Nonsurgical Approach Research Articles

Efficacy of adjunctive systemic or local antibiotic therapy in peri-implantitis: a systematic review and meta-analysis of randomized controlled clinical trials.

This systematic review and meta-analysis considered the results of randomized controlled clinical trials (RCTs) to evaluate the efficacy of systemic or local antibiotic therapy in peri-implantitis. Two independent authors screened publications from three electronic databases to include RCTs meeting all the inclusion and exclusion criteria. A meta-analysis was performed to evaluate the weighted mean differences in survival rate (SR) and changes in pocket probing depth (PPD), bone level (BL), and clinical attachment level (CAL). The study cohorts were defined as antibiotic and control groups with subgroups for analysis. Seven studies including 309 patients (390 implants) were considered. Within the limitations of this review, patients in the antibiotic groups exhibited significant improvements in PPD. Subgroup analysis indicated that the administration of systemic antibiotics or the use of antibiotics in non-surgical treatments did not result in a significant alteration in BL. It was established that the addition of antibiotics can ameliorate PPD and SR in the treatment of peri-implantitis, whether through surgical or non-surgical approaches, and also shows moderate performance regarding BL and CAL. Considering the lack of application of new technologies in the control group and the hardship of assessing the potential risks of antibiotics, careful clinical judgment is still necessary.

Associated factors with non[sbnd]operative management failure in bowel obstruction

BackgroundBowel obstruction caused by adhesion syndrome is a prevalent condition in emergency departments, presenting significant economic and morbidity challenges. While nonsurgical approaches succeed in 70–90% of cases, surgery becomes necessary for nonresponsive patients. This study aims to identify predictors of non-operative management failure in patients with bowel obstruction upon emergency room admission. MethodsA retrospective cross-sectional analytical study was conducted from 2015 to 2022 at Hospital Militar Central, focusing on patients with bowel obstruction secondary to adhesion syndrome. Comparative analysis of medical and surgical histories and admission laboratory values aimed to identify possibles factors associated with non-operative management failure and subsequent surgical intervention. ResultsAmong 354 patients with bowel obstruction, 130 met inclusion criteria, of whom 98 responded to non-operative treatment and 32 experienced treatment failure. Significant differences were found between groups, including age (p: 0.035), history of two or more abdominal surgeries (10.2% vs. 25%, p: 0.01), appendectomy (17% vs. 37%, p: 0.01), previous surgical intervention for bowel obstruction (22.5% vs. 9.38%, p: 0.008), and hospital stay duration (4.26 vs. 13.2 days, p: 0.001). In multivariate analysis using Poisson regression, age had a prevalence ratio (PR) of 1.01 [95% CI (1.00; 1.02), p < 0.04] for non-operative management failure, the history of peritonitis had a PR of 3.83 [95% CI (2.34; 6.26), p < 0.001], while each unit increase in lactate showed a PR increase of 1.24 [95% CI (0.99; 1.57), p 0.05]. ConclusionAge, history of peritonitis, and elevated lactate values upon emergency room admission are predictive factors for non-operative management failure in bowel obstruction in the population studied.

A Very Low-Calorie Ketogenic Diet Approach for Post-Bariatric Weight Regain: A Pilot Study

Weight regain (WR) after bariatric surgery, particularly sleeve gastrectomy, is a significant challenge, often driven by a combination of metabolic, behavioral, and lifestyle factors. Non-surgical interventions to manage WR are critical, given the increased risks and reduced efficacy of revisional surgeries. In this context, very low-calorie ketogenic diets (VLCKDs) have gained attention for their potential to promote weight loss and improve body composition in individuals struggling with WR. This study assessed the safety and efficacy of a VLCKD in 11 patients who experienced WR following sleeve gastrectomy. Over an 8-week period, patients demonstrated a significant average weight loss of 6.3% (p = 0.005), along with improvements in body composition, including reductions in body fat percentage (p = 0.003) and waist circumference (p = 0.003). Metabolic markers, such as insulin resistance (HOMA-IR), also improved significantly (p = 0.041). Although a decrease in the glomerular filtration rate was observed (p = 0.007), this finding is unlikely to be clinically relevant over the short term. Importantly, no major adverse events were reported, with only mild constipation observed. These results suggest that VLCKDs may be a promising non-surgical approach for managing WR post-bariatric surgery, though further studies are needed to assess long-term effects, especially on renal function.

