Reduced Treatment Time Research Articles

Setup accuracy and margins for surface-guided radiotherapy (SGRT) of head, thorax, abdomen, and pelvic target volumes

The goal of the study was to evaluate the inter- and intrafractional patient setup accuracy of target volumes located in the head, thoracic, abdominal, and pelvic regions when using SGRT, by comparing it with that of laser alignment using patient skin marks, and to calculate the corresponding setup margins. A total of 2303 radiotherapy fractions of 183 patients were analyzed. All patients received daily kilovoltage cone-beam computed tomography scans (kV-CBCT) for online verification. From November 2019 until September 2020, patient setup was performed using laser alignment with patient skin marks, and since October 2020, using SGRT. The setup accuracy was measured by the six degrees of freedom (6DOF) corrections based on the kV-CBCT. The corresponding setup margins were calculated using the van Herk formula. Analysis of variance (ANOVA) was used to evaluate the impact of multiple factors on the setup accuracy. The inter-fractional patient setup accuracy was significantly better using SGRT compared to laser alignment with skin marks. The mean three-dimensional vector of the translational setup deviation of tumors located in the thorax, abdomen, and pelvis using SGRT was 3.6 mm (95% confidence interval (CI) 3.3 mm to 3.9 mm) and 4.5 mm using laser alignment with skin marks (95% CI 3.9 mm to 5.2 mm; p = 0.001). Calculation of setup margins for the combined inter- and intra-fractional setup error revealed similar setup margins using SGRT and kV-CBCT once a week compared to laser alignment with skin marks and kV-CBCT every other day. Furthermore, comparable setup margins were found for open-face thermoplastic masks with AlignRT compared to closed-face thermoplastic masks with laser alignment and mask marks. SGRT opens the possibility to reduce the number of CBCTs while maintaining sufficient setup accuracy. The advantage is a reduction of imaging dose and overall treatment time. Open-face thermoplastic masks may be used instead of closed-face thermoplastic masks to increase the patient's comfort.

Five-Fraction Proton Therapy for Chordomas and Chondrosarcomas of the Skull Base: Preliminary Results of a Prospective Series

To describe the first series of patients with clival chordomas and chondrosarcomas treated with extremely hypofractionated proton therapy in a single institution with focus on acute tolerance and dosimetric parameters. A total of 11 consecutive patients with biopsy proven chordomas and chondrosarcomas were prospectively included in a five-fraction proton therapy protocol between June 2022 and January 2023. The inclusion criteria for this protocol were: Age > 18 yo., Karnofsky Performance Status (KPS) ≥ 70%, absence of metastases, no previous radiation courses, clinical target volume (CTV) up to 50 cc and CTV location relative to organs at risk that allowed compliance with the necessary dose restrictions for hypofractionated treatments in 5 fractions, according to the international guidelines. Treatment was delivered with a Proteus®ONE cyclotron using Pencil Beam Scanning (PBS) Intensity-Modulated Proton Therapy (IMPT). Patient setup was performed with CBCT imaging at isocenter and X-Ray obliques, allowing a robust planning with 1 mm setup uncertainty and 3.5% range uncertainty. IMPT plans were obtained with RayStation employing 4 to 6 non-coplanar beams. In 7 patients' apertures were used in 2 of the beams, to reduce lateral penumbra and to optimize dose gradient. A total of 11 patients (7 males and 5 females) with an age range between 29 and 79 yo, were included. 6 patients with classic chordomas and 5 patients with grade I-II chondrosarcomas were treated with a total dose of 37.5 GyRBE and 35 GyRBE, respectively, in 5 daily fractions. All the patients had received previous surgery with complete resection in 2 patients, subtotal resection in 7 patients and partial resection in 2 patients. Most common symptoms at diagnosis were diplopia and headache and baseline median KPS after surgery was 90% (70 - 100%). Median CTV was 30.62 cc (10.56 - 47.47 cc). Median CTV coverage was V95% = D95.5%. Median maximal dose for the brainstem was 26.5 GyRBE (30 - 24.7 GyRBE) and for the optic pathway was 20.7 GyRBE (8.9 - 23.6 GyRBE). Median follow-up was 3 months (8 - 1 months). Acute toxicity during follow-up was mild, with grade I - II headache (64%), grade I asthenia (45%), grade I nausea (27%), grade I dysphagia (18%) and reversible alopecia (45%). Only one patient showed nystagmus and mild loss of strength in left lower limb related with an ischemic brainstem lesion, in a low dose region, not clearly radiation related. 8 patients had a 3-month follow-up MRI with no signs of progression. Five-fraction proton therapy for the treatment of clival chordomas and chondrosarcomas is dosimetrically feasible and well tolerated for selected patients. Proton therapy remains a limited resource, consequently, reducing treatment time can have significant financial and psychosocial implications. Longer follow up is needed to validate these results.

