Blinded Examiners Research Articles

A Case Series With Cysteamine-Isobionicamide Complex: Clues for Skin-Rejuvenating Activity.

Skin aging is inevitable. Wrinkles, skin texture abnormalities, senile hyperpigmentation, loss of skin tone, dryness, atrophy, and telangiectasias represent some of the hallmarks of aged skin. Skin rejuvenation can be addressed by topical therapies, such as topical retinoids and antioxidants or physical modalities with energy-based devices, all providing acceptable outcomes. In this case series, we aimed to test the rejuvenating potential of the combination of cysteamine (a naturally occurring antioxidant) and isobionicamide (a derivative of the anti-aging molecule niacinamide) applied topically. Healthy male and female patients (N = 7) aged between 25 and 70 years and having Fitzpatrick skin types I-VI were recruited. Topical application of a cysteamine-isobionicamide formula was done once daily. Treatment lasted for 16 weeks. Clinical high-resolution photos were acquired using LifeViz 3D at recruitment and after 16 weeks. Blinded dermatological examinations and scoring were performed. Self-assessment and quality of life (QoL) questionnaires were collected. Clinical photos showed improvement in skin luminosity, increased evenness of skin tone, and reduction of fine wrinkles as well as hyperpigmentation. Patients as well as clinical investigators blinded to the chronology of photos observed the improvements in skin texture, luminosity, and radiance, the brightening of the dark spots, as well as the reduction of both number and volume of wrinkles after 16 weeks of daily application. Furthermore, a significant improvement in patients' quality of life was recorded. This case series represents the first evidence that topical application of cysteamine isobionic-amide complex could be considered as a safe and effective option in the reversal of skin photoaging.

Accuracy of Near-Infrared Imaging in Detection of Proximal Caries Lesions in Deciduous Molars: An in vitro Study

Plain Language SummaryTooth decay is the most prevalent chronic disease in childhood, and early detection of proximal lesions is essential for implementing a treatment plan based on minimal intervention. The aim of this in vitro study was to evaluate the accuracy of the nonionizing method near-infrared imaging (NIRI) generated by the iTero Element 5D scanner for detecting proximal caries lesions in deciduous molars, comparing it with visual inspection and bitewing radiography. The gold standard was histological analysis. A total of 182 deciduous molars, divided into 91 pairs of first and second molars, were evaluated by two blinded examiners. Teeth with sound proximal surfaces and carious lesions (ICDAS 0–5) were included, while teeth with restorations, marginal crest breakdown on the mentioned surfaces, and extensive dentin resorption were excluded. Two distinct thresholds were considered for the assessment of caries detection methods: enamel lesion (D1) and dentin lesion (D3). Sensitivity (ability of a method to correctly identify carious lesions when they are present), specificity (ability of a test to correctly identify healthy surfaces without carious lesions), accuracy (combines sensitivity and specificity, representing the overall ability of a method to provide correct diagnoses), and area under the ROC curve (illustrates how sensitivity and specificity vary) were calculated for each method in the statistical analysis. We conclude that NIRI was able to detect caries lesions similarly to visual inspection for lesions located in dental enamel but was less effective than bitewing radiography for lesions in both enamel and dentin.

Comparative evaluation of smear layer removal efficacy using various final irrigation protocols: a SEM study

Objective: This study aimed to assess the efficacy of 0.2% Chitosan and 17% EDTA, with or without ultrasonic activation, in removing the smear layer (SL). Methods: Fifty bovine incisors were sectioned 17 mm from their apices, instrumented using ProTaper Universal instruments and divided into five groups (n=10): I- Distilled water + conventional irrigation (CI) (control), II- 17% EDTA + CI, III- 0.2% Chitosan + CI, IV- 17% EDTA + passive ultrasonic irrigation (PUI) and V- 0.2% Chitosan + PUI. The roots were split longitudinally and examined under a scanning electron microscope at 500x magnification to assess SL removal. SL presence was scored by three blinded examiners using a five-point scale. Data was analyzed using Kruskal-Wallis and Mann-Whitney U-tests (p<0.05). Results: The statistical analysis revealed significant differences in SL removal among groups (p<0.05). Group IV (EDTA + PUI) exhibited significantly higher removal efficacy than other groups (p<0.05). SL removal was highest in the cervical third compared to middle and apical thirds. Conclusions: EDTA combined with PUI demonstrated superior SL removal.

