Anatomical Retention Research Articles

Learning in context: Undergraduate students' knowledge and the content retention of anatomy between discipline-specific and integrated course approaches.

Undergraduate introductory human anatomy and human physiology courses are either taught as discipline-specific or integrated anatomy and physiology (A&P) sequences. An institution underwent a curricular revision to change the course approach from discipline-specific Human Anatomy and Human Physiology to an integrated A&P I and II sequence, allowing the unique opportunity to explore the potential role of contextual learning in academic achievement and content retention. Mediation and moderation analysis was used to evaluate lecture examinations, laboratory practical examinations, and anatomical content retention between the different course approaches. Undergraduate students in the integrated A&P I course approach performed significantly better on lecture assessments and had a higher anatomy content retention rate at the end of the year than students enrolled in the standalone Human Anatomy course. The lecture examination averages between Human Physiology and A&P II (the second course in the sequence), as well as the anatomy laboratory practical examinations, were not significantly different between discipline-specific and integrated course approaches. The results suggest contextual learning-providing physiological context to anatomical structures-increases the anatomical content retention and academic achievement overall.

3D-printed resin composite posterior fixed dental prosthesis: a prospective clinical trial up to 1 year

ObjectivesThis clinical trial evaluated the clinical behavior of 3D-printed posterior resin composite fixed dental prostheses (FDPs).Materials and methodsBetween 10 October 2020 and 5 August 2022, 49 patients aged 19–60 years (16 men, 33 women) received 68 3D-printed resin composite 3-unit posterior FDPs (ELS Even Stronger, Saremco, Switzerland). FDPs were followed up 2 weeks after placement (baseline), 6 months after placement, and 1 year after placement by two independent calibrated observers using modified FDI criteria for anatomical form, secondary caries, marginal adaptation, surface roughness, color match, fracture of material, staining surface, staining margin, approximate anatomical form, retention, gingival health, and patient's view. Survival analyses were performed using Kaplan–Meier analyses.ResultsA total of 59 restorations were evaluated and the mean observation period was 8.63 months. Failure types were categorized as mechanical and biological. Failures were observed in 14 FDPs. Nine FDPs showed mechanical failure and five FDPs showed biological failure. Mechanical failures were mostly experienced as connector fractures. Eight FDPs showed cohesive fractures (seven in a single connector at either at the mesial or distal and one in the pontic itself). Biological failures, including root canal treatment and gingival tissue reactions, were observed within the first 6 months. Based on mechanical failures, the survival rate was 86.7% including the biological complications; this corresponded to 71.6% (Kaplan–Meier). After 1 year, two FDPs showed surface luster loss (score 4), two-color mismatches (score 4), and two-surface staining (score 4).Conclusion3D-printed resin composite FDPs were observed acceptable after 1 year of clinical follow-up, providing that the experienced failure types were mainly associated with fractures in the connector region, which requires revision of design parameters.Clinical Trial RegistrationClinical Trials.Gov, NCT04600297.

MANAGEMENT OF UNERUPTED ANTERIOR TEETH: AN AUDIT OF TREATMENT OUTCOMES

Introduction: Anterior teeth are valuable for aesthetics, speech and mastication . Their absence, impaction and/or delayed eruption create significant distress often leading to early presentation to the dental office. This study presents an audit of the management of impacted anterior teeth that presented at a tertiary level dental clinic. The periodontal outcomes of the aligned teeth were also reported.
 Methods: This is an observational study spanning a nine-year period. Demographic data, clinical presentation as well as post alignment dental and periodontal status of the impacted teeth were assessed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 26. Fisher’s exact test and paired samples T-test were used for categorical and continuous variables respectively. Significance was set at P < 0.05.
 Results: Twenty-eight (1.76%) cases presenting with failed eruption of thirty-two anterior teeth were found during the period under review. Eight patients were treated by extraction, orthodontic treatment and space closure or prosthetic replacement with a mean treatment time of 2.83 ± 2.66 years. Thirteen patients completed treatment by orthodontic alignment with mean alignment time of 1.4 ± 1.5 years and treatment time of 3.6 ± 2.5 years. There was significant difference in the post-operative root length of aligned teeth compared to their normal antimeres (p < 0.005).
 Conclusion: Patients with impacted anterior teeth presented later than was beneficial for spontaneous alignment of their teeth. The average 1.5mm loss of root length observed was not detrimental to the anatomical retention or function of the aligned teeth. There is need for more enlightenment with regards to early presentation for dental problems to avoid expensive and time-consuming treatments.