Prospective Evaluation of Implementation of a Tattoo-less Workflow for Non-Spine Bone SBRT

Oligometastatic disease has expanded the clinical indications for non-spine bone (NSB) SBRT. Optical surface monitoring systems (OSMS) may reduce treatment time if it represents an effective surrogate for bone intrafraction motion monitoring. We aimed to identify whether OSMS could substitute for 2D-3D mid-imaging and enable a tattoo-less set up in NSB SBRT. Beginning 11/2019, OSMS was incorporated in parallel with an existing workflow using CBCT and mid 2D-3D kV/kV imaging for pre- and mid-imaging for NSB SBRT. The ability of OSMS to detect both observed out-of-tolerance (>2mm/>2deg) shifts and manual couch shifts was analyzed. A workflow incorporating OSMS reference captures, CBCT for pre-treatment verification and OSMS/triggered imaging (TI) for intrafraction monitoring was developed and deployed for rib/sternum SBRT beginning 11/2021 and all NSB SBRT beginning 2/2022. All NSB SBRT treatment appointments were analyzed through statistical process control (SPC) with use of an XmR chart of average set up and total treatment time per quarter from 2/2019 to 2/2023. Special cause rules were based on IHI rules and conduced with spreadsheet software. From 2/2019 to 2/2023, 1962 NSB SBRT fractions were delivered, including 337 rib, 150 sternum, 197 femur, 266 ilium, 222 multi-site. Over 104 femur and 87 ilium images, there were no over tolerance intra-fraction events detected with 2D-3D or OSMS. Over 20 manual shifts, OSMS could detect 2mm shifts to within 0.4mm 67% of the time and 0.8mm 95% of time. There was no difference in treatment set up time following adoption of an OSMS/TI workflow as a replacement for 2D-3D mid-imaging. A reduction in rib SBRT delivery and multi-site treatment set-up times was significantly associated with the adoption of OSMS/TI and OSMS, respectively, as assessed based on special cause variation with 8 consecutive points below the mean. Integration of OSMS and triggered imaging has enabled the transition to a completely tattoo-less workflow, thus sparing patients the need for permanent tattoos whilst also allowing more continuous motion monitoring and reduced radiation exposure related to unnecessary 2D-3D or CBCT mid-imaging. Treatment times were significantly reduced for patients receiving rib SBRT or multi-site NSB SBRT with this workflow.

Clinical Outcomes of Synchronous Lung Stereotactic Body Radiation Therapy Lesions via Single-Isocenter/Multi-Lesion Treatments

Lung cancer patients with synchronous primary or oligometastatic (< 5 lesions) with associated co-morbidities may not retain their treatment position for the extended stereotactic body radiotherapy (SBRT) treatment times with individual isocenter plans for each lesion due to discomfort or shortness of breath. SBRT using a single-isocenter/multi-lesion (SIML) volumetric arc therapy (VMAT) plan with flattening filter free (FFF) beam could significantly shorten overall treatment time, improve patient comfort and compliance and clinic efficiency. We report clinical results of treating multiple lung metastases or synchronous primary lung cancers with SIML lung SBRT. Eighty patients with synchronous primary lung cancers or oligometastatic lung tumors (two, n = 61; three, n = 10; four, n = 4; five n = 5; total treated lesions, n = 193) were simulated with abdominal compression and/or 4D-CT MIP images and treated with a highly-conformal SIML VMAT lung SBRT plans via 3-4 non-coplanar arcs. Common prescriptions were 50-55 Gy/5 fractions and 54 Gy/3 fractions prescribed 70-80% isodose line to the each PTV. Acuros dose calculation for 6MV-FFF beam was used for tissue heterogeneity corrections. RTOG-0618/0813 criteria were used to dose constraints to organs at risk (OAR) and target conformality. Treatment was delivered every other day or twice weekly with CBCT-guidance, adjustments made with 6DOF couch corrections on a medical linear accelerator, and treatment delivery time within 15 minutes. Local control rates and toxicity profile was evaluated using CTCAE v. 5.0 grading for pneumonitis, rib fracture and chest wall pain. All plans met RTOG-0618/0813 requirements for each tumor coverage, dose to OAR including normal lung and ribs. Mean follow up after last fraction of treatment was 16.9 months (range, 1.0-54.2 months). PTV volume ranged from 2.17 to 167.8 cc with mean volume of 16.1 cc. Of the 80 patients treated, 71 had adequate post-treatment thoracic CT imaging to assess local control. Local control was achieved in 167/175 (95.4%) of treated and followed lesions. CTCAE grade 1 asymptomatic pneumonitis was noted on thoracic CT scans in 42/71 (59.2%) of patients and occurred, on average 4.8 months after SBRT. Symptomatic pneumonitis and rib fracture did not occur in any patient. CTCAE grade 2 chest wall pain occurred in 4/80 (5.0%) treated patients and was managed conservatively with over-the-counter NSAIDS or acetaminophen. SIML lung SBRT for synchronous primary lung cancers or multiple lung metastases can be used as a variant to traditional multiple isocenter SBRT or chronologically separate treatment courses, and has excellent local control rates and low toxicity profile in our patient population. It can help improve comfort and compliance of the patients who have difficulty lying still for an extended treatment course, and significantly reduces treatment time via isocenter shifts/repeated CBCTs for image guidance, thus improving clinic efficiency.