Comparison of Implant Precision with Robots, Navigation, or Static Guides

Precise surgical positioning according to a digital plan is important for aesthetic and biologically stable dental implant restorations. This randomized controlled trial compared implant placement assisted by robotic surgery (RS), dynamic navigation (DN), or 3-dimensional printed static guide (SG). An overall 45 patients with a missing tooth in the premolar/molar region were randomly assigned to 1 of the 3 groups. Implant positional accuracy (primary outcome), early wound healing, soft tissue microcirculation, patient-reported outcome measures, and surgeon preference were measured by calibrated blind examiners. One adverse event occurred in DN and RS. In RS (n = 15), the global platform, apex deviation, and angular deviations (mean ± SD) were 1.1 ± 0.4 mm, 1.5 ± 0.6 mm, and 4.7° ± 2.5°, respectively. Similarly, deviations were 1.3 ± 0.6 mm, 1.9 ± 0.9 mm, and 5.5° ± 3.5° in the DN group (n = 14) and 1.1 ± 0.6 mm, 2.0 ± 1.2 mm, and 6.2° ± 4.0° in the SG group (n = 13). Significantly smaller differential deviations (mesial-distal) at the platform and apex levels were found in the RS group than the SG group (P < 0.05). Surgery was significantly shorter with a SG (P < 0.001), and this was associated with better postoperative recovery at 3 d. The surgeon assessed DN as providing easier access to reach the surgical site. No significant differences were found upon comparing soft tissue microcirculation and oxygen saturation immediately, 1 h, or 7 d after surgery. Patient-reported outcomes were comparable in the 3 groups, except that patients in the SG group reported better oral health–related quality of life 3 d after surgery. It can be concluded that RS showed near-zero 3-dimensional systematic error in implant position, while DN and SG demonstrated a centrifugal error pattern. All 3 guided approaches had uneventful wound healing and acceptable patient-reported outcomes. The 3 groups had specific cost-benefit profiles. After additional technical developments, future trials with larger sample sizes and longer follow-up periods should be performed to analyze the cost-effectiveness of different guided surgical approaches.

Generational shift for clinical application of the QLF system for evaluating tooth wear

BackgroundNo study has quantitatively assessed tooth wear using a clinical quantitative light-induced fluorescence (QLF) system. This study aimed to compare fluorescence parameters (ΔFwear) between the research QLF system (QLF-D) and clinical QLF system (Qraycam Pro) and evaluate the validity of both systems in detecting dentin exposure from tooth wear. MethodsThirty-five human molars and premolars were collected. Two blinded examiners conducted evaluations. Images from QLF-D and Qraycam Pro were captured and analyzed by the first examiner to calculate ΔFwear, representing the maximum fluorescence intensity for occlusal wear. The stage of tooth wear was determined by the second examiner using the tooth wear index (TWI). The area of interest (AOI) was determined as the cusp without defects, such as caries or fractures. Only areas mutually agreed by both examiners were included in analysis. The Kruskal-Wallis test was conducted to assess differences in ΔFwear between two devices. ROC analysis evaluated the validity of both systems in determining dentin exposure using AUROC. ResultsThirty-eight AOIs were analyzed. ΔFwear significantly increased with higher TWI scores. Median ΔFwear for TWI scores (0, 1, and 2) were 6.9 %, 10.3 %, and 24.8 %, respectively, for QLF-D, and 5.7 %, 7.7 %, and 23.9 %, respectively, for Qraycam Pro. No significant differences in ΔFwear were observed between QLF-D and Qraycam Pro for any TWI score. The AUROC for both systems was 0.95. ConclusionΔFwear was comparable between QLF-D and Qraycam Pro and demonstrated high validity in detecting dentin exposure. These findings support the clinical application of the QLF for quantitative tooth wear assessment.

Effectiveness of a toothbrushing intervention utilizing puzzle-solving game assisted with visual aids among adolescents: A single-blind randomized controlled trial.