Clinical comparison of different glass ionomer-based restoratives and a bulk-fill resin composite in Class I cavities: A 48-month randomized split-mouth controlled trial

ObjectiveThe aim of this study is to compare the retention rates (primary outcome) of high-viscosity glass ionomer (GI), glass carbomer (GC), zirconia-reinforced GI (ZIR), and bulk-fill (BF) composite resin restorations. Secondary outcomes included anatomical form, marginal adaptation, marginal discoloration, color match, surface texture, post-operative sensitivity and secondary caries. MethodsTwo calibrated operators placed 128 restorations in 30 patients with a mean age of 21 years. The restorations were evaluated by one examiner at baseline and at 6, 12, 18, 24, and 48 months using the modified US Public Health Service criteria. The data were statistically analyzed using Friedman test. Differences between restorations were analyzed using Kruskal–Wallis test. ResultsAfter 48 months, 23 patients and 97 restorations (23 GI, 25 GC, 24 ZIR, and 25 BF) were evaluated. Patient recall rate was 77%. No significant difference was observed between the retention rates of the restorations (p > 0.05). GC showed significantly lower results than the other three fillings in terms of anatomical form (p < 0.05). There was no significant difference in the anatomical form and retention between GI, ZIR, and BF (p > 0.05). No significant change was observed in the postoperative sensitivity or secondary caries for any of the restorations (p > 0.05). ConclusionsGC restorations showed statistically lower anatomical form values, indicating lower wear resistance than the other materials. However, no significant difference was observed in the retention rates (as primary outcome) as well as the other secondary outcomes of the four different restorative materials after 48 months. Clinical SignificanceGI-based restorative materials and BF composite resin restorations in Class I cavities yielded satisfactory clinical performance after 48 months.

Retrospective evaluation of fiber-reinforced periodontal splints and resin bridges in the anterior region

Aim: The aim of this study was to evaluate the clinical performance of fiber-reinforced periodontal splints (FRSs) and adhesive bridges (FRBs) in treating anterior single-tooth defects.&#x0D; Methodology: Sixty-five patients who received FRSs and FRBs from 2001 to 2012 were recalled and evaluated clinically. The FRS and FRB restorations of the patients were clinically evaluated in terms of anatomical form, marginal adaptation, marginal coloration, secondary caries, and retention, according to the modified United States Public Health Service (USPHS) criteria. The current restoration statuses of the patients from 5 to 10 years post-treatment were photographed and recorded. Patient satisfaction level was assessed using a visual analogue scale (VAS), and periodontal pocket depth was measured. Clinical follow-up data were obtained and analyzed with the Chi-squared test (p&lt;0.05).&#x0D; Results: When each of the modified USPHS criteria was compared with the baseline values, statistically significant differences were observed between the groups. There were statistically significant differences when the categories were evaluated according to initial values (p&lt;0.05). When the clinical evaluation criteria were compared with each other, no statistically significant differences were found (p&gt;0.05). While the most successful results were obtained in the FRB group, most of the restoration losses and repairs occurred in the FRS group. According to the data obtained, 38% of restorations were lost and all restorations had been intact for at least 5 years. All lost restorations were in FGS restorations. The recall rate was 49% (n=32). Twenty (62.5%) of 32 patients rated their satisfaction with the restorations as being between 90 and 100, 8 (25%) as being between 80 and 90, and 4 (12.5%) as being between 70 and 80 on the VAS scale. The pocket depths of the patients at 5- and 10-years post-restoration were 2.3–3.8 mm and 2.4–5.2 mm, respectively.&#x0D; Conclusion: Fiber-reinforced restorations performed due to the loss of anterior single teeth and periodontal tissue can serve patients clinically for at least 5 years. FGK and FGS restorations can be considered alternative treatments that can further delay the more expensive implant and prosthetic treatment options for years.&#x0D; &#x0D; How to cite this article: Ünlü N, Altınbilek N, Velioğlu MS. Retrospective evaluation of fiber-reinforced periodontal splints and resin bridges in the anterior region. Int Dent Res 2021;11(Suppl.1):122-7. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.19&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Neurotic personality trait as a predictor in the\xa0prognosis of composite restorations: A 24-month clinical follow up\xa0study