OPTIMIZATION OF THE MEDICAL REHABILITATION PROGRAM FOR THE WOUNDED USING THE HYPERBARIC OXYGEN THERAPY

Background. The use of the hyperbaric oxygenation therapy (HBO) in the program of medical rehabilitation of the wounded in a timely manner and according to the indications leads to an increase in cardio-respiratory syndrome indicators, improvement of microcirculation in damaged tissues, reduction of the healing time of postoperative scars. An integrated approach to the rehabilitation of the wounded with the use of HBO contributes to the reduction of treatment time for amputee prosthetics Aim. To optimize the rehabilitation program using the hyperbaric oxygenation method in a rehabilitation center, on the basis of studying the features of the clinical picture and the functional state of the wounded with the consequences of mineexplosive and gunshot wounds. Materials and Methods. Under the supervision there were 215 patients with amputation defects, aged 20 to 50 years, who were injured during the special military operation between March 2022 and June 2023. Results. The hyperbaric oxygenation therapy (HBO) resulted in faster healing and epithelialization of wounds, an active growth of granulations, expansion of the zone of viable tissues, and improvement of microcirculation. Conclusions. As a result of medical rehabilitation using the hyperbaric oxygenation method in the rehabilitation center, the most patients achieved the planned rehabilitation ePect.

Dosimetric evaluation of accelerated partial breast irradiation (APBI) using volumetric modulated arc therapy (VMAT) technique

Purpose: Five-fraction radiation therapy treatment regimens for accelerated partial breast irradiation (APBI) using intensity modulated radiotherapy (IMRT) have become increasingly used after several phase three trials demonstrated similar or reduced toxicity compared with whole breast irradiation. Improving the treatment efficiency of this technique could significantly improve delivery accuracy and tolerability, especially for treatment plans utilizing deep inspiration breath hold (DIBH) technique. The aim of this study was to determine the optimal technique for APBI, with a focus on volumetric modulated arc therapy technique (VMAT) and flattening-filter free (FFF) delivery. Methods: Ten APBI cases, five cases each left and right breast, were randomly selected. Each case was contoured following guidelines included in the APBI-IMRT-Florence Trial and planned to use both non-coplanar static-field IMRT with standard flattened-filter (FF) beam and VMAT techniques with both FF and FFF beam. For each VMAT plan, two partial arcs were used with patient-specific start and stop angles. Arc extents emulated opposed tangential fields and were chosen based on target and organ at risk (OAR) locations. Evaluated OARs included the heart, ipsilateral and contralateral lung, and normal breast. All plans were generated using the Eclipse treatment planning system (Version 15.6). A prescription dose of 30Gy delivered in 5 fractions was used for all cases. Plans were compared and evaluated using several dose metrics as well as treatment time. Results: For targets, VMAT exhibited similar coverage (V95%) but higher Dmax compared to IMRT (105% (IMRT) v.s .111% (VMAT), p=0.002. VMAT provided similar OAR avoidance compared to IMRT for the heart (Dmean, V3Gy, V0.5Gy), ipsilateral lung (V10Gy), contralateral lung (V5Gy) and contralateral breast Dmax within 10cGy/2% (p~0.005). VMAT contributed slightly lower dose outside the target in the ipsilateral breast, with an average difference in V15Gy of approximately 8% (37% (IMRT) v.s. 29% (VMAT)). Finally, because IMRT delivery is non-coplanar, and typically requires at least 5 treatment fields, co-planar VMAT reduced the total treatment significantly. VMAT with FF beam energies also used fewer monitor unites compared to IMRT with FF beam energies. The utilization of FFF beam energies for VMAT further improved delivery time compared to IMRT. Overall, VMAT with FFF beam energies reduced treatment time by approximately 20% compared to IMRT with FF beam. Conclusions: Co-planar partial-arc FFF VMAT technique produced equivalent target coverage, improved efficiency, better normal tissue sparing, and shorter delivery time compared to non-coplanar IMRT technique. Shorter delivery time also assists in the reduction of patient motion associated with breath hold. VMAT technique with FFF delivery is a suitable replacement for IMRT in APBI.

Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times

The benefit of endovascular stroke therapy (EVT) in large vessel occlusion (LVO) ischemic stroke is highly time dependent. Process improvements to accelerate in-hospital workflows are critical. To determine whether automated computed tomography (CT) angiogram interpretation coupled with secure group messaging can improve in-hospital EVT workflows. This cluster randomized stepped-wedge clinical trial took place from January 1, 2021, through February 27, 2022, at 4 comprehensive stroke centers (CSCs) in the greater Houston, Texas, area. All 443 participants with LVO stroke who presented through the emergency department were treated with EVT at the 4 CSCs. Exclusion criteria included patients presenting as transfers from an outside hospital (n = 158), in-hospital stroke (n = 39), and patients treated with EVT through randomization in a large core clinical trial (n = 3). Artificial intelligence (AI)-enabled automated LVO detection from CT angiogram coupled with secure messaging was activated at the 4 CSCs in a random-stepped fashion. Once activated, clinicians and radiologists received real-time alerts to their mobile phones notifying them of possible LVO within minutes of CT imaging completion. Primary outcome was the effect of AI-enabled LVO detection on door-to-groin (DTG) time and was measured using a mixed-effects linear regression model, which included a random effect for cluster (CSC) and a fixed effect for exposure status (pre-AI vs post-AI). Secondary outcomes included time from hospital arrival to intravenous tissue plasminogen activator (IV tPA) bolus in eligible patients, time from initiation of CT scan to start of EVT, and hospital length of stay. In exploratory analysis, the study team evaluated the impact of AI implementation on 90-day modified Rankin Scale disability outcomes. Among 243 patients who met inclusion criteria, 140 were treated during the unexposed period and 103 during the exposed period. Median age for the complete cohort was 70 (IQR, 58-79) years and 122 were female (50%). Median National Institutes of Health Stroke Scale score at presentation was 17 (IQR, 11-22) and the median DTG preexposure was 100 (IQR, 81-116) minutes. In mixed-effects linear regression, implementation of the AI algorithm was associated with a reduction in DTG time by 11.2 minutes (95% CI, -18.22 to -4.2). Time from CT scan initiation to EVT start fell by 9.8 minutes (95% CI, -16.9 to -2.6). There were no differences in IV tPA treatment times nor hospital length of stay. In multivariable logistic regression adjusted for age, National Institutes of Health Stroke scale score, and the Alberta Stroke Program Early CT Score, there was no difference in likelihood of functional independence (modified Rankin Scale score, 0-2; odds ratio, 1.3; 95% CI, 0.42-4.0). Automated LVO detection coupled with secure mobile phone application-based communication improved in-hospital acute ischemic stroke workflows. Software implementation was associated with clinically meaningful reductions in EVT treatment times. ClinicalTrials.gov Identifier: NCT05838456.

Mechanical and Plasma Electrolytic Polishing of Dental Alloys.

