Cavity Margins Research Articles

Tuberculosis of the calcaneus in children.

To review 10 children with calcaneal tuberculosis in terms of presentation, healing, and functional outcome. Medical records of 7 boys and 3 girls aged 7 to 12 (mean, 9.8) years who presented with calcaneal tuberculosis were reviewed. The erythrocyte sedimentation rate of all patients was elevated. All patients presented with pain and swelling around the lateral malleolus and a 'heal-up' sign; 7 of them presented with an additional discharging sinus. Three patients had palpable lymph nodes in the right inguinal or left popliteal region. Symptoms had lasted for one month to 1.5 years. Two patients had healed tuberculosis in the lungs; 8 patients had no pulmonary involvement. Seven patients had a single lytic lesion in the calcaneal body (n=1), tuberosity (n=3), and extension to anterior process (n=3). Three patients had multiple lytic lesions in the calcaneum; one of them had bilateral involvement who had lesions in the phalanges, lumbar spine, and ulna. Two patients had subtalar joint involvement. The mean follow-up period was 17 (range, 8-60) months. The erythrocyte sedimentation rate returned to normal after 3 months in 7 patients and after >6 months in 3 patients. The subtalar range of movement was normal in all except for 2 patients. One patient developed subtalar ankylosis. Sinuses healed in a mean of 10 (range, 2-16) weeks. No patient had pain on level walking after treatment. At 3 months, remineralisation of bone was evident in all patients. Sclerosis of cavity margins and sequestra resorption was noted from 6 to 9 months. No patient experienced recurrence. The 'heel up' sign was common in children with calcaneal tuberculosis in this endemic region. The central granuloma-type presentation was the most common. Pathological fractures and involvement of the subtalar joint were not common. Subtalar joint involvement was a poor prognostic factor.

Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious cervical lesions

ObjectiveThe objective of this randomized controlled clinical trial was to evaluate the 13-year clinical performance of a mild two-step self-etch adhesive in non-carious cervical lesions with and without prior selective phosphoric acid-etching of the enamel cavity margins. MethodsA total of 100 non-carious cervical lesions in 29 patients were restored with Clearfil AP-X (Kuraray Noritake). The composite restorations were bonded following two different approaches: (1) application of Clearfil SE Bond (Kuraray Noritake) following a self-etch approach (CSE-NE); (2) selective phosphoric acid-etching of enamel cavity margins before application of Clearfil SE Bond (CSE-E). The restorations were evaluated after 6 months, 1, 2, 3, 5, 8 and 13 years of clinical service regarding retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality and post-operative sensitivity. ResultsThe patient recall rate at 13 years was 62%. Six restorations, 4 of the CSE-NE group and 2 of the CSE-E group, were clinically unacceptable due to loss of retention (1 CSE-NE, 1 CSE-E), a severe marginal defect (2 CSE-NE, 1 CSE-E) and caries occurrence in combination with a severe marginal defect (1 CSE-NE) leading to a clinical success rate of 86% (CSE-NE) and 93% (CSE-E). Ageing of the restorations was characterized by a further increase in the percentage of restorations with a clinically acceptable small marginal defect (CSE-NE: 87%; CSE-E: 83%) and/or superficial marginal discoloration (CSE-NE: 53%; CSE-E: 56%). The presence of small marginal defects (CSE-NE: 86%; CSE-E: 68%) and superficial marginal discoloration (CSE-NE: 41%; CSE-E: 20%) at the incisal enamel side was more frequently noticed in the CSE-NE group than in the CSE-E group. The difference, however, was not statistically significant (McNemar, p>0.05). SignificanceAfter 13 years, the clinical effectiveness of Clearfil SE Bond in non-carious Class-V lesions remained excellent, with selective acid-etching of the enamel cavity margins only having some minor positive effect on marginal integrity and absence of marginal discoloration.

Effect of microparticulate silver addition in dental adhesives on secondary caries in vitro.