The role of personality traits in modulating the incidence and progression of medical disease conditions are well documented, however, there is a paucity of information for its effects on dental health conditions and specifically on the prognosis of restorative dental materials. This study aims to evaluate the clinical performance of Micro-hybrid and Nano-ceramic composite restorations among patients with different personality traits. A total of 323 patients, indicated to receive operative treatment at a University Dental College Hospital, were invited to participate in this study. Consenting patients were requested to complete the Big Five Inventory (BFI-44 Item) personality questionnaire and were evaluated by a psychiatrist for categorizing the participants based on their personality traits. Out of the recruited patients, 124 patients falling in to the dominant trait of Agreeableness (n = 62) and Neuroticism (n = 62) were included in the study for further investigation. Next, patients from the Agreeableness (Group A) and the Neuroticism personality trait group (Group N) were randomly divided into two subgroups each—sub group Am (n = 44) and Nm (n = 48) for Micro-hybrid composite restorations and Sub group An (n = 42) and Nn (n = 47) for Nano-ceramic composite restorations. Two trained and calibrated dentists prepared the cavities according to previously published methodology. The restorations were evaluated at baseline (immediately after restoration), 6-months, 12-months and 24-months intervals by two blinded independent dental professionals for anatomical form, secondary caries, color match, retention, marginal adaptation, surface texture, marginal discoloration and post-operative sensitivity. There is no statistically significant difference noted in various parameters of restoration performance between Micro-hybrid composite and Nano-ceramic composite compared among ‘agreeableness’ personality group and among ‘neuroticism’ personality group after controlling the personality trait factor. Higher ‘Neuroticism’ individuals had higher restoration deterioration in color matching and surface texture when compared to higher ‘Agreeableness’ trait individuals. Regression analysis showed no effect of gender or cavity size on the outcome of results. Assessment of personality traits may serve as a useful tool during treatment planning which would aid clinicians in choosing suitable restorative dental material and prosthesis design according to individual patient’s physiological and functional needs, thereby overall improving the quality of treatment provided.

METHOD OF TREATMENT AND MAINTENANCE THERAPY OF PROSTHETIC STOMATITIS IN PATIENT WITH DIABETES MELLITUS

Relevance. Adaptation to prostheses and their further wearing is often associated with traumatic injuries of the oral mucosa. Mechanical traumas of the oral mucosa with removable laminar dentures, toxic effects of plastic components, the allergic effects of the prosthesis on the oral mucosa and the prosthesis wearer's body as a whole, as well as a stress factor considerably contribute to the occurrence of prosthetic stomatitis. Most often, a removable laminar denture acts as a combined stimulus. The manifestations of diabetic microangiopathies in the oral mucosa enhance the severity of prosthetic stomatitis in individuals with diabetes mellitus. The clinical picture of prosthetic stomatitis also depends on the size and condition of denture supporting area, for instance, atrophy of the edentulous jaws, conditions for anatomical retention of dentures. Therefore, the treatment of stomatitis in patients who wear removable laminar dentures is still a challenging problem in orthopaedic and therapeutic dentistry.&#x0D; Purpose and objective: to investigate available treatment approaches and maintenance therapy for managing prosthetic stomatitis in patients with diabetes mellitus who wear removable acrylic laminar dentures; to offer our newly developed treatment and maintenance therapy of prosthetic stomatitis in diabetic patients.&#x0D; Material and methods. The existing approaches and methods of treatment and maintenance therapy for prosthetic stomatitis in patients with diabetes mellitus were thoroughly investigated with clear focus on their advantages and disadvantages. The available methods to manage the complications caused by laminar denture wearing in patients with diabetes mellitus include topical remedies and oral hygiene products. The treatment of prosthetic stomatitis in patients who wear dentures is often reported as ineffective. Therefore, at present, it is relevant to search for new methods of treating prosthetic stomatitis under diabetes mellitus with the use of agents that boost the body antioxidant protection, stimulate tissue regeneration and epithelialisation.&#x0D; Results. The method we have developed for the treatment of prosthetic stomatitis in individuals with diabetes mellitus includes the application of 2% Thiotriazolin ointment for local treatment, and Thiotriazolin preparation for systemic therapy. Thiotriazoline is a domestic drug of polytropic action. It has membrane-stabilizing, antioxidant and reparative properties. Thiotriazoline stimulates tissue regeneration and epithelialisation processes, somewhat reduces the intensity of the inflammatory process. In dental practice, 2% Thiotriazolin ointment is recommended to treat ulcerative lesions of the oral mucosa and periodontal tissues. Our treatment method includes the following steps: after the denture adjustment and sanitation of the oral cavity done, patients are prescribed to apply 2% Thiotriazolin ointment onto the denture supporting areas, which are the most often traumatized, in particularly, onto the maxillary tubercles, along the transitional fold, in the sublingual, retromolar and retroalveolar spaces, daily for 7-10 days. The patients are also recommended to apply 2% Thiotriazolin ointment onto the inner surface of the prosthesis base. For systemic therapy, “Thiotriazolin” is prescribed to be taken by mouth in a dosage of 1 tablet of 100 mg per day for 30 day course.&#x0D; Supportive therapy involves Quvertin, while Lizak tablets are used for local prophylaxis. Following the oral sanitation, patients are prescribed to Lizak tablets (should be held in the mouth until dissolved slowly) 3-4 times a day for 5-7 day course. As part of a comprehensive supportive therapy, patients are prescribed Quvertin tablets, 1 tablet twice a day 30 minutes before meals (chew the tablet) for 30 day course.&#x0D; Conclusion. The proposed method of the therapy of prosthetic stomatitis in people with diabetes mellitus is quite easy to use, causes no side effects, produces a positive effect on the clinical course of the conditions, and enabled to achieve a stable remission after the disease, and, thus, can be recommended for implementing into dental practice. The described maintenance therapy for diabetic patients with prosthetic stomatitis is clinically effective, has no side effects, and can increase the periods of remission after the disease. This combination therapy can be recommended as an effective treatment option in therapeutic and orthopaedic dentistry.