(1) Background: In dentistry, a reduction in surface roughness is established mostly by conventional mechanical polishing to hinder biofilm adhesion. This is time- and labor-intensive. Plasma electrolytic polishing is believed to be an effective finishing method due to the reduced treatment time and materials used for applications in dentistry. (2) Methods: Co-Cr-Mo dental alloy samples were sandblasted and prepared with either plasma electrolytic or conventional mechanical polishing. Evaluation of the polishing methods was obtained by atomic force microscopy, scanning electron microscopy and energy-dispersive X-ray spectroscopy. (3) Results: The sandblasted samples showed the highest surface roughness (Heraenium® Sun 991 ± 288 nm; Wironit® 1187 ± 331 nm). Our results show that with plasma electrolytic polishing, Co-Cr-Mo surfaces can be polished with a surface roughness in the nanometer range, comparable to those achieved by conventional mechanical polishing. Conventional mechanical polishing (Heraenium® Sun 134 ± 23 nm; Wironit® 114 ± 11 nm) provided lower surface roughness values compared to plasma electrolytic polishing (Heraenium® Sun 288 ± 94 nm; Wironit® 261 ± 49 nm). We anticipate our pilot study as a starting point for future studies to refine process parameters and quantitative microbiological assays. (4) Conclusions: Plasma electrolytic polishing might have a promising future for polishing dental alloys.

A Practical Method to Prolong Expiratory Breath Holds for Abdominal Stereotactic Body Radiation Therapy

Abstract Objective: Motion management is crucial to safe and efficacious abdominal stereotactic body radiation therapy (SBRT). Expiratory breath hold (EBH) treatment is attractive as it minimizes target motion compared with other techniques; however, only a proportion of patients can perform an EBH to permit efficient treatment. We implemented a technique utilizing supplemental oxygen and mild hyperventilation in patients receiving abdominal SBRT, with the hypothesis that it may prolong EBHs and reduce treatment times. Materials and Methods: Starting in August 2020, we provided patients supplemental oxygen (50% FiO2) and encouraged mild hyperventilation at 18 breaths/min with a metronome to improve EBHs for patients undergoing abdominal SBRT. We evaluated all completed treatments with this supplemented procedure (EBHsupp) as well as historical controls treated with EBH prior to this new procedure (EBHRA, where RA signifies room air). EBH durations and treatment times were assessed. Statistical comparisons were made with chi-square test, Student t-test, and Mann-Whitney U test. Results: For 20 patients treated with SBRT via EBHsupp and 26 patients treated with SBRT via EBHRA, there were no statistical differences in baseline patient characteristics or treatment planning characteristics between the groups. The EBHsupp group had significantly increased maximum (52.8 s vs 34.5 s, P &lt; .001) and median (24.9 s vs 18.7 s, P = .002) EBH times and required less EBH per treatment (8.9 vs 12.7, P &lt; .001). The mean treatment time was 3 minutes less for EBHsupp compared with EBHRA (17.6 min vs 20.8 min, P = .025). Conclusion: Patients receiving supplemental oxygen and mild hyperventilation exhibited prolonged EBH time and reduced overall treatment time during abdominal SBRT. This intervention may improve individual patient breath-hold times, reduce treatment times, and increase the number of patients eligible for EBH-based abdominal SBRT.

The Curved Presplitting Technique in a Totally Edentulous Atrophic Mandible: A Surgical Case Report.

The management of horizontally fully edentulous atrophic ridges is a common problem in dental implantology. This case report describes an alternative modified two-stage presplitting technique. The patient was referred for an implant-supported rehabilitation of their edentulous mandible. CBCT scans showed a mean available bone width of about 3 mm. At the first stage, four linear corticotomies were performed using a piezoelectric surgical device. At the second surgical stage 4 weeks later, bone expansion was performed, and four implants were placed in the interforaminal area. The healing process was uneventful. No fractures of the buccal wall and no neurologic lesions were observed. Postoperative CBCT scans showed a mean bone width gain of about 3.7 mm. Implants were uncovered 6 months after the second surgery, and 1 month later, a fixed provisional screw-retained prosthesis was delivered. This approach could be used as a reconstructive technique that avoids using grafts and reduces treatment times, possible complications, postsurgical morbidity, and costs by exploiting the patient's native bone as much as possible. Considering the limitations of a case report, randomized controlled clinical trials are needed to confirm the results and validate this technique.