The aim of the present study was evaluate the effect of microparticulate silver additions in adhesives on secondary caries formation using an artificial mouth model. One hundred eight intact human third molars received standardized Class-V resin composite restorations (Filtek Supreme XTE bonded with Syntac, Scotchbond 1 XT, Futurabond M). Adhesives were charged with different amounts of microparticulate silver (0%/0.1%/0.5%). After storage for 4weeks at 37°C, teeth were subjected to 10,000 thermocycles (+5°C and +55°C), and impressions were taken. Streptococcus mutans 10449 was used in a nutrition medium for secondary caries simulation in a fully automated artificial mouth. After completion of thermocycling and biological load cycling, impressions were taken and replicas were investigated under a light microscope for gap widths at enamel and dentin margins. Evaluation of fluorescence was carried out using a special FITC filter. The demineralization depths at the cavity margin were evaluated using Xpert for Windows working at a pixel distance of 5μm. After thermocycling, no difference in gap widths and demineralization depths was found (p > 0.05). After incubation, gap widths and demineralization depths were significantly reduced with higher amounts of silver loading in most of the adhesives (p < 0.05). The 0.5% silver addition resulted in a slight decrease of secondary caries at resin-dentin margins (p < 0.05). Addition of microparticulate silver in commercially available dental adhesives has the potential of reducing secondary caries. The chosen setup was able to produce secondary caries with a distinct in vivo appearance. Microparticulate silver additions in dental adhesives may have an impact on inhibition of secondary caries.

1ボトル1ステップシステムのEr:YAGレーザー照射歯質に対する接着

Various studies have revealed that the Er:YAG laser is effective in endodontic, periodontal and surgical treatments, and it is used in actual clinical practice. In particular, the Er:YAG laser shows excellent clinical effects when cutting hard tooth tissue, and there have been many studies on adhesive restoration involving teeth irradiated with Er:YAG laser. In this study, focusing on the one-bottle one-step bonding system, we performed tensile bond and marginal leakage tests to evaluate its adhesive properties to enamel and dentin irradiated with Er:YAG laser.Experiment 1Flat bovine enamel or dentin surfaces were prepared using a model trimmer and water-resistant polishing paper (#600), and were irradiated with Er:YAG laser (100mJ, 10pps). Non-irradiated specimens were used as a control. After bonding procedures were performed on these adherent surfaces of 3mm in diameter, the specimens were stored in 37°C distilled water for 24 hours, and were divided into two experimental groups: the 24-hour storage group and the thermal stress group. In the thermal stress group, the specimens were subjected to 2,000 or 5,000 thermocycling in water from 5°C to 55°C with a dwell time of 30s at each temperature. Thereafter, a tensile bond test was performed in each group (n = 10).Experiment 2Saucer cavities (3mm in length, 2mm in width, and 1.5mm in depth) in extracted human molars were prepared setting the anatomical cervical line as the center, using a high-speed cutting diamond point. The marginal line was placed in the enamel on the coronal side and in the dentin on the gingival side. After cavity preparation, the internal cavity walls were uniformly irradiated with Er:YAG laser (100mJ, 10pps). Non-irradiated specimens were used as a control (n = 10). After bonding and filling procedures, these specimens were stored in 37°C distilled water for 24 hours, and thermo-stressed after finishing and polishing. Then, the dye-penetration test was performed according to the following procedures. The root apex was sealed using glass-ionomer cement, and the tooth surface was fully coated with nail varnish except for the area approximately 1mm off the cavity margin. After immersion in 0.5% basic fuchsin at 37°C for 24 hours, each specimen was cut longitudinally at the center of the cavity using a low-speed diamond saw. The degree of dye penetration into the coronal (enamel) or cervical (dentin) wall was evaluated by optical microscopy.From these experiments, the following conclusions were obtained:1. In the tensile bond test, the lased dentin exhibited lower bond strength than the non-irradiated dentin, while enamel showed almost the same bond strength regardless of the laser irradiation.2. In the dye penetration test, marginal microleakage was observed in the dentin cavity wall, whereas good marginal integrity was demonstrated at the enamel margin.