Maintaining good oral hygiene through effective toothbrushing is crucial for preventing dental issues in adolescents. Conventional oral health education (OHE) and video demonstration approach are passive means of OHE, that often fail to engage this age group. This study introduced an innovative approach to OHE by combining jigsaw puzzle and visual aids to improve oral health outcomes among adolescents. To assess the effectiveness of Jigsaw Puzzle-assisted Visual Reinforcement (JPVR) technique on toothbrushing knowledge, practices, and clinical oral health parameters compared to conventional OHE and video demonstration among adolescents. This single-blind randomized controlled trial involved 195 adolescents aged 12-15 years randomly allocated to three groups: conventional OHE (control), video demonstration and JPVR. Interventions were administered, and assessments were carried out at baseline, 1 month, and 3 months. Prior to the start of the study, the oral hygiene aids used were standardized. Outcomes were measured using a self-designed, validated closed-ended questionnaire to assess the toothbrushing knowledge and practices. This was followed by clinical examination carried out using gingival and plaque indices by a blinded examiner. At baseline, groups had comparable knowledge, practices, and clinical parameters. At 3 months, the JPVR group demonstrated significantly higher knowledge, better practices, lower plaque, and reduced gingival scores compared to other groups. The JPVR technique improved toothbrushing knowledge, practices, and clinical oral health parameters among adolescents. This approach fostered active learning and knowledge retention and is a cost-effective strategy for promoting positive oral health outcomes among children.

Comparative Effectiveness of Miswak and Toothbrushing on Dental Plaque and Gingivitis: A Randomized Controlled Trial.

The miswak, crafted from the Salvadora persica tree, is a traditional teeth-cleaning twig that has served as a natural substitute for toothbrushes and toothpaste across diverse regions for centuries. This study aimed to evaluate and compare the effectiveness of miswak and a conventional toothbrush in reducing dental plaque and gingivitis over a two-week period. This two-week randomized, single-blind (clinical investigator), two-parallel-arm clinical trial was conducted at Princess Nourah University College of Dentistry (PNUCD). Stratified random sampling identified sixty participants who were then randomly assigned to two study groups: the miswak group and the toothbrushing group. To facilitate data collection, a self-designed form was employed to document participants' initials, assigned group, the Silness and Loe plaque index, and the Loe and Silness gingival index. The clinical examination, conducted by two blinded and trained examiners using a mouth mirror and explorer under natural light, aimed to assess the specified indices. The collected data were analyzed using IBM SPSS Statistics, Version 22. Following the intervention, the miswak group exhibited no significant change in the plaque scores (p = 0.58) compared to the toothbrush group (p = 0.007). A notable rise in gingival score was observed within the miswak group (p < 0.001), whereas no significant change was noted within the toothbrush group (p = 0.52). Over a two-week period, miswak was successful in controlling dental plaque; however, gingival scores were higher, which could be attributed to the aggressive use of miswak. With proper training, the use of miswak has the potential to contribute positively to gingival health, particularly in regions where it is readily accessible and affordable.

Tactile sensation in relation to roughness and reflection of active initial lesions in primary (deciduous) and permanent dentition in vitro

ObjectivesThis study evaluated whether a relationship exist between tactile sensation, roughness and reflection intensity in active enamel lesions of primary (deciduous) and permanent dentition. MethodsFreshly extracted teeth of the primary (n=29) and permanent (n=60) dentition of patients who underwent serial extractions under general anesthesia due to multiple deep caries lesions showing active lesions (International Caries Detection and Assessment System scores of 2) were selected. The mean linear (Ra), area-related (Sa), volume-related (Vmc) roughness and vertical reflection intensity (VRI) of sound (S) and carious (C) areas were determined by using a 3D-laser-scanning-microscope and a multi-sensor microscope with two different chromatic-confocal optics. Furthermore, two blinded examiners evaluated the roughness by tactile examination using three different explorers (S23H,405CP11, S3C). ResultsMean differences (95%CI) between S and C for teeth of the primary dentition were: Ra:-1.9(-2.3;-0.4)µm, Sa:-31.8(-1.8;0.0)µm, Vmc:-1.8(-1.6;-0.0)ml/m2, VRI:29(20;43) and for teeth of the permanent dentition: Ra:-4.0(-2.5;-1.0)µm, Sa:-4.8(-3.0;-1.1)µm, Vmc:-4.6(-3.4;-0.5)ml/m2, VRI:34(19;44) differing significantly between S and C (p<0.05,Wilcoxon test). No significant difference was observed between 1st and 2nd dentition (p>0.05, Kruskal-Wallis test) as well as commercial and experimental optic (p>0.05). The highest positive predictive value (PPV) was achieved by examiner 1 with explorer S3C (1st dentition 67%;2nd dentition 100%;pooled dentition 88%)), while examiner 2 revealed the highest PPV with explorer S23H (89%;86%;88%). ConclusionDifferences in roughness and reflectance between sound and caries-active enamel surfaces could be evaluated in both primary and permanent dentition. These differences could also be reliably detected using three different explorers with good validity. However, the most predictive explorer seems to differ between examiners. Clinical SignificanceIn both primary (deciduous) and permanent dentition active caries lesions exhibit significantly higher roughness and lower vertical reflection intensity compared with sound enamel. These differences are detectable by blind tactile examination and objective methods such as 3D-laser-scanning or multi-sensor microscopy, highlighting their utility in caries diagnosis in both dentitions.