Comparing Ultrasonography With Plain Radiography in the Diagnosis of Long Bone Fractures

Objective: This study was designed to compare sonography to skeletal radiography, in the diagnosis of long bone fractures. Materials and Methods: This was a cross-sectional and analytical study including 188 patients of varied ages that had 251 suspected long bone fractures. It was conducted over a 9-month period, in the emergency department of a teaching hospital, within the Swat district of Pakistan. After assessing the clinical symptoms of the fracture by an emergency orthopedic physician, sonography was followed by a radiograph performed for these referred patients. Results: Sonography shows a diagnostic accuracy of 91.23% for detecting long bone fractures, with a sensitivity and specificity of 100% and 76.84%, respectively. The positive predictive value and negative predictive value were 87.64% and 100%, respectively. Sonography was able to detect small fractures (up to 0.23 mm) that are often missed on the patient’s radiograph. Conclusion: Sonography may be useful as an initial screening imaging technique for the diagnosis of long bone fractures. The potential exists to reduce the need for unnecessary skeletal radiographs, which could reduce treatment time, cost, and ionizing radiation hazards.

Generalized information with examples on the possibility of using a service-oriented approach and artificial intelligence technologies in the industry of e-Health

The object of the research is the review of ways of implementing service-oriented approaches (SOA) and artificial intelligence (AI) technologies in modern healthcare systems. The generalization of these ways will allow to cope with complex modern challenges, such as increasing demand for medical services, growing volumes of data, and the need for high-quality and effective treatment. This work is aimed at this. The field of e-Health is rapidly gaining popularity and combines many different systems. But due to the large number of tools and system providers with different architectures, there is a problem that different systems are difficult or impossible to integrate and connect with each other. It is shown that the use of SOA makes it possible to break down complex systems into separate services that can interact with each other to ensure fast and accurate data processing, effective management of medical resources, and improvement of the quality of medical services. AI can be used to analyze large volumes of medical data, predict risks, diagnose diseases, and develop individualized treatment plans. The use of AI in healthcare systems helps improve diagnostic accuracy, reduce treatment times, and improve patient outcomes. The synergy of SOA and AI in health care systems is important when SOA provides the means to integrate various AI solutions, which allows for the interaction of different services and the exchange of data to ensure effective treatment and collaboration between medical professionals and artificial intelligence systems. Such distribution of systems makes it possible to scale them without affecting other services that are already running. Therefore, it becomes possible to use unified data transfer protocols and combine different services into one system without radically changing the codebase and building additional layers of abstraction for interaction between services that cannot be combined in one system. Examples of the use of SOA and AI in modern health care systems to improve the quality of medical services, optimize resources and ensure an individual and effective approach to patient treatment, which can be used at the next stages of medical reform in Ukraine, are considered.

Double vibratory stress relief treatment of welded pipes as an alternative to heat stress relief treatment: Effects on hardness, Charpy impact energy and CTOD

This work analyzes the effects of intermittent resonant vibration treatment in pipes welded to connectors applied in the field of oil and gas wells. The vibratory stress relief (VSR) process was applied intermittently under two conditions: the first one, called Simple Vibration Treatment (TVS), which consisted of a resonant vibration treatment with the vibrational system at the mean length of the product, a second step, with the product being rotated 90°. The results obtained with this process led us to study a new resonant vibration process with the purpose of intensifying the previous one, taking care that no defects would be introduced into the product. This condition, called Double Vibration Treatment (TVD), consisted of a treatment formed of three steps: the first two steps were performed in the same way and with the same procedure used in the Single Vibration Process (TVS). The third step consisted of carrying out a second resonant vibratory treatment with the vibrator positioned on the longitudinal weld of the pipe, close to the circumferential weld of the pipe with the connector. These VSR treatments were compared with the stress relief heat treatment PWHT (Post Weld Heat Treatment) which is normally used after welding the connectors to the pipe. The resonant vibration treatments (VSR), did not introducing any damage to the product, presented reduced treatment time, and tended to positively affect the evaluated mechanical properties, exceeding or equaling the same tendency presented by the heat treatment. The resonant Doble Vibration Treatment (TVD) showed the best results, affecting the evaluated properties more positively than the TVS, which practically promoted the same trend of results produced by PWHT. The studies were characterized by Vickers hardness tests, Charpy V impact fracture tests and CTOD fracture toughness tests, and the results were analyzed using ANOVA statistical modeling.

Corticotomy-Assisted Orthodontic Treatment: A Literature Review

The increased number of adults seeking orthodontic treatment has led to the need for faster results as social limitations arise with the use of fixed or even removable appliances. Corticotomy-assisted orthodontic treatment (CAOT) has been proposed as a technique that accelerates tooth movement and leads to a substantial reduction in treatment time. This review was conducted by searching four databases for original articles about CAOT, review articles and articles about alternative techniques and periodontal effects up to 31 December 2022. The aim of the review was to present the historical and biological background of CAOT, the description of the technique and some alternative and less invasive techniques that have been proposed. Indications, contraindications and periodontal side effects are also discussed.