Lumpectomy specimen margins are not reliable in predicting residual disease in breast conserving surgery

BackgroundIn breast conserving surgery, the concordance between lumpectomy margin (LM) status and the status of the corresponding lumpectomy cavity remains uncertain. MethodsWe analyzed pathology reports of lumpectomies from 2004 to 2006. We included those which contained both ink-directed LM and complete (≥4) separate corresponding shaved cavity margins (SCMs). SCM pathology was used as a surrogate for lumpectomy cavity status, to determine the predictive value of LM for residual disease. ResultsPathology from 1,201 pairs of LM and SCM from 242 patients was compared. LM status predicted corresponding lumpectomy cavity status with 50.9% sensitivity, 69.5% specificity, 35% positive predictive value, and 81.4% negative predictive value, giving an overall accuracy of 64.9%. ConclusionsOriented LMs are not reliable for predicting lumpectomy cavity status, and therefore not reliable for directing re-excision. Taking complete, oriented SCMs at the time of lumpectomy may improve accuracy compared with traditional LM assessment.

HER-2 positive breast cancer is associated with an increased risk of positive cavity margins after initial lumpectomy.

BackgroundThe effect of breast cancer subtype on margin status after lumpectomy remains unclear. This study aims to determine whether approximated breast cancer subtype is associated with positive margins after lumpectomy, which could be used to determine if there is an increased risk of developing local recurrence (LR) following breast-conserving surgery.MethodsWe studied 1,032 consecutive patients with invasive cancer who received lumpectomies and cavity margin (CM) assessments from January 2003 to November 2012. The following data were collected: patient age, cT stage, pT stage, grade, status of CM, lymph node status, menopausal status, ER, PR, HER-2, and Ki67, as well as the presence of extensive intraductal component (EIC) and lymphovascular invasion (LVI). A χ2 test was used to compare categorical baseline characteristics. Univariate and multivariate logistic regression analyses were performed to evaluate associations between pathologic features of CM status. Kaplan-Meier actuarial cumulative rates of LR (ipsilateral in-breast) were calculated.ResultsA total of 7,884 pieces of marginal tissue were collected from 1,032 patients, and 209 patients had positive CMs. Of the patients tested, 52.3% had luminal A subtype, 14.9% were luminal B, 12.8% were luminal-HER-2, 8.1% were HER-2 enriched, and 11.8% were triple negative. Univariate analysis showed that EIC (P <0.001), LVI (P = 0.026), pN stage (N1 vs. N0: P = 0.018; N3 vs. N0: P <0.001), and luminal B (P = 0.001) and HER-2 (P <0.001) subtypes were associated with positive CMs. Multivariable analysis indicated that only EIC (P <0.001), pN stage (P = 0.003), and HER-2 subtype (P <0.001) were significantly correlated with positive CMs. On multivariable analysis, HER-2 subtype was an independent prognostic factor in LR (P = 0.031).ConclusionsThe HER-2 subtype was the predictive factor most associated with positive CMs and an independent prognostic factor for LR. This result suggests that the increased risk of LR in HER-2 breast cancer is due to an increased microscopic invasive tumor burden, which is indicated by margin status after lumpectomy.Electronic supplementary materialThe online version of this article (doi:10.1186/1477-7819-12-289) contains supplementary material, which is available to authorized users.

An in-vitro evaluation of microleakage among nano ceramics and nano hybrid composite resins in Class V cavities

Background: Prevention of micro-leakage plays an important role in the success of composite restorations. This has led scientists to find newer composite restorative materials. Materials and Methods: Twenty-four human freshly extracted molar was randomly selected for this study. The teeth were stored in 0.1% thymol solution diluted in 0.4% saline. Class V cavities were prepared at the cemento-enamel junction on the buccal surfaces of each tooth. One coat of seventh generation bonding agent G-bond (GC Japan) was applied to all the samples. The samples were randomly divided into two groups of 12 samples each. All the samples were restored with composite resin using single increment technique as per the grouping. The teeth were then stored at 370°C water, except when they were removed from storage and subjected to thermo cycling for 1000 cycles in water between 50°C and 550°C for 30 s in each bath and 15 s transfer between bath. After thermo cycling, the samples were dried superficially, and two coats of nail varnish applied to the entire sample surface, leaving a 1 mm window around the restored cavity margins. All teeth were immersed in 2% methylene blue solution for 24 h at room temperature. The teeth were sectioned in the bucco – lingual direction across the center of the restoration using a slow speed saw (Isomet 1000, Buchler, USA). The sectioned teeth were examined by two calibrated inspectors for dye penetration levels. Results: Mann–Whitney U-test showed that there was no significant difference in dye leakage between Group I and Group II. However, at experimental level, when observing the enamel and dentinal margin, Group II showed a greater degree of leakage than Group I. Conclusion: In the present study, it was observed that self-etch adhesive systems and single increment technique are beneficial as they help in reducing the application time and technique related sensitivity.