Guided biofilm therapy versus conventional protocol—clinical outcomes in non-surgical periodontal therapy

BackgroundThe aim of the randomized controlled clinical trial study was to evaluate the effectiveness in reducing pathologically increased pocket probing depths (PPD > 3 mm) using the Guided Biofilm Therapy (GBT) protocol (adapted to the clinical conditions in non-surgical periodontal therapy (NSPT): staining, air-polishing, ultrasonic scaler, air-polishing) compared to conventional instrumentation (staining, hand curettes/sonic scaler, polishing with rotary instruments) both by less experienced practitioners (dental students).MethodsAll patients were treated according to a split-mouth design under supervision as diseased teeth of quadrants I/III and II/IV randomly assigned to GBT or conventional treatment. In addition to the treatment time, periodontal parameters such as PPD and bleeding on probing (BOP) before NSPT (T0) and after NSPT (T1: 5 ± 2 months after T0) were documented by two calibrated and blinded examiners (Ethics vote/ Trial-register: Kiel-D509-18/ DRKS00026041).ResultsData of 60 patients were analyzed (stage III/IV: n = 36/ n = 24; grade A/ B/ C: n = 1/ n = 31/ n = 28). At T1, a PPD reduction of all diseased tooth surfaces was observed in 57.0% of the GBT group and 58.7% of the control group (p = 0.067). The target endpoint (PPD ≤ 4 mm without BOP) was achieved in 11.5% for GBT (conventional treatment: 11.2%; p = 0.714). With the exception for number of sites with BOP, which was at T1 15.9% in the GBT group and 14.3% in the control group (p < 0.05) no significant differences between the outcomes of the study were found. At 30.3(28.3) min, the treatment time was significantly shorter in GBT than in the control group at 34.6(24.5) min (p < 0.001).ConclusionsWith both protocols (GBT/ conventional instrumentation) comparably good clinical treatment results can be achieve in NSPT in stage III-IV periodontitis patients.Trial registrationThe study was registered before the start of the study and can be found under the number DRKS00026041 in the German Clinical Trials Register. The registration date was 19/08/2021.

Cognitive and motor improvement by tummy time practice in preemies from low-income settings: a randomized clinical trial.

Early intervention and parental education for preemies are limited in some low-income countries. Thus, this study aimed to assess whether daily tummy time (TT) associated with usual care (UC) enhances motor and cognitive development in preemies from low-income countries. The main and secondary aim was to assess prone head elevation (PHE) and motor and cognitive functions, respectively. Thirty-one preemies with a mean gestational age at birth of 33.3 ± 1.6 weeks and weighing <2,500 g were included and 18 completed all assessments. Parents from the TT group were asked to perform TT with their preemies for at least 20 min during daily activities and playtime. Motor and cognitive functions were assessed by a blinded examiner using the motor and cognitive composite scores of Bayley-III after two and four months of corrected age. PHE was given by the angle from the tragus of the ear to the supporting surface of the infant; measurements were obtained using the Kinovea® software at baseline, after two, three, and four months of corrected age. The Bayley-III motor composite score of the TT group was higher than the UC group after two and four months of corrected age. The PHE angle increased over time but did not differ between groups. Nevertheless, TT expanded the perspective of preemies to explore their bodies and environment, favoring the stimuli for motor and cognitive patterns. The loss of participants (31%) was one of the limitations of the study, illustrating the challenge of providing continued early interventions to preemies from low-income countries. In this sense, TT practice is a home intervention that may improve motor and cognitive function of preemies immediately after hospital discharge.

