Radiographic Treatment Outcomes Research Articles

Comparative outcomes of the treatment of unruptured paraophthalmic aneurysms in the era of flow diversion

Background Paraophthalmic aneurysms present a challenge to surgeons and their ideal management remains up for debate. We studied recent outcomes of these lesions in a single center. Methods A retrospective chart review of all patients undergoing treatment for paraophthalmic aneurysms from 2017–2019 was performed. Factors including patient demographics, aneurysm characteristics, treatment modality, radiographic treatment outcome, clinical outcome, and length of stay were collected, and bivariate analysis was performed. Results In total 84.5% (82/97) of aneurysms were treated endovascularly and 15.5% (15/97) surgically. In the surgery cohort, there were three transient perioperative complications (20%) and one minor postoperative complication (6.7%). Complete aneurysm occlusion or near complete (<2mm residual) was achieved in 100% (15/15). All but one patient had mRS ≤1 at the last follow-up. In the endovascular group, 78.1% (64/82) underwent flow diversion alone. Endovascular treatment was associated with a 4.9% (4/82) rate of periprocedural complications: 3 transient events, and 1 death, and a 3.7% (3/82) rate of delayed complications: 2 transient vision changes, and one death. Rate of total occlusion was 87.8% (72/82). 76 patients (92.7%) had mRS ≤1 at the last follow-up. Length of stay was significantly shorter in the endovascular group (3.4 days vs. 7.0 days) [p < 0.001]. Conclusions This series demonstrates similar safety to previously reported series as well as the efficacy of both surgical clipping and endovascular embolization of paraophthalmic aneurysms. Rate of complications and treatment efficacy were similar in both groups although this represents a single institution series not generalizable to all centers.

Outcomes After Chevron Osteotomy with and Without Additional Akin Osteotomy: A Retrospective Comparative Study

BackgroundChevron osteotomy is one of the most common approaches to hallux valgus corrective surgery. This procedure is often combined with Akin osteotomy of the proximal phalanx of the hallux. There are no definitive guidelines specifying the indications for a given osteotomy technique nor data on postoperative loss of correction or the effect of the type of first-ray surgery on the development of adjacent-joint arthritis. The aim of this study was to assess radiographic treatment outcomes via chevron osteotomy with and without Akin osteotomy.MethodsThe study evaluated 117 patients treated in the period 2016–2019. Ninety-nine of those patients underwent distal chevron osteotomy alone, and 18 patients underwent a combined chevron–Akin double osteotomy. The analyzed radiograms had been obtained preoperatively, at 6 weeks after surgery, and after a long-term follow-up. The following parameters were assessed: the intermetatarsal angle (IMA), hallux valgus angle (HVA), interphalangeal angle (IPA), postoperative recurrence of valgus deformity, adjacent-joint arthritis, and complications.ResultsChevron-Akin osteotomy helped maintain lower HVA and IPA values in long-term follow-up in comparison with those in the patients who underwent chevron osteotomy alone. The chevron osteotomy group showed a significant increase in the mean HVA from 18.37° at the first follow-up visit to 20.81° at the last follow-up visit. There were no differences between the groups in terms of the remaining assessed radiographic parameters. Hallux valgus surgery does not increase adjacent-joint arthritis.ConclusionThe use of combined chevron-Akin osteotomy does not affect HVA or IMA correction. The combination of chevron and Akin osteotomies reduces the risk of increased HVA and IPA in long-term follow-up. The additional Akin osteotomy does not increase the risk of adjacent-joint arthritis. Combining chevron osteotomy with Akin osteotomy is recommended in hallux valgus deformity correction.

Periapical Healing following Root Canal Treatment Using Different Endodontic Sealers: A Systematic Review.

The healing of the periapical tissues is crucial to the success of root canal treatment. The review studies effectively examine various endodontic root canal sealants in terms of periapical healing. This systematic review was formulated following the PRISMA 2020 guidelines and registered in the international prospective register of systematic reviews (PROSPERO) number-CRD42021239192. To find relevant articles, PubMed Central and Medline databases (until February 2022) were searched. Studies that evaluated healing following the application of different endodontic sealers were analysed. A primary outcome measure was the resolution of periapical lesions following the endodontic treatment. In vivo studies comparing radiographic treatment outcomes and articles with a minimum of 6-month follow-up were included. A total of 9 clinical trial studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was high in four studies out of nine studies. Periapical lesions showed significant healing after endodontic treatment regardless of sealer type, although bioceramic and bioactive sealers had shown better results.