Abstract P2-03-11: In situ imaging of the tumor cavity during breast lumpectomy using optical coherence tomography

Abstract Re-operation rates for breast lumpectomy procedures are exceedingly high, often over 30%, depending on the institution and surgical technique. Because current standard-of-care relies on post-operative histopathology to provide a microscopic view and assessment of surgical margins, there has been great interest in developing new imaging solutions to visualize tissues intraoperatively with high-resolution, and provide real-time feedback on the margin status. While it is possible to use a variety of microscopic imaging methods in the operating suite, including frozen-section histology, touch-prep cytology, confocal or scattering-based microscopy, all these techniques are limited to visualizing margins on ex vivo resected specimens, and do not provide a means for visualizing the in situ tumor cavity for evidence of positive margins or residual disease. Optical coherence tomography (OCT) is a high-resolution, real-time, optical biomedical imaging technology that is the optical analogue to ultrasound imaging, except images are based on backscattered near-infrared light. OCT is capable of performing optical biopsies of in situ tissue at resolutions that approach those in histopathology. With the use of an advanced computed imaging technique called ISAM (Interferometric Synthetic Aperture Microscopy), even higher imaging resolution over larger depths is possible, commensurate with the depths (1-2 mm) visualized by pathologists to determine negative, close, or positive margins. Past studies by our group and others have demonstrated the feasibility of intraoperative OCT for assessing tumor margin and lymph node status during breast cancer surgery, but to date, all studies have been performed on resected lumpectomy tissue. In this study, we report the development of a novel handheld surgical imaging probe that enables 2-D and 3-D OCT/ISAM imaging of the in situ tumor cavity, in addition to the margins of excised specimens. To date, this handheld OCT/ISAM probe has been used in 10 breast cancer surgeries where both in situ and ex vivo imaging was performed. Four of these cases involved in situ imaging of the cavity margin after a suspicious area was visually and tactically identified, and was subsequently resected, followed by ex vivo imaging and validating post-operative histopathology. Representative cases included fibroadipose tissue, fibroadenomas, and high-grade ductal carcinoma in situ. Distinct microstructural features identified on OCT/ISAM and confirmed with histopathology demonstrate that this technique can visualize the in situ tumor cavity, as well as the surgical margins on resected specimens, with micron-scale resolution. OCT/ISAM has the potential to determine margin status in real-time during the surgical procedure, when further surgical resection to establish clear margins and reduce re-operation rates is possible. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-03-11.

A Novel Radio-Opaque Hydrogel Marker Can Be Used to Decrease Interobserver Variability in the Delineation of the Lumpectomy Cavity