Long-term Outcomes of Boston Type I Keratoprosthesis, and Efficacy of Amphotericin B and Povidone-Iodine in Infection Prophylaxis

To evaluate the long-term outcomes, anatomic retention, and complications of Boston type I keratoprosthesis (KPro). Retrospective, interventional case series METHODS: A retrospective chart review of implantations performed January 2008-December 2017 was conducted. Risk factors for anatomical retention and functional success were analyzed. The incidences of infections with and without antimicrobial medications were compared. Twenty-seven eyes of 26 patients were recruited. The most common indication for KPro surgery was failed penetrating keratoplasties (22 eyes, 81.5%). All patients had preoperative best-corrected visual acuity (BCVA) worse than 3/60. Over the mean follow-up of 83.4 ± 28.4 months, 15 eyes (55.6%) demonstrated improved BCVA. The anatomical retention rate was 88.9%, and the functional success rate was 44.4% (retained KPro with BCVA ≥ 3/60). Eyes with ocular surface disease (OSD) had significantly more complications than those without OSD. The most common complications were retroprosthetic membrane formation (15 eyes, 55.6%) and infection (13 eyes, 48.1%). Infectious keratitis was primarily caused by gram-positive bacteria, whereas endophthalmitis was chiefly caused by fungal infection. The infection incidence was significantly lower in eyes using topical 0.1% amphotericin B and 5% povidone iodine (P=.008 and .021, respectively). With its good retention rate and visual outcomes, Boston type I KPro could be an alternative treatment for patients with conventional penetrating keratoplasty failure, especially with appropriate patient selection and complication prevention. Standard prophylactic antibiotics with the addition of topical 0.1% amphotericin B and 5% povidone iodine might be optional effective regimens for infection prevention, especially in tropical countries.