Sensitivity and specificity of the sensory collapse test for nerve entrapment syndrome in the upper extremity

ObjectivesSeveral prospective blinded studies have found poorer sensitivity for the sensory collapse test than reported by Susan E Mackinnon’s team. However, the blinded examiner had no knowledge of the patient's clinical presentation, or even of the purpose of the test. In these conditions, it seems difficult to perform the sensory collapse test correctly. The aim of the present study was to evaluate the efficacy of the sensory collapse test in the diagnosis of nerve compression in the upper extremity, using a trained, “partially” blinded examiner, with a minimum of clinical information in order to avoid bias due to poor execution of the test, while still unable to influence the test result. MethodsSeventy-two patients with diagnosis of nerve entrapment in the upper extremity were included prospectively. The sensory collapse test was performed by two examiners, one of whom was blinded to laterality and to the site of nerve compression, aware only of the affected nerve. Using electrodiagnosis study as reference, the sensitivity and specificity of the sensory collapse test were calculated for each examiner. ResultsThe unblinded examiner showed 72% sensitivity and 57% specificity, and the blinded 68% sensitivity and 57% specificity. ConclusionsThe sensory collapse test is useful for diagnosis of nerve entrapment in the upper limb, even with a blinded examiner. Level of evidence3.

Salivary Oxidative-Antioxidant Profile Following Adjunctive Gaseous Ozone Administration in Non-Surgical Periodontal Treatment: A Randomized Controlled Trial.

Background: Periodontitis is associated with increased oxidative stress, which may impair treatment outcomes. Ozone therapy has shown promise in reducing oxidative stress and improving periodontal health. This study examined the impact of adjunctive gaseous ozone administration on salivary oxidative stress markers in patients with periodontitis stages II-IV and grades A-C undergoing non-surgical periodontal treatment (NSPT). Methods: Ninety patients with periodontitis were randomly allocated to either the test group (NSPT with gaseous ozone administration) or the control group (NSPT alone) using computer-generated randomization. The OzoneDTA system was used to deliver ozone at 2100 ppm for 60 s per site once weekly for 4 weeks. Clinical periodontal parameters (probing depth [PD], clinical attachment level [CAL], plaque index [PI], gingival index [GI]) and salivary oxidative stress markers (malondialdehyde [MDA], total antioxidant capacity [TAC], superoxide dismutase [SOD]) were assessed by blinded examiners at baseline, 3, and 6 months post-treatment. Results: Mixed ANOVA revealed significant three-way interactions between time, treatment, and stage or grade for clinical and biochemical measures (p < 0.001). The test group exhibited significant improvements in TAC (mean difference: 0.45 ± 0.12 mmol/L, p = 0.002), MDA (-0.38 ± 0.09 nmol/mL, p = 0.001), and SOD (65 ± 18 U/mL, p < 0.001) compared with the control group, with more pronounced effects in stages III and IV. Large effect sizes (Cohen's d > 0.8) were observed for the test group between baseline and 6 months for all markers. Conclusions: Gaseous ozone administration as an adjunct to NSPT can effectively improve clinical periodontal parameters and salivary oxidative stress markers, particularly in stages III and IV periodontitis. The enhanced outcomes may be attributed to ozone's antimicrobial and immunomodulatory properties, which synergistically reduce oxidative stress and promote periodontal healing.

Automated immunohistochemistry of intra-epidermal nerve fibres in skin biopsies: A proof-of-concept study.