Accurate lumpectomy cavity (LC) delineation is necessary to define a target for cavity boost or partial breast irradiation (PBI), but the LC is not always well visualized on CT. Surgical clips mark discrete points along the cavity margin, leaving the majority of the LC border undefined. We introduced a novel radio-opaque hydrogel marker to lumpectomy cavities of female cadavers to assess the effect on inter-observer variability in defining the lumpectomy cavity during CT-based treatment planning. Three refrigerated, unfixed female cadaveric specimens underwent lumpectomy procedures with oncoplastic closures by breast surgeons. Saline was introduced via an indwelling catheter to eliminate air. Baseline simulation CT images were performed, and the saline was replaced by the hydrogel marker via the catheter. The hydrogel marker used in this cadaveric series is an FDA-approved injectable polyethylene glycol-based hydrogel designed to be visible under CT, MR and ultrasound imaging for several months after implantation. LC contouring was performed on the axial slices of the simulation CT data sets by three breast radiation oncologists. To assess change in visibility of the LC with the addition of hydrogel, a cavity visualization score (CVS) of 1-5 was assigned to each LC by each physician observer, and the median CVS was compared for each cavity with and without the hydrogel. LC volume variability was assessed by Vmax/Vmin and the coefficient of variation for volume (COVvol), defined as the standard deviation of the mean divided by the mean. A conformity index (CI) was used to evaluate variability of the LC shape, defined as the sum of the intersections of all possible pairs of delineations divided by the sum of unions of all possible pairs. Paired-samples (repeated measures) t tests were used to compare differences between groups. The median CVS increased in 7/9 cavities with the hydrogel. For all cavities, the median change in CVS when hydrogel was introduced was +2 (range, 0 to +2). The mean LC volume decreased from 17.8 cm3 to 7.0 cm3 with the addition of the hydrogel (p = 0.002). Mean COVvol decreased from 0.41 to 0.28 (p = 0.025) and Vmax/Vmin decreased from 2.6 to 1.8 (p = 0.023). The mean CI increased from 0.30 to 0.47 (p = 0.009). The addition of a radio-opaque hydrogel marker to lumpectomy cavities with oncoplastic closure at the time of surgery may increase cavity visualization and decrease inter-observer variability of volume and shape when delineating the cavity for adjuvant radiation therapy. In addition, there is a significant decrease in the delineated LC volume, which could potentially have dosimetric benefits. Further study is warranted.

Composite polymerization stress as a function of specimen configuration assessed by crack analysis and finite element analysis

ObjectivesTo test the null hypothesis that polymerization-induced stress was not influenced by cavity dimensions and geometries. MethodsFour experimental groups, with different C-factors and specimen volumes were defined using bottom-less glass disks (height: 1 or 2mm) with a central hole 3 or 6mm in diameter, and 3mm wall thickness. Another four groups were created by bonding a glass plate to the bottom of the disks. Additionally, disks with 2-mm height, 3mm in cavity diameter, and 4.5-mm thick walls were prepared. Vickers indents (9.8N, 20s) were made at the top surface at 600μm from the cavity margin. The lengths of the indentation diagonal and the corner cracks parallel to the cavity margin were measured. Ten minutes after restoration (Majesty Esthetic, Kuraray), cracks were re-measured. Stresses at the indent site were calculated based on glass fracture toughness and increase in crack length. Data were subjected to ANOVA/Tukey or Kruskal–Wallis/Mann–Whitney tests (alpha: 5%, n=8). Finite element analysis (FEA) was used to estimate stress at the interface and the effective structural rigidity of the substrate. ResultsOverall, for experimental and FEA results, cavities developed higher stress than bottom-less disks. Increasing wall thickness did not affect stress. When similar geometries and C-factors were compared, higher volumes developed higher stress and had greater incidence of margin cracking. Clinical significanceC-factor is a suitable predictor for polymerization stress in low compliance environments, particularly due to its simplicity. However, the influence of cavity size cannot be disregarded especially for the development of marginal cracking. The interaction between size, geometry and stiffness is likely to become more complex according to the complexity of the cavity shape.

Systematic cavity shaving: Modifications of breast cancer management and long-term local recurrence, a multicentre study

The status of the surgical margins of lumpectomy is one of the most important determinants of local recurrence in breast cancer. Systematically practicing cavity margin resection is debated but may avoid surgical re-excision and allow the diagnosis of multifocality. This multicentric retrospective study included 294 patients who underwent conservative management of breast cancer with 2-4 systematic cavity shavings. Clinico-biological characteristics of the patients were collected in order to establish whether surgical management was modified by systematic cavity shaving. Local recurrence rate with a long-term follow up of minimum 4 years was evaluated. Cavity shaving avoided the need for re-excision in 25% of cases and helped in the diagnosis of multifocality in 8% of cases. Resection volume was not associated with usefulness of the cavity shaving. No predictive factor of positive cavity shaving was found. The rate of local recurrence was 3.7% and appeared in a median time of 3 years and 8 month. Only one quarter of the patients with local recurrence had initially positive lumpectomy margins but negative cavity shaving. Systematic cavity shaving can change surgical management of conservative treatment. No specific target population for useful cavity shaving was found, such that we recommend utilising it systematically.