All-On-Four Concept Literature Review

The All-on-4 concept is a dental implant technique that provides a solution for patients who have lost or are about to lose all of their teeth in one or both jaws. This concept was developed to simplify the implant process and make it more accessible for individuals with extensive tooth loss. In the review performed in Pubmed and Cochrane Library between 2005 and 2023, Full arch implant-supported prosthesis, 4-implant full arc, osseointegration, inclined implant, total edentulism and different combinations in which some of these keywords were used together were chosen. 100 of the articles achieved from the review were evaluated with respect to the subject we examined. The inclusion criteria for articles were as follows: 1-Articles were related to the all-on-four concept. 2-Abstracts were obtained when the full texts could not be obtained. The All-on-4 concept in dental implantology offers several advantages, making it a popular and effective solution for patients with extensive tooth loss. The All-on-4 concept allows for the immediate loading of prostheses onto the implants shortly after surgery. Compared to traditional implant approaches, All-on-4 reduces treatment time significantly. The concept utilizes tilted posterior implants, which take advantage of available bone and reduce the necessity for bone grafting in areas with insufficient bone volume. All-on-4 may be more cost-effective than traditional implant-supported restorations due to the reduced number of implants and the associated surgical procedures. The concept aims to provide a fixed, full-arch prosthesis that closely resembles natural teeth. Numerous studies have reported high success rates for the All-on-4 concept, with the majority of patients experiencing successful osseointegration and long-term stability of the implants. All-on-4 often results in a more comfortable experience for patients, with fewer surgical interventions and reduced healing periods. The tilted posterior implants increase the contact between bone and implant, enhancing stability and support for the prosthesis.

Cumulative success rate and marginal bone loss for immediate and early loading protocols in a single implant-supported crown: A randomized controlled split-mouth clinical trial

Statement of problemNew loading protocols with reduced treatment time have gained popularity because of their advantages. However, whether the success rate with immediate loading (IL) is worse than with early loading (EL) is still unclear. PurposeThe purpose of this randomized controlled trial with a split-mouth design was to evaluate the marginal bone loss and the cumulative success rate (CSR) 1 year after an IL protocol in single implant-supported crowns. The test groups were loaded after less than 24 hours (test group) and EL at 60 days (control group). Material and methodsSeventeen participants received 34 implants. The recall appointments were at baseline, 30 days, 60 days, and 1 year. The outcome measures evaluated were pain, implant clinical mobility, probing depth measurements, peri-implant disease, marginal bone loss, implant insertion torque, implant stability quotient (ISQ) value, and the CSR. A 2-way repeated measures ANOVA identified the significant differences for probing depth and ISQ. A 3-way repeated measures ANOVA followed by a pairwise t test analyzed marginal bone loss, and a nonparametric Wilcoxon test analyzed insertion torque (α=.05). ResultsNo differences were found between the insertion torque, ISQ, and marginal bone loss values (P>.05). When analyzing probing depth, no differences were found when comparing IL versus EL at baseline, 30 days, and 1 year (P>.05). The global CSR was 91.17%, 88.23% for the IL group and 94.11% for the EL group. ConclusionsWhen analyzing marginal bone loss, the groups were similar. The global CSR was 91.17%, 88.23% for the IL group, and 94.11% for the EL group.

Comparison of the efficacy of pulsed ultrasound and laser in tooth movement: A literature review

When orthodontic treatment is performed, several cells responsible for bone remodeling are stimulated, including fibroblasts, osteoblasts, osteoclasts, and other cells. Bone remodeling is essential as it allows us to move dental pieces from their original position to the desired location within the dental arch, correcting malocclusion, achieving functional occlusion, and, in some cases, enhancing facial harmony. One reason why patients may hesitate to undergo orthodontic treatment is the long duration, typically spanning 24 to 36 months (2-3 years). Currently, new techniques have been developed to reduce treatment time, periodontal inflammation, hyalinization and intense pain. These techniques can be classified into three categories: 1) Biochemical stimuli, 2) Mechanical or physical, and 3) Surgical intervention. A thorough search of current literature was conducted across various scientific sources to explore this topic. The objective of this literature review is to compare the effectiveness and efficiency of laser and pulsed ultrasound techniques in tooth movement. By examining the advantages and disadvantages of each physical technique, we aim to determine the most suitable and minimally invasive approach to bone remodeling, ultimately reducing orthodontic treatment time while ensuring effective tooth movement without causing unwanted pain or adverse effects for the patient.

