see Fig. S1^† for the full diffractograms and reference pattern ICSD 97851). Hence, XRD confirms the formation of the perovskite phase from ball-milling of precursors. Furthermore, the high-resolution signals presented in Fig. 1b, c and e reveal a shift towards higher angles (smaller interatomic distances) when CsBr is partly replaced by KBr. This means that K⁺, which has a smaller ionic radius than Cs⁺, is effectively incorporated in the perovskite crystal structure, leading to mixed-cation (KCs)PbBr₃. Such a cation-replacement is not trivial, as potassium is thought to be too small to occupy the “A” site in APbBr₃.^28,30,31 Indeed, concomitant to the shift of the main perovskite peaks, we also note that new peaks appear in the diffractogram (see Fig. S1^† and 1a, d, f). These peaks are consistent with the non-perovskite APb₂Br₅ phase. For potassium-based lead halide compounds, this phase is the most commonly reported.^35,36 We also ball-milled pure KBr and PbBr₂ mixtures (without CsBr) in different ratios and found that KPb₂Br₅ was the dominant phase – along with unreacted KBr – even in KBr-rich conditions, see Fig. S2.^† Therefore, we can conclude that the use of KBr as a source of K⁺ to replace Cs⁺ in inorganic perovskites is possible but limited by the higher stability of KPb₂Br₅ as compared to KPbBr₃. When we reduced the amount of KBr to 5% (A = K_0.05Cs_0.95) we also observed similar perovskite peak shifts and formation of KPb₂Br₅, although to a lesser extent (see Fig. S3^†). This suggests that the amount of Cs⁺ that can be replaced by K⁺ in the perovskite structure (without leading to the formation of KPb₂Br₅) is below 5%. This value is lower than previously reported by others.²⁹ Other characterization methods such as high-resolution transmission electron microscopy and energy dispersive X-ray spectroscopy could possibly further elucidate the amount of potassium that is present under each form (included in the perovskite lattice or as separated KPb₂Br₅ compound). The optical characterization of the powders resulting from ball-milling equimolar ABr:PbBr₂ mixtures with A = K_0.2Cs_0.8 is presented in Fig. 1g–i. Absorption (g) and photoluminescence (h) spectra are mostly unchanged with respect to the reference sample (A = Cs). Photoluminescence spectra (Fig. 1h) evidently consist of two sub-bands with maxima at about 522 and 540 nm (see deconvolution of the PL spectra as a sum of two Gaussian contours in ESI, Fig. S4^†). Because of the broad and asymmetric nature of the PL spectra, it is not possible to unambiguously evaluate the impact of potassium incorporation on the optical bandgap. Indeed, it could be expected that the observed shrinkage of the lattice would affect the optical bandgap of the material and result in a shift of the PL peak. However, the origin of the two bands observed in both PL spectra might be due to different reasons. In a previous report on mechanosynthesis of CsPbBr₃via ball-milling of CsBr and PbBr₂ a similar asymmetric spectrum was obtained and attributed to the presence of bulk and nano-sized CsPbBr₃.¹⁶ Another possible explanation is linked to the emission from free electrons in conducting band and trap-localized carriers.