Survival and Treatment Outcomes in Gastric Cancer Patients with Brain Metastases: A Systematic Review and Meta-Analysis.

Brain metastases (BM) from gastric cancer (GC) are rare but associated with poor prognosis, significantly impacting patient survival and quality of life. The objective of this systematic review and meta-analysis is to consolidate existing research on BM from GC, evaluate the incidence and clinical outcomes, and explore the effectiveness of treatment options. A systematic search was conducted across the Medline, Web of Science, and Scopus databases, following PRISMA guidelines. Eighteen high-quality studies, as per the Newcastle-Ottawa Quality Assessment Scale, were included, encompassing 70,237 GC patients, of whom 621 developed BM. Data on progression-free survival (PFS), overall survival (OS), neurological symptoms, and HER2 status were analyzed using a random-effects model. The incidence of BM in GC patients was found to be 2.29% (95% CI: 1.06-3.53%), with the range extending from 0.47% to 7.79% across studies. HER2-positive status was significantly associated with a higher likelihood of developing BM, with an odds ratio of 43.24 (95% CI: 2.05-913.39; p = 0.02), although this finding was based on limited data. The surgical resection of BM was linked to significantly improved survival outcomes, with a mean difference in OS of 12.39 months (95% CI: 2.03-22.75; p = 0.02) compared to non-surgical approaches. The surgical resection of brain metastases in GC patients significantly enhances overall survival, while HER2-positive patients may show a higher risk for developing BM. These findings underscore the importance of tailored therapeutic approaches for GC patients with BM.

Quality of life in patients with epilepsy caused by hippocampal sclerosis: a comparison of surgical and non-surgical approaches

Quality of life in patients with epilepsy caused by hippocampal sclerosis: a comparison of surgical and non-surgical approaches

Surgical and Non-Surgical Approach for Tear Trough Correction: Fat Repositioning Versus Hyaluronic Acid Fillers.

Objective: This paper compares two popular techniques for tear trough correction-fat repositioning and hyaluronic acid (HA) fillers-highlighting their efficacy, safety profiles, patient satisfaction, and associated complications. Methods: A narrative review of 20 studies comparing fat repositioning and HA fillers was conducted, focusing on parameters such as duration of results, volume restoration, complication rates, and patient satisfaction. Results: Fat repositioning provides long-lasting results but carries higher surgical risks compared with HA fillers. The transconjunctival approach is suitable for patients with minimal skin excess. The supraperiosteal plane allows for a quicker procedure and, despite postoperative edema and temporary irregular contouring, shows no difference in final cosmetic outcomes compared with other planes. Internal fixation reduces the risk of fat relapse and skin scarring but carries the risk of suboptimal positioning. HA fillers offer immediate, minimally invasive results but require periodic maintenance. The use of a cannula reduces the risk of vascular occlusion. Combining a high G' filler for the midface with a low G' with low hydrophilicity for the tear trough reduces the amount of filler needed and prolongs the results. Both surgical and non-surgical methods are effective, depending on patient needs and anatomical considerations. Conclusions: Fat repositioning is ideal for patients seeking long-term correction and are willing to undergo surgery, while HA fillers suit those preferring non-invasive treatments with customizable, short-term effects. Both techniques have pros and cons that must be matched to patient goals and conditions.