Managing a Facial Talon: A Rare Morphological Variation on Maxillary Permanent Central Incisor

Talon cusp or Eagle's Talon is a developmental anomalous structure that is thought to arise due to evagination of the coronal surface of a tooth before the commencement of calcification. The facial form of talon cusp is a rare morphological variation occurred on the facial surface of incisors that are often associated with clinical problems such as poor esthetic, soft tissue irritation, and caries susceptibility. We report a case of facial talon cusp on permanent maxillary right central incisor in a 9-year-old girl who visited our department with esthetic concern. The patient was managed with a minimally invasive approach by selective grinding followed by the application of fluoride varnish at a regular interval. Direct resin-based composite restoration performed to achieve esthetic rehabilitation, demonstrated satisfactory clinical and radiographic treatment outcomes.

Equivalent union rates between intramedullary nail and locked plate fixation for distal femur periprosthetic fractures – a systematic review

BackgroundThe incidence of periprosthetic fracture following total knee arthroplasty continues to rise as the number of knee arthroplasty procedures increases. Management of periprosthetic fractures can be complex, with locked compression plating (LCP) and intramedullary nailing (IMN) being the most commonly used treatment options. We performed a systematic review to report and compare the clinical and radiographic outcomes of patients treated with intramedullary nail fixation versus plate fixation for periprosthetic fractures of the distal femur. MethodsSeveral databases were screened. Studies evaluating intramedullary nail fixation or locked plate fixation for distal femur periprosthetic fractures were included. Primary and secondary variables as mentioned below, when included, were analyzed and compared. ResultsOne prospective comparative study, 9 retrospective comparative studies, and 28 retrospective case series with 1,188 patients were included in this review. No statistically significant differences were found between IMN and LCP when analyzing union rate or time to union. Plating demonstrated a statistically significant decrease in the overall complication rate and reoperation rate when compared with IMN (p<0.003). IMN demonstrated a slightly higher percentage of patients reaching full weight bearing status and a quicker time to full weight bearing (100% and 7.6 weeks) when compared to plating (94% and 15.8 weeks). A higher percentage of patients treated with IMN returned to preinjury activity when compared to those treated with plating (70.8% vs. 61.6%). ConclusionsBoth intramedullary nail and locked plate fixation offer unique benefits in terms of clinical and radiographic outcomes for treatment of periprosthetic distal femur fractures after total knee arthroplasty. While the standard of care remains controversial, an increase in the recent literature has allowed for better clarification of the significant clinicoradiologic advantages and disadvantages of both popular treatment options.

Surgical Treatment of Scoliosis-Associated with Syringomyelia: The Role of Syrinx Size.

The treatment of the syrinx prior to correction of the scoliosis in syringomyelia-associated scoliosis (SMS) patients remains controversial. The aim of this study is to evaluate the role of the syrinx size in the management of SMS patients. This was a retrospective study of 36 SMS patients. They were divided into 2 groups: Group A (26 with a small syrinx, syrinx(S)/spinal cord(C) ratio ≤0.7) and Group B (10 with a large syrinx, S/C ratio >0.7). Patients with a large syrinx accepted prophylactic neurosurgery prior to scoliosis surgery. They were evaluated at baseline, 1-week and last follow-up after correction surgery for changes in curve correction, global coronal balance, thoracic kyphosis (TK), sagittal vertical axis (SVA), and Scoliosis Research Society (SRS)-22 scores. The syrinx size of patients in Group A was significantly smaller than that of in Group B. The syrinx size was significantly decreased after prophylactic neurosurgery in Group B. The radiographic parameters of scoliosis at baseline, 1-week and last follow-up after scoliosis surgery were comparable between two groups. No abnormal signal was detected during the process of neuromonitoring in both groups. Pre- and postoperative SRS-22 scores were similar between two groups. Prophylactic neurosurgery may be beneficial for decreasing the risk of correction surgery in SMS patients with large syrinx (S/C ratio >0.7). After the intervention of syrinx prior to scoliosis correction, SMS patients with large syrinx could obtain similar clinical and radiographic outcomes of treatment with pedicle-screw-based spinal instrumentation and fusion compared to the patients with small syrinx.