³⁷ In this second hypothesis, it is possible that an exchange of a part of Cs atoms by K decreases the relative contribution of the PL emission from free electrons at 522 nm and, respectively, increases contribution of the emission from trap states at 540 nm. Following the delayed luminescence model,³⁸ trap-assisted luminescence should be longer lived than the emission of free electrons from the conducting band, as is indeed observed in Fig. 1i. However, we cannot exclude other possible origins of this longer lifetime such as trap passivation by molecular KBr which fills halide vacancies at the surface²⁸ or by the other two mechanisms that our data prove to happen concomitantly: (i) replacement of Cs⁺ by K⁺ as monovalent cation in the perovskite structure, and (ii) formation of KPb₂Br₅ which might act as passivating layer on top of CsPbBr₃. This passivation (independently on the exact mechanism from which it originates) should result in a higher photoluminescence quantum yield (PLQY). However, the absolute PLQY of these powder samples is too low for us to conduct reliable measurements.Open in a separate windowFig. 1XRD (a–f) and optical (g–i) characterization of powders prepared from addition of PbBr₂ to CsBr (REF; black lines) or Cs_0.8K_0.2Br (green lines). XRD peaks corresponding to APbBr₃ perovskite (b, c, and e) present a shift upon addition of KBr. Panels (a, d, and f) present a rise in intensity linked to the formation of non-perovskite APb₂Br₅ phase. Full diffractograms are presented in Fig. S1.^† Absorption (g) and photoluminescence (h) spectra remain mostly unchanged while photoluminescence lifetime (i) is increased.We also replaced KBr by KX (X = Cl or I) while keeping CsBr and PbBr₂ as precursors in the mechanosynthesis. Fig. 2 shows XRD and optical characterization of the resulting powders. Fig. 2a–c demonstrate that the perovskite phase is formed in all cases and that the heteroanion (Cl or I) introduced via the potassium salt is replacing Br in the APbX₃ structure. Indeed, when KI is used the main perovskite peaks shift towards lower diffraction angles consistent with the introduction of the larger I⁻ anion compared to Br⁻. The opposite applies when KCl is used. As a result, we observe significant shifts in the bandgap of the perovskite as shown by absorption and photoluminescence (Fig. 2d, e). Hence, our results show that KX can also be used as a source of anions to tune the optical properties of the resulting inorganic perovskite. This means that the X halide does not only remain tightly bound to K⁺ at the surface of the perovskite material affecting only surface-related effects (surface quenching traps) but also enters the structure and thus affects bulk-related properties (bandgap).Open in a separate windowFig. 2XRD (a–c) and optical (d and e) characterization of powders prepared from KI (red), KBr (green), and KCl (blue). Shifts in diffractograms are consistent with the incorporation of the heteroanion (I or Cl) in the perovskite structure. This translates into a smaller (KI) or higher (KCl) bandgap as observed in absorption (d) and photoluminescence (e).In conclusion, we have shown that incorporating potassium halides in the mechanosynthesis of inorganic cesium lead halide perovskites leads to several chemical, structural and optical effects. First of all, potassium partly replaces cesium in the APbBr₃ perovskite structure. Second, the potassium salt can also act as a source of heteroanions to tune the bandgap of the resulting perovskite. Third, KPb₂X₅ phase forms concomitantly with the perovskite phase. This phase may act as a surface passivation layer as longer lifetimes are observed on samples with added KBr with respect to pure CsPbBr₃. These findings will aid to further optimize thin film perovskite based devices such as LEDs and solar cells that recently have shown beneficial effects of incorporating potassium halides.     