Changes in Upper Airway Space in a Patient with Pycnodysostosis Following Primary Surgery and Orthodontic Treatment: A 12-Year Follow-Up Case Report

Pycnodysostosis (PDS) is an autosomal recessive form of osteosclerotic skeletal dysplasia characterized by craniofacial anomalies, a high-arched palate, and a narrowed pharyngeal space due to mandibular and maxillary deficiencies. These structural anomalies in the upper airway predispose PDS patients to obstructive sleep apnea (OSA). OSA can be managed in PDS patients using either a conservative (non-surgical and multidisciplinary) approach or surgical interventions. Given the craniofacial anomalies associated with PDS, orthodontic treatment aims to address the maxillary transverse deficit and retrognathia. Currently, there is no evidence regarding the impact of orthodontic therapy on OSA levels among PDS patients. This study reports the long-term morphological and functional changes in the upper airway of a PDS patient following adenotonsillectomy and uvulopalatoplasty at an early age (3.6 years) and orthodontic camouflage in late mixed dentition (10 years). Polysomnographies (PSGs), nuclear magnetic resonance (NMR), and lateral cephalograms taken before and after ENT surgery and orthodontic treatment were analyzed. Lateral X-rays were evaluated for changes in the posterior airway space (PAS), while polysomnographies provided the apnea–hypopnea index (AHI). The NMR scans were segmented to measure the perimeter and radius of the upper airway. The findings of this study indicate that improvements following uvulopalatoplasty (UPP) were partial and temporary. Nonetheless, orthodontic therapy and the use of elastics did not appear to influence the PAS or AHI. Future studies with larger cohorts are needed to evaluate the long-term effectiveness of the UPP procedure. This study was conducted in accordance with the CARE guidelines.

A Three-Month Clinical Trial on the Efficacy of Hyaluronic Acid Adjunctive Non-Surgical Therapy for Periodontitis in Patients with Type 2 Diabetes Mellitus.

Background/Objectives: Conventional periodontal treatment for patients with diabetes has shown promising results, primarily focusing on glycated hemoglobin (HbA1c) levels as an endpoint measure. The properties of hyaluronic acid (HA) have been harnessed in various periodontal therapies, and it is a promising agent also in a non-surgical approach. The aim of this clinical trial was to assess the efficacy of hyaluronic acid in a local adjunctive non-surgical treatment for periodontitis in patients with type 2 diabetes. Methods: Eighty adult participants with well-controlled type 2 diabetes (HbA1c 7% (53 mmol/mol) or less) took part in the trial. The clinical parameters of periodontitis as well as the glycated hemoglobin (HbA1c) levels were evaluated, and an analysis of the potential differences between the control (placebo) and intervention (HA) groups was performed. Results/Conclusions: A decrease in all the clinical values of periodontitis after treatment was observed in the vast majority of patients in both groups. Differences in the clinical parameters were observed 12 weeks after the intervention between the patients in the placebo and HA therapy groups. Bleeding on probing (BoP) was reduced in the control group to 15-25% and was approximately 5.5% more in the intervention group (9.5-18.25%). The clinical attachment level (CAL) decreased 1 mm more in the HA therapy group (1-2 mm) than in the no adjunctive treatment group (2-3 mm). The probing depth (PD) was reduced similarly in both groups (3-3.75 mm). Due to the bilateral relationship between diabetes and periodontitis, healthcare professionals seek advancements in managing periodontal inflammation. The results of this study indicate that non-surgical periodontal treatment with HA as an adjunctive agent is worth considering in the therapy for patients with diabetes.

Nonsurgical Clinical Approach To Managing A Periapical Lesion In An 11-Year-Old: A Case Report

Periapical lesions in pediatric patients often require careful management to preserve tooth vitality and promote healing. This case report discusses a nonsurgical clinical approach to managing a periapical lesion in an 11- year-old patient using a calcium hydroxide-based paste known for its bioactivity and biocompatibility. The patient presented with a necrotic tooth and associated periapical radiolucency. Following diagnosis, a conservative treatment plan was implemented, involving debridement of the canal system and the application of Metapex as an intracanal medicament. Clinical and radiographic evaluations were conducted over a six-month period to assess healing and periapical regeneration.