Students’ Approach to Anatomical Terminology and Retention in Histology

Introduction & Objective Anatomical terminology, with its Latin and Greek roots, can be complex for students to comprehend as they navigate courses in the anatomical disciplines. Graduate students in anatomy courses have varying prior experience with classical languages and medical/anatomical terminology which impacts how they approach learning. While rote memorization of terms is often thought to be the prevailing approach, students may use many different methods to develop a vocabulary in the anatomical sciences. Although learning terminology is a necessary component of anatomical science courses, few studies focus on how students acquire their anatomical vocabulary and the impact it has on learning outcomes. The aim of this study was to evaluate how students approach anatomical terminology in a histology course, their retention of common terms, and the relationship between terminology retention and course performance. Materials & Methods Students in a graduate histology course at Indiana University were encouraged to voluntarily complete a post-course quiz. Students were asked to provide brief definitions for 10 anatomical terms and 10 combining forms relevant to material covered in histology and describe their approach to learning terminology. Suitable terms utilized in the instrument were determined by the frequency of each term in the required texts for the course. Quantitative data was analyzed using Spearman's correlation to determine the relationship between final course grades and quiz results. Responses to the learning approach questions were analyzed using thematic analysis Results Twelve students (36%) completed the post-course quiz. The average score on the quiz was a 63%. There was a statistically significant positive correlation (rs=.716, p=.009) between final grade and performance on the terminology quiz. Indicating students who performed well on the quiz also performed well in the histology course. Qualitative results suggest that students with some anatomical terminology experience found their background helpful in recalling terms. Many also reported making attempts to “break down” the words into more familiar parts. Others expressed a desire to understand the terminology prior to beginning the course to gain a deeper understanding of the content. Conclusion Overall, students felt that recognizing anatomical terminology helped them understand histology more clearly despite their performance in the course or on the terminology quiz. The relationship between terminology retention and final grade suggests that terminology remains an important component in engaging with and learning anatomical content. This study demonstrates a need for further research on how students obtain and use their anatomical vocabulary throughout the anatomical disciplines. Significance/Implication Understanding how students naturally approach anatomical terminology and the outcomes of those approaches may provide valuable insight for the development of interventions to assist in the learning of anatomical terminology and content.

Outcomes of the Boston type 1 and the Aurolab keratoprosthesis in eyes with limbal stem cell deficiency

PurposeTo analyse the outcomes of keratoprosthesis in eyes with limbal stem cell deficiency (LSCD) and to compare the outcomes in two different keratoprosthesis devices.MethodsThis was a single-centre retrospective comparative case...

A randomized controlled 10 years follow up of a glass ionomer restorative material in class I and class II cavities

ObjectiveTo evaluate the durability of a glass ionomer restorative material in Class I and Class II cavities during 10 years compared with a micro filled composite resin. MethodsFifty-nine participants (mean age 24 years) received 140 (80 Class I and 60 Class II) glass ionomer (GI) or composite resin (CR) restorations. Evaluation was performed with slightly modified USPHS criteria at baseline, and yearly during the 10 years. Data were analyzed with Cohran's Q and McNemar's tests. ResultsFifty-one patients and 124 restorations (61 GI / 38 Class I - 23 Class II, 63 CR / 38 Class I, 25 Class II) were evaluated after 10 years. The recall rate was 86.4%. The overall clinical recall rate of restorations was 88.6%. The success rate of Class I and II restorations were calculated as 100% for both materials. The cumulative failure rate (CRF) of all Cl I and Cl II GI restorations was 3.17% in total, but CFR was 8 % for Cl II GI restorations. A significant difference was observed between the marginal discoloration scores of restorations at 10 years (p = 0.022). No significant difference was seen between two restorative materials in terms of marginal adaptation (p > 0.05). A significant change was seen in color match of GI restorations at 10 years (p < 0.05). No significant change was found for the anatomical form, secondary caries, postoperative sensitivity, surface texture, and retention for either restorative material (p > 0.05). ConclusionsBoth tested restorative materials showed an acceptable success rate in the restoration of Class I and Class II cavities during the 10-year follow up.