To develop a standardised, automated protocol for detecting protein gene product 9.5 (PGP9.5) positive intra-epidermal nerve fibres (IENFs) in skin biopsies, transitioning from the established manual technique to an automated platform. This automated method, although currently intended for research applications, may improve the accessibility of this diagnostic test for small fibre neuropathy in clinical settings. Skin biopsies (n = 274) from 100 participants (fibromyalgia syndrome n = 62; idiopathic small fibre neuropathy: n = 16; healthy volunteers: n = 22) were processed using an automated immunohistochemistry platform. IENF quantification was performed by blinded examiners, with reliability assessed via a two-way mixed-effects model to evaluate inter- and intra-observer variability. The automated staining system reproduced intra-epidermal nerve fibre density (IENFD) counts consistent with free-floating sections (mean ± standard deviation: free-floating: 5.6 ± 3.4 fibres/mm; automated: 5.9 ± 3.2 fibres/mm). A median difference of 0.3 with a lower bound 95% Confidence Interval (CI) at -0.00005 established non-inferiority against a margin of -0.4 (p = .08). Specifically, the inter-class correlation coefficient (class denotes consistency in measured observations) was 99% (95% CI: 0.9-1), indicating excellent agreement between free-floating and automated methods. The inter- and intra-class coefficient between examiners were both 99% (95% CI: 0.9-0.1) for IENFD, demonstrating high reliability using sections stained using the automated method. Automated immunohistochemistry provides high-throughput reliable and reproducible intra-epidermal nerve fibre quantification. This method, although currently proof-of-concept, for research use only, may be more widely deployed in histopathology laboratories to increase the adoption of IENFD assessment for the diagnosis of peripheral neuropathies.

Can a Low-Fidelity Arthroscopic Simulator Improve Technical Expertise in Performing Temporomandibular Joint Arthroscopy?

BackgroundChallenges in temporomandibular joint (TMJ) arthroscopy training include the cost of operating room time, surgical risks, and the accessibility of cadavers and high-fidelity simulators. A low-fidelity simulator (LFS) was developed for initial TMJ arthroscopy training. PurposeThe aim of this study was to evaluate improvement in TMJ arthroscopic skills after training with an LFS using the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale. Study design, setting, sampleA prospective randomized controlled study was conducted. Subjects included Oral and Maxillofacial Surgery residents in post-graduate year (PGY) 1–5 at Thomas Jefferson University. Chief residents actively performing TMJ arthroscopy were excluded. Predictor variableThe predictor variable was participation in LFS training. Subjects were randomly assigned to the LFS training or no LFS training group. Main outcome variablesThe primary outcome variable was simulated surgical skill measured by total ASSET score (maximum score of 35). The secondary outcome variables were simulated surgical skill measured by each ASSET domain score and time to completion (TTC). CovariatesThe covariates included sex, age, handedness, PGY, endoscopic experience, open TMJ surgery experience, and experience with musical instruments and sports. AnalysesData analyses included paired T-tests to determine changes in outcome variables after TMJ arthroscopy training between experimental groups, and ANOVA and chi-square tests to identify associations between covariates. Inter-rater reliability of the blinded examiners was evaluated using Cronbach’s alpha correlation. A P-value < .05 was considered significant. ResultsThe sample was composed of 10 residents: 5 (100%) males in the no LFS group, 3 (60%) males and 2 (40%) females in the LFS group (P = .4). There was no significant difference between the groups in pre-TMJ arthroscopy training ASSET scores (P = .3). After training, the total ASSET score improved by 3.40 ± 6.87 in the no LFS group and by 6.27 ± 2.68 in the LFS group (P = .03). Conclusions and relevanceStudy results showed that low-fidelity simulation can improve fundamental arthroscopic skills. Future research should be conducted on a larger scale to further validate this model and show the transfer of skill improvements to cadaver and live patient settings.

Imaging the Area of Internal Limiting Membrane Peeling after Macular Hole Surgery.

Background: The aim of this study was to compare en-face optical coherence tomography (OCT) imaging and confocal scanning laser ophthalmoscopy (cSLO) imaging at different wavelengths to identify the internal limiting membrane (ILM) peeling area after primary surgery with vitrectomy and ILM peeling for macular hole (MH). Methods: In total, 50 eyes of 50 consecutive patients who underwent primary surgery with vitrectomy and ILM peeling for MH were studied. The true ILM rhexis based on intraoperative color fundus photography was compared to the presumed ILM rhexis identified by a blinded examiner using en-face OCT imaging and cSLO images at various wavelengths. To calculate the fraction of overlap (FoO), the common intersecting area and the total of both areas were measured. Results: The FoO for the measured areas was 0.93 ± 0.03 for en-face OCT, 0.76 ± 0.06 for blue reflectance (BR; 488 nm), 0.71 ± 0.09 for green reflectance (GR; 514 nm), 0.56 ± 0.07 for infrared reflectance (IR; 815 nm) and 0.73 ± 0.06 for multispectral (MS). The FoO in the en-face OCT group was significantly higher than in all other groups, whereas the FoO in the IR group was significantly lower compared to all other groups. No significant differences were observed in FoO among the MS, BR, and GR groups. In en-face OCT, there was no significant change in the ILM peeled area measured intraoperatively and postoperatively (8.37 ± 3.01 vs. 8.24 ± 2.81 mm2; p = 0.8145). Nasal-inferior foveal displacement was observed in 38 eyes (76%). Conclusions: En-face OCT imaging demonstrates reliable postoperative visualization of the ILM peeled area. Although the size of the ILM peeling remains stable after one month, our findings indicate a notable inferior-nasal shift of the overall ILM peeling area towards the optic disc.