Rethinking the Role of Formal Physical Therapy in Glenohumeral Osteoarthritis: A Nationwide Study Comprising More than Two Million Patients in the United States

Introduction: This study aims to determine whether incorporating physical therapy into a nonsurgical approach can effectively manage the course of glenohumeral osteoarthritis (OA) and potentially prevent patients from requiring total shoulder arthroplasty (TSA). Methods: This retrospective cohort consisted of patients diagnosed with glenohumeral OA between 2010 and 2021 using ICD-9, ICD-10, and current procedural terminology codes in the PearlDiver database. Two- and five-year TSA rates were compared between patients who had physical therapy within 1 year after glenohumeral OA diagnosis and patients who did not. Results: The study consisted of 2,710,463 patients with glenohumeral OA. After propensity score matching, among patients with corticosteroid injection, patients who received physical therapy had significantly higher 2- and 5-year TSA rates compared with those without physical therapy (2-year TSA: 0.60% vs. 0.35%, OR [95% CI]: 1.74 [1.50, 2.01] and 5-year TSA: 1.13% vs. 0.65%, OR [95% CI]: 1.74 [1.56, 1.93]). A similar association was also significant among patients without corticosteroid injection (0.35% vs. 0.16%, OR [95% CI]: 2.17 [2.03, 2.21] and 0.78% vs. 0.37%, OR [95% CI]: 2.11 [2.01, 2.21]). Conclusion: Individuals who had physical therapy as a part of their nonsurgical treatment did not have any decrease in the probability of requiring TSA.

To Dor or Not to Dor? Heller Myotomy, a Retrospective Study.

Achalasia is a neurodegenerative disorder affecting esophageal sphincter function. Treatment options include non-surgical and surgical approaches, such as Heller myotomy (HM). Combining Dor fundoplication with HM is controversial but may prevent gastroesophageal reflux disease (GERD). This retrospective cohort study aimed to assess whether HM with Dor fundoplication reduces GERD rates and increases dysphagia rates. Eighty patients who underwent HM between January 2018 and August 2023 were included. Sixty-four patients had Dor fundoplication and were matched 4:1 to 16 patients without fundoplication. Records were reviewed for GERD and achalasia symptoms at various postoperative time points. No significant differences in GERD or dysphagia symptoms were found between the two groups at any time point. Similarly, there were no significant differences in chest pain or dysphagia treatment. In conclusion, this study suggests that the addition of Dor fundoplication to HM does not significantly impact postoperative GERD or achalasia-related symptoms.

Non-Surgical Approaches to the Management of the Intrathoracic Goiter-A Systematic Review.

Intrathoracic goiters (ITGs) are usually managed by surgical excision, However, over recent years, non-surgical strategies are emerging as an alternatives for treating this condition. A systematic review of research published since 2017 in the PubMed database was conducted and a total of 39 articles were retrieved, along with methodological issues and future directions in the research on ITGs. Several non-surgical treatments exist, including radio-iodine ablation (RIA) and mini-invasive approaches, such as transcervical microwave ablation (TcMA), transcervical radiofrequency ablation (TcRfA), or selective embolization of the thyroid arteries (SETA). Despite encouraging reports, their current use remains limited. Treatment of ITGs requires a multidisciplinary thyroid team, and when non-surgical options are chosen, patients need to be carefully selected, and their outcomes must be prudently considered and discussed with the patient.

Trigeminal Neuralgia in the Presence of a Vascular Loop and Response to Medical Management: Experience From Saudi Arabia.