Surgical treatment of peri-implantitis – Consensus report of working group 4

The following consensus report is based on four background reviews (Keeve etal., Implant Dent 2019 28(2): 177-186; Ramanauskaite etal., Implant Dent 2019 28(2): 187-209; Koo etal., Implant Dent 2019 28(2): 173-176; Sculean etal., Implant Dent 2019 210-216). The surgical treatment of peri-implantitis is indicated in the cases where the first choice of treatment, the non-surgical one, failed with recurrence of bleeding and suppuration. The aim of this review was to systematically screen the literature for possible surface decontamination techniques and material during surgical treatment, the surgical regenerative and non-regenerative treatments of peri-implantitis, radiological and clinical outcomes, the importance of the presence of fixed and or keratinised peri-implant gingiva, and to determine predictable therapeutic options for the clinical surgical management of peri-implantitis lesions. Existent clinical, radiographic and microbiological data do not favour any decontamination approaches and fail to show the influence of a particular decontamination protocol on surgical therapy. Using implantoplasty in surgical non-regenerative treatment leads to a significant decrease in bleeding on probing and probing depth, and may result in improvement of clinical and radiographic parameters, up to 3years after surgery compared with mechanical debridement alone. Surgical augmentative peri-implantitis therapy resulted in improved clinical and radiographic treatment outcomes compared with the baseline in the majority of studies with 6 months to 7-10 years of follow-up. There is no evidence to support the superiority of a specific material, product or membrane in terms of long-term clinical benefits. The best treatment modality to improve the width of keratinised attached mucosa and bleeding and plaque scores, and to sustain the peri-implant marginal bone level, is the use of an apically positioned flap combined with a free gingival graft.

Effectiveness of passive ultrasonic irrigation on periapical healing and root canal disinfection: a systematic review.

Objectives To evaluate the effectiveness of passive ultrasonic irrigation (PUI) compared with non-activated irrigation (NAI) on periapical healing and root canal disinfection.Data source A comprehensive search without restrictions was performed in the following systematic electronic databases: PubMed, Scopus, Cochrane, Web of Science, ScienceDirect and OpenGrey. Additional studies were sought through hand-searching in the main endodontic journals.Data selection We included clinical trials that compared PUI and NAI clinical success and root canal disinfection outcomes. The risk of bias was assessed based on the Cochrane Collaboration common scheme for bias assessment. The power analysis of each study was calculated based on the disinfection rates and sample size, and the evidence was qualified using the GRADE tool.Data synthesis A total of 346 non-duplicated studies were retrieved in the systematic search. One study that assessed the clinical success rate through periapical radiographic healing evaluation and two studies that evaluated root canal disinfection through bacterial growth were considered eligible. These three studies were classified as low risk of bias. The study evaluating radiographic treatment outcome showed no statistical difference (P >0.05). The studies demonstrated large variability among methodology and, in general, low power and moderate evidence. Inconclusive results were reported regarding root canal disinfection when comparing PUI to NAI strategies.Conclusions Based on the findings, there was no evidence of effectiveness improvement on periapical healing and bacterial disinfection that supports the use of PUI over the NAI in clinical practice.

Carpometacarpal Fracture-Dislocations: A Retrospective Review of Injury Characteristics and Radiographic Outcomes.