A Pilot Study Evaluating Shaved Cavity Margins with Micro-Computed Tomography: A Novel Method for Predicting Lumpectomy Margin Status Intraoperatively

Microscopically clear lumpectomy margins are essential in breast conservation, as involved margins increase local recurrence. Currently, 18-50% of lumpectomies have close or positive margins that require re-excision. We assessed the ability of micro-computed tomography (micro-CT) to evaluate lumpectomy shaved cavity margins (SCM) intraoperatively to determine if this technology could rapidly identify margin involvement by tumor and reduce re-excision rates. Twenty-five SCM from six lumpectomies were evaluated with a Skyscan 1173 table top micro-CT scanner (Skyscan, Belgium). Micro-CT results were compared to histopathological results. We scanned three SCM at once with a 7-minute scanning protocol, and studied a total of 25 SCM from six lumpectomies. Images of the SCM were evaluated for radiographic signs of breast cancer including clustered microcalcifications and spiculated masses. SCM were negative by micro-CT in 19/25 (76%) and negative (≥2mm) by histopathology in 19/25 (76%). Margin status by micro-CT was concordant with histopathology in 23/25 (92%). Micro-CT overestimated margin involvement in 1/25 and underestimated margin involvement in 1/25. Micro-CT had an 83.3% positive predictive value, a 94.7% negative predictive value, 83.3% sensitivity, and 94.7% specificity for evaluation of SCM. Evaluation of SCM by micro-CT is an accurate and promising method of intraoperative margin assessment in breast cancer patients. The scanning time required is short enough to permit real-time feedback to the operating surgeon, allowing immediate directed re-excision.

Micro-computed tomography (Micro-CT): a novel approach for intraoperative breast cancer specimen imaging

Intraoperative radiographic examination of breast specimens is commonly performed to confirm excision of image-detected breast lesions, but it is not reliable for assessing margin status. A more accurate method of intraoperative breast specimen imaging is needed. Micro-CT provides quantitative imaging parameters, image rotation, and virtual "slicing" of intact breast specimens. We explored the use of micro-CT for assessment of a variety of clinical breast specimens. Specimens were evaluated with a table top micro-CT scanner, Skyscan 1173 (Skyscan, Belgium), with a 40-130 kV, 8 W X-ray source. Skyscan software for 3D image analysis (Dataviewer and CTVox) was employed to review 3D graphics of specimens. Scanning for 7 min and another 7 min for image reconstruction provided the desired resolution for breast specimens. Breast lumpectomy specimens, shaved cavity margins, mastectomy specimens, and axillary lymph nodes were imaged by micro-CT. The micro-CT images could be rotated in all directions and cross sections of internal portions of specimens could be visualized from any angle. This provided information about spatial orientation of masses and calcifications relative to margins in intact lumpectomy specimens. Micro-CT is a potentially useful tool for assessment of breast cancer specimens, allowing real-time analysis of tumor location in breast lumpectomy specimens or shaved cavity margins. Micro-CT may also be useful for assessing sentinel lymph nodes and mastectomy specimens.

An evaluation of intraoperative digital specimen mammography versus conventional specimen radiography for the excision of nonpalpable breast lesions

BackgroundThis study examined the impact of intraoperative digital specimen mammography (IDSM) compared with conventional specimen radiography (CSR) for nonpalpable breast lesions in patients undergoing breast-conserving surgery (BCS). MethodsIn this retrospective cohort study, 201 consecutive image-detected nonpalpable breast lesions underwent BCS after preoperative localization and specimen radiography. Data on patient, tumor, and surgical factors were collected. ResultsCSR was performed in 105 patients and IDSM was used in 96 patients. Patient and tumor factors were similar in both groups. Using univariate analysis, CSR resulted in more positive margins (19% vs 6.2%; P = .012). Rates of cavity margin resection, reoperation, and operative times were similar for CSR and IDSM. Independent predictors of positive margins on multivariable analysis were use of CSR, microcalcifications on mammography, the need for bracketing for localization, and no cavity margin excision (all P < .05). ConclusionsIn this study, the use of IDSM resulted in fewer positive margins after BCS, although operative times were similar.