Trigeminal neuralgia (TN) is a neurovascular disorder characterized by severe, episodic facial pain, often attributed to vascular compression of the trigeminal nerve. The commonly reported artery responsible for compression is the superior cerebellar artery. Additionally, the anterior inferior cerebellar artery is also noted as a potential contributor to vascular loop compression. These vascular structures can lead to nerve root atrophy or displacement, which is significant in the pathophysiology of TN. While extensively studied globally, the specific characteristics of TN in the Saudi Arabian population remain underexplored. The primary objective of this study is to evaluate the response to medical management in patients with TN and vascular loop compression. The study was conducted at King Fahad Specialist Hospital in Dammam, Saudi Arabia, from April to August 2023, and utilized a retrospective case series design to review medical reports of 13 patients diagnosed with TN and vascular loop compression. The primary objective was to evaluate the response to medical management in this specific patient population. In this study, we included 13 patients with TN, providing a comprehensive snapshot of the patient population under study, encompassing demographic characteristics, clinical presentations, treatment responses, and other relevant variables. The mean age of the patients in the study is 48.23 years, with a standard deviation of 11.7, and a range from 30 to 71 years. The main findings of this study underscore the positive response to medical management in patients with TN and vascular loop compression. All patients in the study responded positively to the treatment, indicating a favorable overall response rate. The time to respond varied, with the majority responding within three months (46.16%), followed by those responding within 12 months (38.46%). This study highlights the potential efficacy of non-surgical approaches in managing the debilitating facial pain associated with TN. The positive outcomes observed in response to medical management emphasize the need for further exploration and validation of non-surgical approaches in the context of TN with vascular loop compression. This finding contributes to the global understanding of TN and offers promise for improving patient quality of life in Saudi Arabia.

Non-surgical treatment of lateral malleolar fractures is safe: long-term follow-up of a comprehensive treatment algorithm

IntroductionA study at Sahlgrenska University Hospital (SU) found significant variation in the treatment of ankle fractures, leading to the development of a structured treatment algorithm (TA). The TA aimed to standardise treatment and reduce the number of unnecessary surgical procedures. A follow-up study concluded that the number of surgeries had significantly decreased since the TA was introduced. However, the long-term effects of the TA and the reduced number of surgical procedures remain unclear. The aim of the study was to analyse the long-term effects of a structured TA for ankle fractures, focusing on complications and reoperation rates.MethodThe present study is a long-term follow-up of the same two cohorts of patients with lateral malleolar fractures of type AO/OTA44-B1, as studied in the previous studies on the TA for ankle fractures at SU. The current study compares a group of AO/OTA 44B1 fractures treated before introducing the TA, the pre-TA cohort (n = 410), with a group treated after introducing the TA, the post-TA cohort (n = 333). Both cohorts were followed for at least four years, and the outcomes were reoperation or complication. Reoperation was defined as any surgical procedure performed ≥ 30 days after the injury.ResultsThe results highlight a statistically significant reduction in the reoperation rate for lateral malleolar ankle fractures from 7.1 to 2.4% (p = 0.006) after introducing a TA that reduced the number of primary surgical procedures. Hardware-related issues were identified as the dominant cause of reoperation in both cohorts. Three major reoperations were observed in the pre-TA cohort compared to none in the post-TA cohort. The present study revealed no increase in the frequency of reoperations (late surgeries) due to non-union.ConclusionThe non-surgical treatment of stable ankle fractures does not lead to an increase in reoperations caused by non-union. A TA that reduces the need for primary surgical procedures for lateral malleolar fractures of type AO/OTA44-B1 has resulted in a significant decrease in reoperation rates and no increase in failure rates. This long-term follow-up demonstrates that a non-surgical approach to isolated lateral malleolar fractures is safe.