Background: The purpose of this study was to evaluate the demographics and early radiographic treatment outcome of patients with carpometacarpal (CMC) injuries at our institution over a 10-year period. Methods: We conducted a retrospective review of all patients who sustained CMC injuries of the second to fifth digits between 2005 and 2015. We recorded demographic data, mechanisms of and associated injuries, treatment methods, and complications. Injury and intraoperative and postoperative radiographs were evaluated, and the adequacy of reduction was determined on lateral radiographs of the hand using a grading system that we developed. Results: Eighty patients were included in this study. Delivering a blow with a closed fist was the most common mechanism of injury; however, high-energy mechanisms also made up a large percentage of those included. Injuries to the fourth and fifth CMC joints were most common, and these were frequently associated with fractures of the metacarpal bases and distal carpal row. Closed reduction and percutaneous pinning offered a higher percentage of patients with concentric reduction at the time of pin removal. Time to surgery was significantly different between those with concentric reduction and those with residual subluxation. Conclusion: The most common mechanism of CMC injuries was blow with a closed fist; however, these injuries can be associated with high-energy mechanisms. Fractures of the metacarpal base and distal carpal row are commonly seen with these injuries. With early diagnosis, closed reduction and percutaneous pinning achieved concentric radiographic reduction. Delayed diagnosis makes closed reduction difficult and was associated with less favorable radiographic outcome.

Radiographic Outcome Differences in Distraction-Based Growing Rod Constructs Using Tandem Versus Wedding Band Connectors

Study DesignComparative cohort study. ObjectiveTo compare coronal deformity control, lengthening efficacy, and sagittal alignment between distraction-based growing rod constructs utilizing tandem versus wedding band connectors. Summary of Background DataDifferent construct designs exist for growing rod treatment of early-onset scoliosis. All use a version of a rod connector, with the two main types being tandem and wedding band. Little data exist to quantify the impact of connector choice on radiographic outcomes of treatment. MethodsA multicenter database of prospectively and retrospectively collected data on early-onset scoliosis patients was reviewed. Patients of any thoracic or thoracolumbar coronal plane deformity whose initial growing rod treatment was initiated before age 10 years and underwent at least 3 years of dual growing rod treatment with either tandem or wedding band connectors were included. Preoperative, immediate postoperative, and prefinal radiographs were reviewed and compared in regard to major curve magnitude, T1–T12 and T1–S1 spinal length, length of instrumentation, and sagittal plane measures. ResultsA total of 209 patients were included. The overall percent change from preoperative to prefinal in all radiographic parameters was not different between the two groups indicating similar efficacy in treatment. After controlling for institutional variation, the improvement of the major coronal Cobb angle from preoperative to prefinal was statistically improved for the tandem group (34° vs. 29°, p = .002) and the difference in T5–T12 kyphosis from preoperative to prefinal was significantly different between the groups (−6° vs. +1.3°, p = .008). ConclusionWe identified little difference in the effects of connector type on radiographic outcomes of patients treated with traditional growing rod, which indicates that both wedding band and tandem connectors function similarly. The small differences detected suggest that tandem connectors may improve major Cobb correction, and wedding band connectors may maintain thoracic kyphosis over time. Level of EvidenceLevel III

Clinical and radiographic outcomes of treatment of comminuted Mason type II radial head fractures with a new implant.

This study aims to evaluate the clinical and radiographic treatment outcomes of comminuted Mason type II radial head fractures, which underwent open reduction and internal fixation (ORIF) using a new implant (mother-child screw, MCS).This study included 16 patients (7 male and 9 female patients; mean age: 40.9 years, age range: 19–68 years), who were treated with ORIF, followed by MCS fixation for comminuted type II radial head fractures. The clinical results were evaluated using the Mayo Elbow Performance Score (MEPS). Radiographs, which included the quality of fracture reduction, stability, osteoarthritis, and heterotopic ossification of the elbow, were investigated. The mean follow-up period was 23.4 months.Anatomical reduction and bone union were achieved in all patients treated with MCS, and mean union time was 6.2 weeks. The average flexion-extension arc of elbow motion was 135.6° (range: 125°–150°), and the average arc of forearm rotation was 155.3° (range: 145°–170°). Furthermore, MEPS was 94.1 (range: 85–100), and the rate of excellent and good was 100%. All patients returned to preinjury work within a mean period of 11.7 weeks. No heterotopic ossification and joint stiffness of the elbow were encountered. Two patients had mild arthritic changes (grade I), but none of these patients complained of pain.The use of MCS fixation for comminuted type II radial head fractures resulted in good clinical and radiographic outcomes.