Poster 366: The Intra-Articular Tendinous Graft Diameter of 10 Millimeter Bone-Patellar Tendon-Bone Grafts in Adolescent Patients: An MRI Analysis of 100 Patients

Objectives: The choice of graft for anterior cruciate ligament (ACL) reconstruction is dependent on a number of factors. However, in adolescents with closing or closed physes, patellar tendon bone-tendon-bone (BTB) autograft has demonstrated higher rates of return to sport and lower rates of revision, when compared to hamstring tendon autograft. ACL graft size may be one predictor of post-operative success as smaller graft diameter is associated with higher rates of rupture requiring revision. Measuring the intra-articular tendinous graft diameter in a BTB graft with standard intra-operative methods is difficult given that cylindrical sizing tubes must pass over the eccentric bone plugs, which tend to be larger than the central soft tissue region. Previous ultrasound and magnetic resonance imaging (MRI)-based studies have validated methods for measuring patellar tendon thickness, yet variance in patellar tendon graft size, including the influence of age and sex, has not been well studied. Therefore, the purpose of this study was to determine the cross-sectional area of the soft tissue portion of a standard 10mm BTB autograft and, by calculation, determine the “collagen graft size” (i.e. graft diameter), as would typically be reported in ACL reconstruction studies. Secondarily, the study sought to assess variance in BTB graft diameter based on age and sex. Methods: A total of 100 patients (10 females and 10 males at each age from 13-17) who underwent a knee MRI at a single academic orthopedic center without documented extensor mechanism pathology were included. After confirming acceptable interrater reliability, patellar tendon cross-sectional areas were measured using MRI images by two independent, blinded examiners and averaged for all analyses. Using the multiplanar reformation (MPR) mode, on the axial plane image the central 10 mm of the patellar tendon that would be harvested for BTB autograft was measured. The Region of Interest (ROI) Area tool was then used to measure the cross-sectional area of a 10-millimeter BTB graft (Figure 1). Autograft diameter was calculated using the equation shown in Figure 2. Intraclass correlation coefficient (ICC) values (via 2-way random-effects model for single measure absolute agreement) were calculated for all measured cross-sectional areas. A threshold coefficient greater than 0.70 indicates sufficient inter-rater reliability. Cross-sectional areas were compared between sex and age using independent samples t-tests and ANOVA, respectively, with a two-tailed significance threshold of P ≤ 0.05. Coefficient of variation was calculated as the ratio of the standard deviation to the mean value. SPSS version 22.0 (IBM Corp., Armonk, NY) was used for all statistical analysis. Results: A total of 100 adolescent patients were included in this study, 50 male and 50 female. All patients’ MR imaging showed evidence of closing or closed physes. The mean age was 15.5 years. The intraclass correlation coefficient for cross-sectional areas between the two examiners was 0.72, 95% CI: [0.609, 0.802]. The average between the two measurements for each image were subsequently calculated and used in all downstream analyses. The mean cross-sectional area was 32 ± 5.13 mm2 (coefficient of variation = 0.16) (Figure 3). The mean calculated graft diameter was 6.3 ± 0.51 mm (coefficient of variation = 0.08). The mean cross-sectional area was significantly greater in males (34 ± 5.86 mm2) than in females (30 ± 5.86 mm2) (P=0.001). Accordingly, the mean calculated graft diameter was as well significantly greater in males (6.5 ± 0.57 mm) than in females (6.2 ± 0.37 mm) (P=0.001). There was no significant association between age and cross-sectional area or graft diameter. Conclusions: Modern imaging-based measurement techniques demonstrate that the true intra-articular tendinous soft tissue portion of 10mm BTB autografts show great variance, but the large majority are under 7mm in diameter and therefore significantly smaller than quad tendon and most hamstring tendon autografts utilized in ACLR surgery today. In light of favorable overall re-tear rates, relative to other graft options, these data suggest the advantages of the BTB construct may stem from graft features other than the actual collagenous intra-articular segment, such as minimal creep, immediate relative rigidity and preservation of the critical dynamic knee flexors/stabilizers. Moreover, future comparative clinical research involving BTB and soft tissue autografts should consider quantifying and utilizing the diameter of the soft tissue component of BTB autografts, which is feasible utilizing MRI-based methods, rather than utilizing the diameter of the associated bone plugs and tunnels.

