Objectives We recently demonstrated a significant correlation between enamel delamination and tooth-level radiation dose in oral cancer patients. Since radiation can induce the synthesis and activation of matrix metalloproteinases, we hypothesized that irradiated teeth may contain active matrix metalloproteinases. Materials and Methods Extracted teeth from oral cancer patients treated with radiotherapy and from healthy subjects were compared. Extracted mature third molars from healthy subjects were irradiated in vitro and/or incubated for 0 to 6 months at 37°C. All teeth were then pulverized, extracted, and extracts subjected to proteomic and enzymatic analyses. Results Screening of irradiated crown extracts using mass spectrometry identified MMP-20 (enamelysin) which is expressed developmentally in dentin and enamel but believed to be removed prior to tooth eruption. MMP-20 was composed of catalytically active forms at Mr=43, 41, 24 and 22 kDa and was immunolocalized predominantly to the morphological dentin enamel junction. The proportion of different sized MMP-20 forms changed with incubation and irradiation. While the pattern was not altered directly by irradiation of healthy teeth with 70 G, subsequent incubation at 37°C for 3–6 months with or without prior irradiation caused the proportion of Mr=24–22 kDa MMP-20 bands to increase dramatically. Extracts of teeth from oral cancer patients who received >70 Gy radiation also contained relatively more 24 and 22 kDa MMP-20 than those of healthy age-related teeth. Conclusion MMP-20 is a radiation-resistant component of mature tooth crowns enriched in the dentin-enamel. We speculate that MMP-20 catalyzed degradation of organic matrix at this site could lead to enamel delamination associated with oral cancer radiotherapy.
This article presents the demographic data for 91 doctors and 347 adult AOB patients, as well as the practitioners' self-reported treatment preferences.
Introduction: Anterior openbite (AOB) continues to be a challenging malocclusion for orthodontists to treat and retain long-term. There are many orthodontic treatment modalities used to treat AOB in adult patients, but there is no consensus on which modalities are most successful. This study aims to identify the overall success rate of AOB orthodontic treatment in the adult population across the United States, as well as factors that influence treatment success. Methods: Practitioners and their adult AOB patients were recruited through the National Dental PBRN. Patient dentofacial and demographic characteristics, practitioner demographic and practice characteristics, and factors relating to orthodontic treatment were reported. Treatment success was determined from post-treatment lateral cephalometric films and intraoral frontal photos. Treatment was categorized into four main groups: aligners, fixed appliances, TADs and orthognathic surgery. Extractions were also evaluated. Univariate and multivariate models were used to evaluate how treatment success varies with treatment modality, pre-treatment dentofacial characteristics, and patient and practitioner demographic and practice characteristics. Results: End of active treatment data was collected from 84 practitioners and 254 patients. Eighty four percent of patients finished with positive vertical overlap of all incisors and 93% with positive overbite on the post-treatment lateral cephalogram. While there were no statistically significant differences in success rates between the treatment groups, patients treated with orthognathic surgery had an increased odds for success when compared to those treated with fixed appliances only. Treatment success was also associated with academic practice setting, pre-treatment IMPA £90°, no to mild pre-treatment crowding, and treatment duration < 30 months. Conclusion: The success of orthodontic treatment in adult AOB patients who participated in this study was very high. While there was a range of success for the major treatment modalities, orthognathic surgery was the only treatment modality that reached statistically significance. There were some pre-treatment dentofacial characteristics and treatment factors associated with successful closure of AOB. I would like thank the University of Washington Department of Orthodontics and the University of Washington Orthodontic Alumni Association for this wonderful opportunity and academically fulfilling experience. Thank you to my research committee members, Greg Huang, Geoffrey Greenlee, and Andrea Burke, for your mentorship and guidance. I would also like to give a special thank you to my research partner, Sam Finkleman. Finally, I would like to express my gratitude and appreciation for my family and friends for all their support.