Arthroscopic percutaneous inverted mattress suture fixation of isolated greater tuberosity fracture of humerus

The purpose of the study was to evaluate the clinical and radiographic outcomes of treatment in patients with isolated greater tuberosity (GT) fractures of humerus using arthroscopic percutaneous inverted mattress suture fixation technique. We attempted to use the arthroscopic percutaneous inverted mattress suture fixation technique in 17 consecutive cases with isolated displaced GT fractures. Fourteen patients were successfully treated without switching to other methods and were available for follow-up at a mean of 22 months (range: 17-38 months) after surgery. For assessment of clinical outcomes, we evaluated the range of motion and the visual analog scale (VAS) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES), and the Korean Shoulder Scale (KSS). At the final follow-up, the VAS improved to 1.0 points (range: 0-3), the mean ASES score improved to 86.9 points (range: 78.3-100) and the KSS improved to 88.6 points (range: 82-100) postoperatively. Mean union time was 10 weeks. Mean forward flexion was 167.8° (range: 140-180°), mean external rotation in neutral position was 36° (range: 20-70°), and mean internal rotation was at the 12th thoracic level (range: T6-L3) at final follow-up. Three cases were switched to open surgery after attempted arthroscopic technique due to large fragment or osteoporosis. In select cases, the arthroscopic percutaneous inverted mattress suture fixation of GT fracture is a simple and reproducible technique with encouraging early results.

Capitellar Fractures in Children and Adolescents: Classification and Early Results of Treatment.

There has been limited published information regarding capitellar fractures in the pediatric population. The purpose of this investigation was to characterize capitellar fracture patterns in children and adolescents and to assess early clinical and radiographic treatment outcomes. A retrospective analysis of 37 children and adolescents with capitellar fractures presenting to a tertiary pediatric hospital from 2004 to 2014 was performed. The mean patient age at the time of injury was 11.8 years. Medical records and radiographs were evaluated for fracture pattern, treatment, healing, and complications. Fractures were categorized on the basis of prevailing patterns of injury, and a classification system is proposed that aids in treatment decision-making. Thirty-two patients had follow-up of at least 6 weeks and were included for assessment of treatment outcomes. The mean follow-up was 12.3 months. Three predominant capitellar fracture patterns were identified. Type-I fractures (n = 25) were anterior shear injuries. Nondisplaced anterior shear fractures were successfully treated with cast immobilization. Displaced anterior shear fractures were treated with open reduction and internal fixation, with good results in a majority of patients. Of the 21 patients with Type-Ib fractures eligible for analysis, 6 (29%) required a secondary surgical procedure for loss of motion related to soft-tissue contracture, osteonecrosis, implant prominence, and/or intra-articular loose bodies. Type-II fractures (n = 9) were posterolateral shear injuries, typically associated with ulnohumeral dislocations. Among 5 patients with displaced fractures and adequate follow-up, 3 patients were treated nonoperatively and had poor results, with loss of elbow motion or mechanical symptoms, and 2 patients were treated surgically and achieved good functional restoration. Type-III fractures (n = 3) were acute chondral shear injuries, which achieved full restoration of motion after surgical treatment. A classification of pediatric capitellar fractures is proposed, guiding treatment and prognosis. Nondisplaced fractures heal successfully with cast immobilization. Good results may be expected with surgical fixation of displaced Type-I fractures (anterior shear). Type-II fractures (posterolateral shear) and Type-III fractures (chondral shear) are more subtle; advanced imaging and timely surgical management for displaced injuries are recommended to optimize clinical results. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Conventional 2.0 mm Miniplates versus 3D Miniplate in Mandibular Fracture Fixation

The aim of the present study was to clinically and radiographically compare and evaluate the treatment outcomes using 3D miniplate versus conventional 2.0 mm miniplates in fractures fixation of the anterior mandible. The study enrolled 16 patients with a total of 18 fractures; suffering from anterior mandibular fractures (symphysis and/or parasymphysis) requiring open reduction and internal fixations through an intra-oral approach. Groups I patients were fixed using 3D titanium miniplates and screws. Group II patients were fixed using two 2.0 mm titanium miniplates and screws.Postoperative primary clinical treatment outcome points for comparative evaluation for all patients were fracture stability, the need for additional IMF, the need for minor occlusal adjustments and satisfactory occlusion. Secondary assessment points were infection, wound dehiscence and neurosensory deficit. Radiographic evaluation postoperatively was in terms of reduction adequacy, bone union and condylar positional change measurement. With respect to all the evaluated parameters, statistical analysis showed no statistically significant difference between the two groups in termsof clinical and radiographic treatment outcomes.