Effect of austempering time on multiphase microstructure evolution and properties of carburized Cr-Mn-Si alloyed steel subjected to bainitization quenching & partitioning heat treatment

An innovative multistage heat treatment, that combines Bainitization and Quenching & Partitioning processes (BQ&P) can be applied to obtain multiphase microstructure in the carburized surface layer comprising nanobainite, ultra-fine martensite and retained austenite. In this study, a carburized medium-carbon Cr-Si-Mn alloyed steel was treated by BQ&P treatments with 20%, 40% and 100% of advancement of bainitic transformation in the top surface to investigate the effect of isothermal holding time on microstructure evolution and properties.Extending the bainitization time leads to an increase in the bainitic ferrite content in the microstructure and more significant fragmentation of the residual austenite blocks. It was shown that multiphase microstructure consisting of nanobainite, ultra-fine martensite and retained austenite results in the higher hardness and wear resistance of the case as compared to the fully bainitic microstructure. The enhanced properties results from the strengthening effect of additional martensite fraction and higher amount of stabilized austenite prone to transformation under friction (transformation induced plasticity, TRIP effect). Furthermore, adjusted parameters of the process lead to favorable mechanical properties in a medium-carbon core (YS ∼ 1430 MPa, UTS ∼ 1820 MPa, KV ∼ 20 Jcm−2). The ability to tailor mechanical and service properties of steel by controlling the fraction of particular phases along with a significant reduction of heat treatment time might designate the BQ&P process to industrial application, e.g. carburized gear wheels.

Digital Dentistry- An Advancement of Dentistry

Digital transformation is the universal outburst happening in every field of human life and touches every activity of us. Health sector is no exception for it. Continuous progress in information technology has made it possible to overcome the limitations and hurdles that existed in health related issues just a few times ago. Digital workflow in dentistry streamlines the working process, reduces treatment times, improves accuracy and overall enhances patient satisfaction.

A chemometric approach to the evaluation of sparkling ciders produced by Champenoise and Charmat methods

The production of sparkling cider could intercept the needs of non-habitual consumers of this alcoholic-beverage. This investigation was aimed to develop procedures for the production of sparkling ciders using the Italian apple variety ‘Limoncella’ by application of both Champenoise and Charmat methods.First of all, the authors apply a chemometric approach to evaluate the effects of duration of the pectolytic treatment carried out on crushed apples and of the sugar added before refermentation on physicochemical, and sensory characteristics of the Champenoise sparkling ciders. The pectolytic treatment was able to influence colour, alcohol, pH, bitterness (higher when the treatment was shorter), titratable and volatile acidity, soluble solids, CO2, total phenolics, sweetness, saltiness, bitterness, and volatile alcohols (higher when the treatment was longer). The addition of sugar increased alcohol, soluble solids, and CO2, and decreased the production of volatile compounds.Then, the effects of the refermentation methods (Champenoise or Charmat) on the same parameters were evaluated. Charmat and Champenoise sparkling ciders differed for parameters showing higher values in the second type, i.e. colour (9.982 and 14.296 SRM), organic acid concentrations, CO2 (6.35 and 7.55 g/L), phenolic (313 and 424 mg/L) and volatile content, foam persistence (2.2 and 3.8), and saltiness (2.1 and 3.2) –– and for some sensory attributes such as taste quality and harmony that received higher scores in Charmat sparkling ciders (4.9 ± 0.7 and 4.9 ± 0.0, respectively) than the Champenoise ciders (3.7 ± 0.5 and 3.7 ± 0.4, respectively). Several esters, alcohols, terpenes, acids, phenols, and norisoprenoids had odour activity values > 1. Principal Component Analysis (PCA) was able to homogeneously group Champenoise ciders based on the duration of the pectolytic treatment and the addition of sugar before fermentation. PCA was also able to distinguish sparkling ciders by refermentation methods.The results indicated that the chemometric approach is a sensitive tool to monitor the quality and authenticity of local sparkling cider productions. The reduction of the pectolytic treatment time was critical to avoid dramatic increases of lactic acid content. The Champenoise method preserved the cider phenolic content but negatively affected their sensory quality.