Factors Affecting Job Satisfaction and Their Correlation with Educational Standards among Dental Assistants

A disparity exists in the educational qualifications of dental assistants working in various public and private institutions in Riyadh, Saudi Arabia. The aim of this study was to assess the influence of professional and personal characteristics on job satisfaction among dental assistants. A cross-sectional survey was performed among dental assistants using a 24-item self-administered questionnaire. Multinomial logistic regression was used to assess the relationship between overall job satisfaction and other variables. The overall response rate was 72.1%. Factor analysis suggested that five underlying factors were related to job satisfaction. The mean score for overall job satisfaction was 3.86 (satisfied) out of 5. Among the work environment factors, the highest mean score, 4.26 (satisfied), was obtained for quality of service, and the lowest mean score, 2.78 (neutral), was obtained for the perception of income. The income and general prospects of the profession was significantly associated with overall job satisfaction. This study suggests that for dental assistants, professional and personal life, quality of service, perception of income and prestige and self-respect are important factors for job satisfaction. Despite differences in professional formation standards, in general, the study participants were considerably satisfied with their jobs.     

Shedding the light on Pharmacists’ roles during COVID-19 global pandemic

Introduction(Background)The role of pharmacists revolves around providing the highest levels of care to society and ensuring the provision of medicine to all patients. However, with the spread of coronavirus disease 2019 (COVID −19), pharmacists as a very important part of healthcare professionals’ team are responsible for fighting against the disease regardless of their setting of practice. The role of pharmacists will undergo a little change to extend and include other roles in order to ensure the safety of the community and limit the virus spread. Also, they will be required to obtain information from reliable sources, and to be up to date, so they can be reliable advisors to the community and raise their awareness.ObjectivesThe purpose of this review is to highlight community and hospital pharmacists’ roles during (COVID-19) global pandemic, and to clearly illustrate how they are contributing to maintain pharmacy services continuity, supporting other healthcare professionals, and facilitating the patient’s education.SummaryClinical pharmacists provide direct patient care through monitoring adverse drug reactions, ensuring individualized treatment, performing evidence-based practice, and evaluating drugs in clinical trials. On the other hand, community pharmacists which are the most accessible healthcare providers by the community increase their awareness regarding the preventive measures, balance medicines supply and demand, provide drive-thru and home delivery services, offer telehealth counselling, psychological support, refer suspected COVID-19 patients, and provide vaccination when available.ConclusionInnovative pharmacists’ roles have emerged to adapt to changes during COVID-19 pandemic, however, they may be needed in the post COVID-19 world as well.     

Systemic lupus erythematosus‐related acute pancreatitis: An exceptional form with severe exocrine and endocrine pancreatitic failure in a Tunisian child

Acute pancreatitis may be the first manifestation in systemic lupus erythematosus or occur during evolution. It is a rare complication, which is often associated with other visceral manifestations. Outcome is usually favorable but can be serious. We report a case of a 17‐year‐old girl with a past history of systemic lupus erythematosus who developed acute pancreatitis revealed by abdominal pain. Elevated serum amylase and lipase levels and pancreatic enlargement on tomography confirmed the diagnosis. Although high‐dose corticosteroid was prescribed, the patient died from a refractory diabetic ketoacidosis.     

Philtrum length and intercommissural distance measurements at mixed dentition period

Anthropometric measurements of the lip and mouth are of great importance in clinical dysmorphology as well as reconstructive plastic surgery. In this study, the philtrum length (PhL) and intercommissural distance (ICmD) nomograms for Egyptian children in the mixed dentition period were established. A group of 1,338 Egyptian students in primary schools (735 boys and 603 girls) were included in the study. The students were at mixed dentition period and their ages ranged from 7 to 12 years. Anthropometric norms of PhL and ICmD were developed with significant sex difference in certain groups. A ratio between PhL and ICmD was developed. These data will help facilitate both objective and subjective evaluation of the lip and mouth for proper diagnosis of orofacial anomalies and variations as well as for ideal treatment plans.     

Vitamin D,autoimmunity and recurrent pregnancy loss: More than an association

Recurrent pregnancy loss (RPL) affects close to 1% of couples; however, the etiology is known in only about 50% of the cases. Recent studies show that autoimmune dysregulation is a probable cause of RPL, which in some cases may be overlooked. In order for a pregnancy to proceed to term, early modulation of immunologic response is required to induce tolerance to the semi‐allogenic fetus. Certain subsets of both the innate and adaptive immune responses play a role in the induction of fetomaternal tolerance. A relatively predominant T‐cell helper (Th) 2 and T regulatory (Treg) cell population seem to favor a better pregnancy outcome, whereas Th1 and Th17 cell populations appear to have an opposite effect. Lately, the role of vitamin D in the modulation of immune response was established. Vitamin D has been shown to promote a more favorable environment for pregnancy through various mechanisms, such as enhancement of the shift toward Th2 cells and regulation of immune cell differentiation and cytokine secretion. Therefore, it seems that vitamin D deficiency sways the balance toward a worse outcome and may play a part in recurrent pregnancy loss. This review sheds light on the immunologic changes, which occur in early pregnancy and the regulatory role vitamin D has in the maintenance of this delicate balance.