Introduction: This paper evaluates patient satisfaction of adults, who received orthodontic treatment for anterior openbite malocclusion across the United States. The factors that influence the satisfaction of these patients are also described. Methods: Practitioners were recruited from the National Dental Practice-Based Research Network. Upon joining the Network, practitioner demographics and information on their practices were acquired. Practitioners enrolled their adult patients in active treatment for anterior openbite. Patient demographics, patient dentofacial characteristics, and details regarding previous and current treatment were collected through questionnaires at enrollment (T1). Pre-treatment lateral cephalograms and intraoral frontal photographs were submitted. Treatment performed and details related to treatment outcome were recorded through questionnaires at the end of active treatment (T2). Post-treatment lateral cephalograms and intraoral frontal photographs were submitted. Patient satisfaction at the end of active treatment (T2) was assessed using a five-point, Likert-like scale and open-ended responses. Predictive univariate models were developed to evaluate the factors that influence patient satisfaction. Open-ended responses were reviewed for general trends. Results: End of active treatment (T2) data was received for 256 patients. Two hundred forty-eight of these patients completed and returned the patient satisfaction questionnaires. High levels of satisfaction were found in our sample of adult patients receiving treatment for anterior openbite malocclusion. Specifically, 96% of the sample reported being very or somewhat satisfied. Only ten patients (4%) were not satisfied with the treatment provided or an element of the final result. Successful openbite closure, treatment modality, and certain patient characteristics may influence patient satisfaction. However, there was insufficient power to demonstrate statistical significance. Open-ended responses directly associated with patient satisfaction were received from twenty-three patients (9%). They relayed positive, neutral, and negative feelings about the treatment received and final results. Additional responses regarding the orthodontic treatment in general, but not specifically linked to patient satisfaction, were received from 119 patients (48%). These comments depict an overwhelmingly positive experience. Conclusions: Adult patients who received orthodontic treatment for anterior openbite malocclusion were generally satisfied with the treatment provided, as well as the final esthetic and functional results.
Objectives To investigate stability and satisfaction in adult anterior open bite (AOB) patients at least 9 months post-treatment, as well as patient and practitioner factors that may be associated with stability and satisfaction. Materials and Methods Practitioners and their adult AOB patients were recruited through the National Dental Practice-Based Research Network. Data on patient and practitioner characteristics, treatment recommendations and factors were previously collected. Treatment stability was determined by assessing post-treatment intraoral photographs. Patient satisfaction was determined from post-treatment questionnaires. Treatment was categorized into aligners, fixed appliances, temporary anchorage devices, and orthognathic surgery. Extractions were also investigated. Retention type was categorized into vacuum-formed, Hawley-style, or bonded retainers, and regimens were classified as full-time or part-time wear. Results Retention data collected from 112 patients had a mean post-treatment time of 1.21 years. There were no statistically significant differences in stability between treatment groups. Depending on whether a qualitative index or a millimetric measure was employed, stability ranged from 65% to 89%. Extractions and less initial lower incisor proclination were associated with higher stability in patients treated with fixed appliances only. High satisfaction was reported by patients at retention. There were no clear differences in stability or satisfaction among retention types or regimens. Conclusions The stability of adult AOB orthodontic treatment was high, regardless of treatment or retainer modality. Satisfaction in adult AOB patients was high, regardless of retention type or regimen.
Objective:To evaluate what specific combination of clinical criteria and d-dimer values may yield at least a 10% positive pulmonary embolism (PE) rate in patients undergoing pulmonary CT angiography (CTA). Materials and Methods: Retrospective review of all patients presenting to the Emergency Department with possible PE who underwent pulmonary CTA and had a d-dimer drawn. Wells scores were retrospectively assigned based on data gathered through medical records. Results: During a 29-month period, 1110 patients underwent pulmonary CTA. Of these, 773 also had a d-dimer drawn. These subjects were stratified based on serum d-dimer levels into negative (≤4 µg/ml), nonpositive (0.41 -1.0 µg/ml), or positive (>1.0 µg/ml) d-dimer categories. The prevalence of positive CTA studies was >10% only in the positive d-dimer group. Subjects were also stratified based on their Wells score into three clinical categories: low (score < 2), intermediate (score = 2 -6), and high risk of pulmonary embolism (score > 6). The prevalence of positive CTA was > 10% only in the group of subjects with high clinical risk. When stratified according to both Wells criteria and d-dimer, only those patients with intermediate or high clinical risk combined with a positive d-dimer (>1.0 µg/ml) had a prevalence of positive pulmonary CTA > 10%. By limiting the use of CTA studies to those patients with positive d-dimer values or high clinical risk, 438 (55.4%) patients could have avoided CTA imaging. Conclusion: Utilizing CTA only in patients suspected of PE with a combination of high clinical risk based on a Wells criteria threshold score > 6 and a serum d-dimer cutoff of 1 µg/ml would increase the prevalence of positive pulmonary CTA studies above 10% and avoid a large number of CTA imaging studies.
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