Quantifying Potential Error in Painting Breast Excision Specimens

Aim. When excision margins are close or involved following breast conserving surgery, many surgeons will attempt to reexcise the corresponding cavity margin. Margins are ascribed to breast specimens such that six faces are identifiable to the pathologist, a process that may be prone to error at several stages. Methods. An experimental model was designed according to stated criteria in order to answer the research question. Computer software was used to measure the surface areas of experimental surfaces to compare human-painted surfaces with experimental controls. Results. The variability of the hand-painted surfaces was considerable. Thirty percent of hand-painted surfaces were 20% larger or smaller than controls. The mean area of the last surface painted was significantly larger than controls (mean 58996 pixels versus 50096 pixels, CI 1477–16324, P = 0.014). By chance, each of the six volunteers chose to paint the deep surface last. Conclusion. This study is the first to attempt to quantify the extent of human error in marking imaginary boundaries on a breast excision model and suggests that humans do not make these judgements well, raising questions about the safety of targeting single margins at reexcision.

Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemo-mechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART).

ABSTRACTBackground: It is important to emphasize that the aspects of pretreatment techniques, as well as the composition and mechanism of adhesion, may decisively influence the effectiveness of the restorative materials in sealing cavity margins and preventing marginal leakage.Aims: This study assessed the in vitro influence of surface preparation techniques on the microleakage of glass ionomer restorations in primary teeth.Materials and methods: The study groups were divided into three different techniques: (1) The chemomechanical caries removal (CMCR) method using the Apacaries gel, (2) the erbium:yttrium aluminum-garnet (Er:YAG) laser method and (3) the atraumatic restorative technique (ART). The teeth restored with a glass ionomer restorative material (Fuji IX GP capsule, GC Corporation, Tokyo, Japan). The dye penetration was measured in micrometers using a polarized light microscope and specific computer software.Results: The results showed that the mean microleakage level after was lowest with the CMCR method using Apacaries gel and highest with the Er:YAG laser. There was a statistically significant difference regarding the mean microleakage level between the group with the CMCR method using Apacaries gel and the Er:YAG laser.Conclusion: Marginal leakage was significantly higher with preparations made using the Er:YAG laser than with the CMCR method using Apacaries gel and spoon excavator (p < 0.05).How to cite this article: Juntavee A, Juntavee N, Peerapattana J, Nualkaew N, Sutthisawat S. Comparison of Marginal Microleakage of Glass Ionomer Restorations in Primary Molars Prepared by Chemomechanical Caries Removal (CMCR), Erbium: Yttrium Aluminum-Garnet (Er:YAG) Laser and Atraumatic Restorative Technique (ART). Int J Clin Pediatr Dent 2013;6(2):75-79.

Microleakage of Er:YAG laser and dental bur prepared cavities in primary teeth restored with different adhesive restorative materials

The purpose of this study was to evaluate and compare the effect of erbium:yttrium-aluminum-garnet (Er:YAG) laser irradiation and conventional dental bur cavity preparation on in vitro microleakage of class V cavities restored with different adhesive restorative materials and two types of self-etching adhesives in primary teeth. Standard class V cavities were prepared on 80 extracted primary, and the teeth were randomly divided into eight subgroups prepared either by dental bur or Er:YAG laser irradiation and then restored with self-cured glass ionomer (GI), resin-modified glass ionomer (RMGI), resin composite and Clearfil SE Bond (two-step self-etching adhesive), and resin composite and Clearfil S3 Bond (one-step self-etching adhesive). Restorations were finished and stored in distilled water at 37 °C for 24 h and then subjected to thermocycling. All the teeth were sealed with nail varnish, placed in a silver nitrate solution, and then vertically cut in a buccolingually direction. Subsequently, the specimens were evaluated for gingival and occlusal microleakage using a stereomicroscope. Data were analyzed using Kruskal-Wallis test followed by Mann-Whitney test. Wilcoxon test was used for comparing occlusal microleakage with gingival microleakage at p < 0.05. A higher degree of occlusal and gingival microleakage values for the teeth restored with GI or RMGI was obtained by both preparation methods compared with that of resin composites and the two self-etching primers. Er:YAG laser irradiation resulted in a significantly higher degree of microleakage only at the gingival margins for teeth restored with GI or RMGI, or composite and Clearfil S3 Bond compared with the bur preparation. The Er:YAG laser-prepared teeth restored with composite and Clearfil SE Bond demonstrated a better marginal seal on occlusal and gingival margins compared with that of bur-prepared cavities. The degree of microleakage in class V cavities was affected by the type of adhesive restorative materials, type of self-etching adhesive, cavity margin location, and tooth preparation method either by Er:YAG laser or dental bur.