Minimum 20-Year Radiographic Outcomes for Treatment of Adolescent Idiopathic Scoliosis: Preliminary Results from a Novel Cohort of US Patients

Minimum 20-Year Radiographic Outcomes for Treatment of Adolescent Idiopathic Scoliosis: Preliminary Results from a Novel Cohort of US Patients

Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial

Oral healthcare expenses are increasing rapidly as a result of the growth of high-cost health technologies worldwide. In many developing/developed countries, low-cost tooth extraction is the alternative treatment option for a high-cost root canal therapy (RCT) for management of human molars with irreversible pulpitis. Vital pulp therapy with calcium-enriched mixture cement (VPT/CEM) as a new alternative treatment option has demonstrated excellent treatment outcomes up to 1 year; if 2-year radiographic/clinical effectiveness as well as cost-effectiveness of the VPT/CEM is also non-inferior compared with RCT, it can serve as a viable treatment for mature molars with irreversible pulpitis. In this prospective, multicenter (n = 23), non-inferiority clinical trial, 407 patients were randomized to either one-visit RCT (n = 202) or VPT/CEM (n = 205) for 27 months. In this part of study, the primary outcome measure was the 2-year clinical and radiographic treatment outcomes. Cost-effectiveness was also analyzed. Mean follow-up times were 24.62 ± 0.72 and 24.61 ± 0.69 months in RCT (n = 166) and VPT/CEM (n = 166) arms, respectively. Clinical success rates in the two study arms were equal (98.19%); however, radiographic success rates were 79.5 and 86.7% in RCT and VPT/CEM arms, respectively, with no statistical difference (P = 0.053). The treatment time span mean was approximately three times greater in the RCT than in the VPT/CEM arm (94.07 vs. 31.09 min; P < 0.001). RCT had a cost of 171.5K per molar tooth compared with 44.5K for VPT. VPT/CEM reduced time and cost spent. When considering clinical as well as cost-effectiveness of VPT/CEM, this treatment option is not only non-inferior but also superior to RCT in mature permanent molar teeth with established irreversible pulpitis. Vital pulp therapy with CEM is a cost-effective and reliable biological technique for endodontic treatment of permanent molar teeth with irreversible pulpitis and can be recommended for general clinical practice.

Radiographic Outcomes of Ring External Fixation for Malunion and Nonunion

Ring external fixators such as the Ilizarov external fixator (IEF) and Taylor Spatial Frame (TSF) have revolutionized management of limb deformity. This study examines radiographic outcomes for treatment of malunions and nonunions with secondary emphasis on comparing radiographic union rates of TSF and IEF. A retrospective chart and radiograph review was performed. Fifty-four patients were included. Most injuries were in the tibia (96%). Fifty patients (93%) achieved radiographic union, two patients required further fixation, and two patients elected to undergo amputation. The preoperative coronal deformity improved from a mean of 12° (range, 0°-41°) to within 3° anatomic. Sagittal deformity improved from a mean of 11° (range, 0°-49°) to within 5° anatomic with some patients intentionally left in recurvatum to accommodate plantarflexion contractures. Limb length discrepancies were corrected to within 1 cm. Twenty-five patients experienced complications (mostly superficial pin tract infections). No statistically significant differences in the radiographic outcomes of TSF compared to IEF were identified.