Comparative Clinical and Radiographic Success Rate of Bioceramic Premix vs Biosilicate-based Medicament as Indirect Pulp Treatment Materials in Primary Molars: A Double-blind Randomized Trial with a Follow-up of 12 Months.

To evaluate and compare the clinical and radiographic success of NeoPUTTY® and Biodentine™ as indirect pulp treatment (IPT) materials in primary molars. This clinical trial was conducted on children aged 5-9 years. Class I carious lesions in primary molars indicated for IPT were divided into two groups-group I, NeoPUTTY®, and group II, Biodentine™. IPC was performed as per the standard protocols. The treated teeth were evaluated for clinical and radiographic success, along with the presence of a dentinal bridge at 6 and 12 months, by three blind examiners independently. All the data were tabulated, and statistical analysis was performed using the Mann-Whitney U test. Interexaminer reliability was analyzed using Fleiss κ statistics, and it showed "good" agreement. Clinical success was 100% in both groups at 6- and 12-month follow-up, while radiographic success was also 100% at 6-month follow-up for both groups. However, at 12-month follow-up, it was 93.33% for group I and 100% for group II. The difference was statistically nonsignificant. The presence of a dentinal bridge at 12-month follow-up was seen in 86.66% of cases in group I and 100% of cases in group II, but there was no statistical difference observed between them with a p-value of 0.555. Within the limitations of the study, we conclude that NeoPUTTY® and Biodentine™ are equally effective as IPT agents in primary teeth. Kothari P, Mathur A, Tirupathi S, et al. Comparative Clinical and Radiographic Success Rate of Bioceramic Premix vs Biosilicate-based Medicament as Indirect Pulp Treatment Materials in Primary Molars: A Double-blind Randomized Trial with a Follow-up of 12 Months. Int J Clin Pediatr Dent 2024;17(7):748-753.

Clinical and Sonographic Evaluation of the Effectiveness of Extracorporeal Shock Wave Therapy in Patients with Lateral Epicondylitis.

This study assessed and compare the clinical and sonographic outcomes of extracorporeal shock wave therapy (ESWT) in patients with lateral epicondylitis (LE). Forty-two LE patients were randomly divided into two groups: the ESWT group (n=21) and the sham-ESWT control group (n=21). Both groups underwent wrist resting splinting, stretching, strengthening exercises for wrist extensors, and ice application. Grip strength, pain, and functionality were assessed by various tests, and common extensor tendon (CET) thickness was measured sonographically before, after, and 1 month after treatment by a blind examiner. At baseline, there was no significant difference between the groups. Significant differences were observed in pain pressure threshold, grip strength, visual analog scale, and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores between baseline, post-treatment, and 1 month after treatment in both groups (p<0.05). However, the Short Form- 12 (SF-12) physical scores showed a significant difference only 1 month after treatment (p<0.01). In the SF-12 mental score tests, no significant difference was found. CET thickness in the ESWT group significantly decreased after treatment and 1 month after treatment (p<0.05), whereas no significant difference was observed in the control group. Both the ESWT and control groups showed a reduction in pain and improvement in function. However, the ESWT group showed statistically superior results in terms of pain reduction and functional improvement compared with the control group. In addition, sonographic evaluation revealed a significant reduction in CET thickness in the ESWT group, whereas no significant change was noted in the control group.

Donor site wound healing following free gingival graft surgery using platelet rich fibrin: A randomized controlled trial.

The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated. Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group. NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4weeks) between groups. CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.

Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial

Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the “static needling”, the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception.Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1).