Favourable dentoalveolar changes after lower premolar extractions for Class III camouflage with completely customized lingual appliances

BackgroundThe aim of the investigation was to evaluate if the inclination of the lower anterior teeth can be controlled reliably after lower premolar extraction for Class III camouflage treatment with completely customized lingual appliances (CCLAs). Treatment outcome was tested against the null hypothesis that lower premolar extractions for non-surgical camouflage treatment of a Class III malocclusion will lead to further compensation by retroclining mandibular incisors during CCLA treatment.MethodsThis retrospective study included 25 patients (f/m 12/13; mean age 20.7 years, SD 9.5 years) with uni- or bilateral Class III molar relationship and a Wits value of ≤ -2 mm. In all consecutively debonded patients, lower premolars were extracted to correct the sagittal relationship with a non-surgical camouflage approach. Lateral head films prior to (T1) and at the end of lingual orthodontic treatment (T2) were used to evaluate skeletal and dentoalveolar effects. A paired t-test with alpha = 5% was used to define differences between the endpoints. The linear correlation between the inclination of the mandibular incisors at T1 and the achieved correction was measured with the Pearson correlation coefficient (PCC). A Schuirmann’s TOST equivalence test was used to check if the final lower incisor inclination was within the defined norms.ResultsThe null hypothesis was rejected as the mean lower incisor inclination was improved by 1.8° despite lower premolar extractions (T1: 86.8°/ T2: 88.6°). There was a strong correlation (-0.75) between the lower incisor inclination at T1 and the achieved correction indicating a controlled correction towards the norm regardless of the initial incisor position. At T2, the interincisal angle as well as the lower incisor inclination were within the norm.ConclusionLower premolar extractions for non-surgical camouflage treatment of a Class III malocclusion will not lead to undesired retroclining of mandibular incisors during CCLA treatment even in severe cases.

Balancing risks and outcomes in schwannoma treatment: Case series

Schwannomas are rare benign tumors originating from Schwann cells of peripheral nerve sheaths, occasionally presenting intraosseously in the oral and maxillofacial region. Management decisions for these tumors require careful consideration of their location, size, and impact on surrounding structures. We present two contrasting cases of schwannomas: One involving a non-surgical approach due to extensive involvement and proximity to critical structures and the other necessitating surgical excision for a well-defined intraosseous lesion. The first case, in a 28-year-old female, highlighted the decision to monitor the lesion due to its significant size and location, while the second case, in a 20-year-old female, demonstrated successful surgical removal with histopathological confirmation of a benign schwannoma. These cases underscore the importance of tailored management strategies based on thorough clinical, radiographic, and histopathological assessments to optimize outcomes and minimize risks associated with surgical intervention.

Assessment of Radiotherapy as a Standalone Treatment Following Neoadjuvant Chemotherapy in Nonmetastatic Breast Cancer: A SEER Database Analysis.

Traditional breast cancer management involves surgery followed by systemic therapies. However, advancements in neoadjuvant chemotherapy (NACT) raise questions about the necessity of surgery in cases with an excellent response to NACT. This study investigates the outcomes of radiotherapy without surgery in selected patients with nonmetastatic breast cancer after a complete or substantial response to NACT. A retrospective study was conducted using the SEER database, reviewing records from 2010 to 2020 for patients with nonmetastatic breast cancer who received NACT, associated with a clinical response, followed by radiotherapy alone. The population included 123 patients, stratified into complete clinical response (cCR) and non-cCR (partial or unspecified clinical response) cohorts. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using Kaplan-Meier and Cox proportional hazards models. The median follow-up was 41 months. Among the patients, 17 (13.82%) achieved cCR. The 5-year OS and CSS for the entire cohort were 65.8% and 71%, respectively, with the cCR group achieving 100% rates for both. Age above 60 and larger tumor size (T3 to T4) were associated with lower OS. The non-cCR group showed a 5-year OS of 61.5% and CSS of 67.1%. This study indicates that omitting surgery in patients with a cCR to NACT may be feasible, as evidenced by this subgroup's 100% OS and CSS rates at 5 and 10 years. These promising results support further research into less invasive breast cancer management. However, prospective studies must validate these findings and identify suitable patients for nonsurgical approaches.