PHONETIC REHABILITATION FOR REMOVABLE DENTAL PROSTHETICS

Removable prosthesis is considered as a device with therapeutic, rehab and prophylactic functions, which allows to improve the quality of life of the dentist. Its use is always aimed at solving three problems: restoration of chewing; restoration of pronunciation of sounds; restoration of aesthetic norms of a person.&#x0D; Fixation of the complete removable denture depends on the anatomical retention, which is determined by the area and form of the prosthetic bed; from adhesion (capillary forces, viscosity of saliva) and from the functional suction of the prosthesis. For the stabilization of prostheses, the contour of the alveolar appendix and the production of artificial teeth are of special importance.&#x0D; Therefore, a complete removable denture is a complex design, which always has a single plan of construction (basis and artificial teeth), but in each case is made taking into account the individual characteristics of the patient's body.&#x0D; Adaptation to a complete removable denture is a multi-layered process. Its inalienable component is neuro-reflex mechanisms. From these positions, the habit of prosthetics is explained by the development of cortical inhibition, which leads to the disappearance of the feeling of a foreign subject in the oral cavity. These changes occur on the basis of the general law, according to which repeatedly the stimulus becomes a brake agent. Based on masticatography, it has been established that addiction to prosthetics is associated with the appearance, perfection and consolidation of new conditioned motor reflexes. An important component of the adaptation process in patients with prosthetics is psychological adaptation. It is believed that it represents the sum of complex conditioned-reflex responses of the patient, which belong to the sphere of human emotions and determine the degree of satisfaction with dentures. The significance of psychological factors in the development of adaptation to prosthetics stimulates the creation of new and improved existing methods for assessing the psycho-emotional state of orthopedic dental patients. According to the results of these methods, high personal anxiety is the main factor that causes the development of psycho-emotional stress during orthopedic treatment.&#x0D; There is also a speech adaptation, which is the result of the interaction of the active organs of the articulation apparatus with dentures. The appearance of improper pronunciation of sounds is considered as a result of motor and sensory disorders of the central or peripheral nature: changes in the structure of the articulation apparatus and violations of muscle inertia involved in articulation; reduction of peripheral hearing and violations of the auditory perception of the central character. Wrong pronunciation is most often observed in groups of whistling, silent sounds, [p], [l], which are characterized by complexity of sounding and, accordingly, the complexity of articulation work. A certain range of works is devoted to methods of studying pronunciation of sounds from different points of view: physical (acoustic), anatomical-physiological and linguistic.&#x0D; Detection of defects of articulation was done by listening. In a number of studies the study of violations of articulation of sounds was carried out using anatomical-physiological and acoustic characteristics with the help of apparatus. Modern methods of speech research are based on listening, audiometry and spectral analysis of sound.&#x0D; Consequently, the features of rehabilitation of toothless patients with the help of a complete removable denture are widely covered in the literature. The concept of pathogenesis of violations with full or partial adentia and about mechanisms of their overcoming with the help of dentures is deepened. However, until now, the literature remains almost uninvolved into the consideration of phonetic aspects as in the analysis of anatomical and physiological features of the toothless mouth during preparation for prosthetics, and at different stages of the use of dentures.

The Aurolab Keratoprosthesis (KPro) versus the Boston Type I Kpro: 5-year Clinical Outcomes in 134 Cases of Bilateral Corneal Blindness

To compare the clinical outcomes of Boston Type I keratoprosthesis (Boston Kpro) with its low-cost version, the Aurolab Kpro (auroKPro). Retrospective comparative case series. This study included 134 eyes of 130 patients with severe bilateral corneal blindness but with wet ocular surfaces. The patients underwent either Boston Kpro (n= 78) or auroKPro (n= 56) implantation based on the device availability and patient's affordability. The primary outcome measurements were anatomical retention (defined as absence of device extrusion, exchange, or explantation) and functional recovery of 20/200 or better visual acuity at yearly time points until 5-years of follow-up. Limbal stem cell deficiency was the most common indication (60.5%) for surgery, followed by multiple failed grafts (35%). Both groups were comparable at baseline with respect to indications for surgery and associated ocular co-morbidities (P > 0.05). The overall anatomical retention rates were similar in the Boston Kpro (55 of 78, 70.5%) and auroKPro (35 of 56, 62.5%) groups (P= 0.11). Kaplan-Meier survival rates at 5 years of follow-up were greater for the Boston Kpro with respect to both anatomical retention (63 ± 6% vs. 43.4 ± 10%, respectively; P= 0.057) and functional recovery (42.4 ± 6% vs. 32.2 ± 7%, respectively; P=0.345), but these differences were not statistically significant. Complications such as intraoperative device breakage (7%) and postoperative extrusions (12.5%) were significantly more common with the auroKPro (P= 0.023). Both the auroKPro and the Boston Kpro are effective treatment options for patients with severe bilateral corneal blindness. The auroKPro can be considered an alternative to the Boston Kpro when affordability or availability of the Boston Kpro is a limiting factor.