Enamel Matrix Derivative in Intrabony Defects: Prognostic Parameters of Clinical and Radiographic Treatment Outcomes

The purpose of this retrospective case series study is to identify possible preoperative parameters that could predict postoperative probing depth (PD), clinical attachment level (CAL) gain, or radiographic defect resolution in intrabony defects treated with enamel matrix derivative (EMD). Sixty-one chronic periodontitis patients, each contributing a 2- or 3-wall intrabony defect treated with EMD, were included. Clinical parameters recorded included the following: PD; CAL; gingival margin position; supracrestal soft tissue (SST); surgical distances of cemento-enamel junction (CEJ) to bone crest (CEJ-BC), CEJ to base of the defect (CEJ-BD), and BC to BD (BC-BD); and depth of 2- and 3-wall components. Radiographic parameters recorded included the following: CEJ-BC, CEJ-BD, BC-BD distances, and radiographic defect angle. Postoperative assessments were performed at 12 months. The probability of postoperative PD >4 mm increased 1.6-fold (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.2 to 2.3) with each 1-mm baseline PD increase. Baseline PD and surgical CEJ-BD were statistically significant predictors of CAL gain; the greater the baseline PD (OR = 0.5; 95% CI = 0.3 to 0.8) and bone loss (OR = 0.6; 95% CI = 0.3 to 0.9), the less likely that postoperative CAL gain was ≤3 mm. Smoking and SST were significantly associated with defect resolution; failure to achieve ≥65% defect resolution was six-fold greater for smokers (OR = 6.5; 95% CI = 1.7 to 24.5) and almost double (OR = 1.7; 95% CI = 1.1 to 2.8) for each millimeter of SST increase. In EMD-treated intrabony defects, baseline PD predicts both CAL gain and postoperative PD. Smoking and SST are predictors of defect resolution.

Clinical and radiographic evaluation of intrabony periodontal defect treatment by open flap debridement alone or in combination with nanocrystalline hydroxyapatite bone substitute

The aim of this study has been to compare the clinical and radiographic outcome of periodontal intrabony defect treatment by open flap debridement alone or in combination with nanocrystalline hydroxyapatite bone substitute application. Thirty patients diagnosed with advanced periodontits were divided into two groups: the control group (OFD), in which an open flap debridement procedure was performed and the test group (OFD+NHA), in which defects were additionally filled with nanocrystalline hydroxyapatite bone substitute material. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL) were measured prior to, then 6 and 12months following treatment. Radiographic depth and width of defects were also evaluated. There were no differences in any clinical and radiographic parameters between the examined groups prior to treatment. After treatment, BOP, GI, PD, CAL, radiographic depth and width parameter values improved statistically significantly in both groups. The PI value did not change, but the GR value increased significantly after treatment. There were no statistical differences in evaluated parameters between OFD and OFD+NHA groups 6 and 12months after treatment. Within the limits of the study, it can be concluded that the additional use of nanocrystalline hydroxyapatite bone substitute material after open flap procedure does not improve clinical and radiographic treatment outcome.

Treatment outcomes of pulpotomy in permanent molars with irreversible pulpitis using biomaterials: A multi-center randomized controlled trial

Objective.To conduct a randomized clinical trial to compare the post-operative pain experience as well as clinical and radiographic outcomes of pulpotomy in human permanent molars with irreversible pulpitis using calcium enriched mixture (CEM) cement or mineral trioxide aggregate (MTA). Materials and mcethods.A total of 413 patients met the inclusion criteria and consented to participate. The patients were randomly allocated into two study arms: MTA pulpotomy (PMTA: n = 208) and CEM pulpotomy (PCEM: n = 205). Numerical rating scale questionnaires were utilized by the patients to record pain intensity (PI) over 7 days post-operatively. The patients were followed-up for 12 months to assess the clinical and radiographic outcomes of treatment. The data was analyzed using Chi-square, Cohen's kappa and t-tests. Results.There was no significant difference in the mean PI recorded during the 7 post-operative days between the two study arms (p = 0.221). The clinical and radiographic success rates for PMTA at 12-month follow-up were 98 and 95%, respectively; and 97 and 92% for PCEM, respectively. There was no significant differences in clinical (p = 0.7) and radiographic (p = 0.4) success rates between the two arms. Conclusions.Excellent treatment outcomes occurred in molar teeth with irreversible pulpitis undergoing pulpotomy with MTA and CEM biomaterials.