A Retrospective Cohort Study of the Clinical Presentation and Visual Outcomes of Blepharoptosis Treatment

Background: Blepharoptosis (ptosis) is the drooping of the upper eyelid, which can be congenital or acquired and caused by various factors. It can lead to vision impairment, such as amblyopia in children, and reduced visual fields in adults, affecting quality of life. Aim: To analyze the clinical manifestation of ptosis, specifically examining the available treatment options and evaluating the resulting visual outcomes. Methods: A comprehensive analysis was conducted on the medical records of patients diagnosed with ptosis who received treatment through both surgical and non-surgical approaches between January 2017 and December 2020. Additionally, an examination of the underlying factors contributing to the condition was performed and presented. Results: A total of 28 patients, with an average age of 31.48 ± 21.66 years, received treatment at our facilities. Out of the 26 cases of unilateral ptosis, 11 patients (43%) underwent surgery, while 15 patients (57%) were treated with medications. The majority of the surgical cases were due to congenital ptosis (8 patients), followed by traumatic ptosis (3 patients). Among the patients who did not undergo surgery, neurological ptosis was present in 6 cases, while congenital ptosis was observed in 5 cases. All cases were successfully managed, resulting in good visual acuity and no complications. Conclusion: The most prevalent type of ptosis is congenital ptosis, which primarily affects males and tends to occur more frequently in the left eye. In acquired cases, traumatic ptosis is the most commonly observed type according to this study. After undergoing surgery, patients with congenital ptosis experienced improved visual outcomes, displaying good cosmetic appearance and achieving a visual acuity of 6/6-6/18.

Vacuum Bell Therapy for Pectus Excavatum: Long-term Experience at a Single Center

AimTo evaluate factors associated with excellent correction in pectus excavatum patients undergoing vacuum bell therapy (VBT). MethodsA single-institution retrospective chart review was performed November 2012–April 2023 to assess corrections of patients who underwent VBT. Patient demographics, presentation, and results were collected. Excellent correction was defined as complete correction or >100 % improved from an average standard chest depth of 0.51 cm. Data are reported using odds ratio & confidence intervals; and paired t-test comparison. A p-value of <0.05 was regarded as significant. ResultsVBT was utilized in 431 patients with 278 patients included and 153 excluded due to loss of follow-up or incomplete data. Of those included, 89 % were male. There were 31 patients with excellent corrections (11 %) and 247 non-excellent corrections. Initial chest depth < 1.5 cm and chest wall flexibility remain important predictors of positive outcome (p=0.008 and < 0.001, respectively). Excellent correction was statistically more likely in patients aged 8 to 12.9 (OR = 2.2, p = 0.039). Surgical correction following VBT was performed in only 15.5 % (42 of 278) of our patients, none of which were in the group with an excellent correction. ConclusionExcellent correction for pectus excavatum via VBT was achieved in a small proportion of patients, with improved outcomes in those initiating therapy at a younger age, with a mild defect, and with increased chest wall flexibility. These data may be used to help determine those more likely to achieve complete correction from a nonsurgical approach and guide decisions towards treatment methods.

Surgical Endodontic Management Of Maxillary Incisors: A Case Report

In the root canal system, infection of the pulp tissue caused by caries or other pathways is the primary cause of apical periodontitis. The ultimate goal of the endodontic treatment is to create adequate conditions for periradicular tissue healing. Nonsurgical endodontic treatment is a highly predictable treatment option in most cases, but surgery may be indicated for teeth with persistent periradicular pathosis unresponsive to nonsurgical approaches. The aim of this article is to highlight the possibility of the successful outcome of surgical endodontic treatment following failed non-surgical treatment of right maxillary central incisor. With proper case selection and operator skill, periradicular surgery can be considered predictable, cost-effective alternative to tooth extraction and tooth replacement.