Simplifying the digital workflow of facial prostheses manufacturing using a three-dimensional (3D) database: setup, development, and aspects of virtual data validation for reproduction

PurposeTo set up the digital database (DDB) of various anatomical parts, skin details and retention elements in order to simplify the digital workflow of facial prostheses manufacturing; and to quantify the reproduction of skin wrinkles on the prostheses prototypes with stereolithography (SLA) and direct light processing (DLP) methods. MethodsTwo structured light scanners were used to obtain the nasal and auricle forms of 50 probands. Furthermore, the ala nasi and scapha areas were captured with the digital single lens reflex camera and saved in jpeg format. The four magnetic retention elements were remodeled in computer aided design (CAD) software. The 14 test blocks with embossed wrinkles of 0.05–0.8mm were printed with SLA and DLP methods and afterwards analyzed by means of profilometry and confocal microscopy. ResultsThe introduced DDB allows for production of customized facial prosthesis and makes it possible to consider the integration of concrete retention elements on the CAD stage, which makes the prosthesis modelling more predictable and efficient. The obtained skin structures can be applied onto the prosthesis surface for customization. The reproduction of wrinkles from 0.1 to 0.8mm in depth may be associated with the loss of 4.5%–11% of its profile with SLA or DLP respectively. Besides, the reproduction of 0.05mm wrinkles may be met with up to 40% profile increasement. ConclusionsThe utilization of DDB may simplify the digital workflow of facial prostheses manufacturing. The transfer of digitally applied skin wrinkles till the prostheses’ prototypes may be associated with deviations from 11 to 40%.

Autologous ear cartilage as a carrier for the Boston Type Ⅰ Keratoprosthesis in a rabbit model

AbstractPurpose:To evaluate complications and anatomical retention when using autologous ear cartilage as a carrier in type 1 Boston keratoprosthesis (Kpro) surgery. Methods: In New Zealand White r...

Does Gastric Retention Pattern Affect Outcome of Gastric Peroral Endoscopic Myotomy for Patients with Gastroparesis? A Preliminary Study

Introduction: Gastroparesis is a disease of impaired gastric motility characterized by nausea, vomiting, early satiety and bloating. Gastric emptying scintigraphy (GES) is primarily used for diagnosis. Gastric per-oral endoscopic pyloromyotomy (G-POEM or POP) has emerged as a novel technique for treating gastroparesis with up to an 80% success rate. As this procedure involves pyloromyotomy, we hypothesize that responders to this therapy are characterized by a more distal retention pattern on GES when compared with non-responders. Methods: This is a retrospective study with IRB approval. We used standardized 4-hour GES as per the SNMMI procedure guideline to quantify proximal and distal retention using the incisura as an anatomical landmark, separating two regions (Figures 1 and 2). Baseline and post-procedure symptom severity were measured using the Gastroparesis Cardinal Symptoms Index (GCSI). Responders were defined by a reduction of at least 1 point in total GCSI and a 25% reduction in at least 2 of the 3 symptom subscales. We compare treatment response and symptom profile in each patient to total gastric half-emptying time (T1/2), proximal gastric T1/2 and a ratio comparing the proximal to total gastric T1/2, which we call retention index (RI). RI serves as a proxy for retention location, with a larger value representing more proximal disease.749_A Figure 1. Proximal stomach selection on gastric emptying scintigraphy in anterior (left) and posterior (right) projections.749_B Figure 2. Distal stomach selection on gastric emptying scintigraphy in anterior (left) and posterior (right) projections.Results: 47 patients underwent G-POEM during the study period. A significant difference (P<0.01) was found in pre-procedure RI between responders and non-responders (Figure 3). A decrease in RI was identified for each patient following the procedure. No significant differences were identified in baseline total or proximal T1/2 between the two groups. No correlations were found between motility patterns and predominant symptoms.749_C Figure 3. Pre-procedure Retention Index vs. Total GCSI Reduction. Note that all responders had RI value greater than 0.84, as indicated by the dashed red line, and all non-responders had RI less than this value.Conclusion: RI was significantly higher in responders. This may represent an important patient selection factor for G-POEM going forwards. A higher RI indicates a more proximal burden of disease. Perhaps the effect of pyloromyotomy goes beyond local distensibility, similarly to how fundic distension can induce antroduodenal motor activity. Larger, prospective studies are warranted to further explore RI as a criterion for G-POEM selection and the correlation between anatomical retention and motor activity. G-POEM has a clear, measurable effect on gastric emptying as shown by the decrease in RI following the procedure. Regional retention patterns may not correlate well with gastroparesis symptoms.

LVP keratoprosthesis: anatomical and functional outcomes in bilateral end-stage corneal blindness

PurposeTo describe the anatomical and functional outcomes of the novel LVP keratoprosthesis (Kpro), developed as an alternative to the modified osteo-odonto keratoprosthesis (MOOKP), in eyes with end-stage corneal blindness where...