Intérêt de la réalisation de recoupes systématiques dans la chirurgie conservatrice du cancer du sein

The quality of surgical margins in lumpectomy are strong criteria to define risk of locoregional recurrence when conservative treatment is undertaken. Intraoperatively, the limits of adequate resection are sometimes difficult to define. This is why some teams propose the realization of systematic cavity margins during the excision of lumpectomy during the same operation. We expose the potential benefits of this type of practice using data from the literature.

Cavity margins and lumpectomy margins for pathological assessment: Which is superior in breast-conserving surgery?

PurposeThis prospective cohort study aimed to compare the efficacy of cavity margins (CMs) and lumpectomy margins (LMs) for pathological assessment in breast-conserving surgery. MethodsWe assessed the CMs and LMs of 163 breast cancer patients during breast-conserving surgery. We compared and analyzed the positivity rates of CM and LM. ResultsThe positivity rate of CM at the case level and individual margin level was 30.7% and 8.0%, respectively. The positivity rate of LM was 12.3%, 33.1%, and 45.4% at the case level and 1.8%, 6.2%, and 9.1% at the individual margin level, when we used the National Surgical Adjuvant Breast and Bowel Project criteria (ink-free), 1 mm-free criteria and 2 mm-free criteria, respectively. The positivity rate of LM with 1 mm-free criteria was similar to that of CM. Delivery of neoadjuvant chemotherapy increased the positivity rate of CM (50.0% versus 25.2%; P < 0.01) but not LM (41.6% versus 30.7%; P > 0.05) at the case level, whereas the positivity rate of CM and LM both increased after neoadjuvant chemotherapy at the margin level (CMs: 15.5% versus 5.6%, P < 0.001; and LMs: 10.7% versus 4.9%, P < 0.001). In univariate and multivariate analysis, delivery of neoadjuvant chemotherapy, higher node-positive stage, and presence of ductal carcinoma in situ component were correlated with positive CM, whereas positive human epidermal growth factor receptor 2 status and higher node-positive stage were associated with positive LM. ConclusionsInk-free criteria may be insufficient for LM assessment in breast-conserving surgery, and at least 1 mm width LM is suggested. After the delivery of neoadjuvant chemotherapy, CM assessment should be routinely performed in addition to LM assessment.

Clinical Outcomes of Breast-Conserving Surgery in Patients Using a Modified Method for Cavity Margin Assessment

This study describes a modified intraoperative method for cavity margin (CM) assessment in place of lumpectomy margin assessment in patients undergoing breast-conserving surgery (BCS). This is a retrospective review of 422 breast cancer patients undergoing BCS with intraoperative CM assessment. After an initial lumpectomy with intent to obtain ≥1-cm margins, separate specimens 1 × 1 cm, 0.5-cm thick were taken from the cavity margin circumferentially. These were frozen without reference to the side of the new margin as a time-saving measure, and parallel sections of the resected surface were evaluated. After a median follow-up of 55.5 months, a cumulative 5-year locoregional recurrence-free survival rate of 95.3%, metastasis-free survival rate of 97.8%, disease-free survival rate of 88.3%, and overall survival rate of 96.0%, was achieved. The CM positivity rates were of no statistical difference when <7, 7-8, and >8 CMs were assessed. The second operation rate was 3.5% because of the false-negative results of the frozen section analysis on CMs. Univariate and multivariate analysis revealed that a higher pN stage and cT stage as well as a lack of adjuvant chemotherapy or radiation demonstrated significantly worse clinical outcomes. Locoregional recurrences and metastasis are both correlated with worse overall survival. The number of the CMs assessed was not associated with clinical outcomes. The modified CM assessment presented here is a rapid, accurate, and oncologically safe approach for margin evaluation in BCS patients. Lumpectomy margin assessment might be spared when this method is used.