A Reinforcement-Based Learning Paradigm Increases Anatomical Learning and Retention-A Neuroeducation Study.

In anatomy education, a key hurdle to engaging in higher-level discussion in the classroom is recognizing and understanding the extensive terminology used to identify and describe anatomical structures. Given the time-limited classroom environment, seeking methods to impart this foundational knowledge to students in an efficient manner is essential. Just-in-Time Teaching (JiTT) methods incorporate pre-class exercises (typically online) meant to establish foundational knowledge in novice learners so subsequent instructor-led sessions can focus on deeper, more complex concepts. Determining how best do we design and assess pre-class exercises requires a detailed examination of learning and retention in an applied educational context. Here we used electroencephalography (EEG) as a quantitative dependent variable to track learning and examine the efficacy of JiTT activities to teach anatomy. Specifically, we examined changes in the amplitude of the N250 and reward positivity event-related brain potential (ERP) components alongside behavioral performance as novice students participated in a series of computerized reinforcement-based learning modules to teach neuroanatomical structures. We found that as students learned to identify anatomical structures, the amplitude of the N250 increased and reward positivity amplitude decreased in response to positive feedback. Both on a retention and transfer exercise when learners successfully remembered and translated their knowledge to novel images, the amplitude of the reward positivity remained decreased compared to early learning. Our findings suggest ERPs can be used as a tool to track learning, retention, and transfer of knowledge and that employing the reinforcement learning paradigm is an effective educational approach for developing anatomical expertise.

Russian Keratoprosthesis in Stevens-Johnson Syndrome.

To evaluate the efficacy and safety of Moscow Eye Microsurgery Complex in Russia (MICOF) keratoprosthesis (KPro) implantation in patients with Stevens-Johnson syndrome (SJS). This was a retrospective case series. Fourteen eyes of 13 patients with SJS underwent KPro implantation at the Chinese People's Liberation Army General Hospital between April 1, 2000, and December 24, 2014. The visual outcome, KPro retention rate, and incidence of postoperative complications and their management were recorded and investigated. The mean age and follow-up duration were 61.5 ± 17.3 years (range: 27-87 yrs) and 62 ± 39.1 months (range: 13-144 mo). Thirteen eyes (92.9%) achieved a best-corrected visual acuity of 20/200 or better, and 8 eyes (57.1%) achieved a best-corrected visual acuity of 20/40 or better after surgery. However, 71.4% (10/14) experienced visual decline because of different postoperative complications. Common complications included corneal melting, glaucoma, vitritis, superficial tissue overgrowth, and retroprosthetic membrane, and the incidence of these complications was 71.4%, 28.6%, 35.7%, 14.3%, and 28.6%, respectively. After repair and autoauricular cartilage reinforcement, all cases had stable anatomical retention at the last visit. The MICOF KPro improved vision of patients with SJS, but lifelong surveillance is necessitated because of a high rate of postoperative complications. Corneal melting was the main reason for KPro failure. Infectious endophthalmitis and glaucoma were the main risk factors for visual loss.

What Can We Learn About MOOKP that We Can Apply to Future Prosthetic Devices?

The purpose of this study is to explain the different types of keratoprosthesis depending on the material; biological or nonbiological, and in the mode of fixation; transcorneal, intracorneal, or epi-corneal fixation; to define the general indications depending on the characteristics of the ocular surface; if it is a wet blinking eye or a dry nonblinking eye; to report our experience with different kinds of keratoprosthesis defining the retention of the prosthesis as the gage of success; and to define the ideal keratoprosthesis for us. We have learned that several factors significantly affect anatomical retention and we were able to demonstrate this in two papers about our long-term experience on the biological keratoprosthesis OOKP and Tibia KPro. Based on this publication, we have about 258 patients with a biological keratoprosthesis with a mean follow-up time of 7.2 years, and about 117 cases with the Boston KPro Type I with a mean follow-up time of 3.1 years. Comparison of artificial corneas is not that easy since indications are different, surgeon experiences are presented in different manners, especially when we talk about visual acuity results. Perhaps the simplest and most logical way of comparing artificial corneas is looking into results of anatomical retention thru time, and evaluating the different complications that we may encounter in each kind in the post-operative period. We finally define our ideal keratoprosthesis depending if it is for a wet blinking eye or for a dry nonblinking eye.