[The assessment of pain intensity using one-dimensional scales]

A retrospective cohort study on 3D printed temporary crowns

In this retrospective cohort study the survival rate, clinical parameters, patient satisfaction with aesthetics and oral health-related quality of life of 3D printed temporary crowns were evaluated. Temporary crowns were 3D printed with a Form3B out of Permanent Crown Resin (Formlabs GmbH). Anonymized data for the restorations' survival (in-situ) was evaluated retrospectively for 98 temporary crowns of 63 patients fabricated within 19 months. Among these restorations, further analysis was conducted for 42 temporary crowns of 24 patients regarding clinical parameters (modified USPHS criteria), patient satisfaction with aesthetics and impact on oral health-related quality of life (OHRQoL) (OHIP 14). Descriptive statistical analysis (significance level of α = 0.05) included a Kaplan-Meier curve for survival analysis, a Kolmogorov-Smirnov test for USPHS, aesthetics and OHIP data, followed by a Wilcoxon test for USPHS and OHIP data and Chi-squared test for aesthetics data. Cronbach's alpha was calculated for OHIP data. The average observation period for survival analysis was 256 days. The survival rate was satisfactory at 98% and n = 2 catastrophic failures (i.e. fracture) occurred. Total OHIP scores, with good reliabilities, improved from 6.63 to 2.21 significantly (p = 0.005) and patient satisfaction with aesthetics (p < 0.001) as well. Clinical analysis with modified USPHS criteria revealed encouraging results.

Impact of dental prosthetic treatment and patients' expectations on the seven domains and four-dimensional scale of the Oral Health Impact Profile

BACKGROUND

Recently, recommendations were given for a new scoring of the Oral Health Impact Profile (OHIP). The original seven domain structure should be replaced by a four-dimensional scale.

OBJECTIVES

To investigate the effect of dental prosthetic treatment on the seven domains and the four-dimensional scale of the OHIP-G49/53 questionnaire.

METHODS

Seventy four patients were grouped according their pre- and post-treatment situation and the type of treatment they received. Patients completed the OHIP-G49/53 questionnaire before prosthetic treatment (T0), and at 1 week (T1), 3 months (T2) and 6 months (T3) after treatment. Treatment effects on the seven domains and the four dimensions of the OHIP scale were analysed, and the oral health-related quality of life (OHRQoL) was measured. Patients' expectations of their prosthetic treatment were also evaluated. Data were analysed using two-way Mixed ANOVA, regression analysis, and Cronbach's alpha test with a level of significance of α ≤ .017.

RESULTS

OHRQoL significantly improved following prosthetic treatment compared with baseline. The largest improvement was found between T0 and T1 evaluations (all p ≤ .001). Unlike the seven-domain scale, the four OHIP dimensions demonstrated further significant improvements across the T1/T2/T3 evaluations (all p ≤ .017). Different pre-treatment findings had different treatment effects on the four OHIP dimensions and seven OHIP domains. Patients' expectations were mainly fulfilled.

CONCLUSION

Compared with the seven-domain scale, the four dimensions showed significant follow-up changes, suggesting the four dimensions are suitable for evaluating treatment effects up to 6 months. Clinically meaningful effects of dental prosthetic treatment can be sensitively measured using the four-dimensional OHIP scale.

Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic?

Aim

In Germany, treatment of HSIL or AIS of the uterine cervix by loop excision is performed almost exclusively under general anaesthesia (GA). International studies and guidelines show high acceptance of local anaesthesia (LA) due to hermeneutic, medical, and economic factors. We performed an observational comparative study aiming to prove advantages of local anaesthesia within the German health system.

Patients and Methods

In a prospective observational study, patients diagnosed with HSIL or AIS of the uterine cervix were treated at the Institute for Cytology and Dysplasia, Berlin, by loop excision in 2021. We started with a feasibility study : 303 patients diagnosed with HSIL/AIS of the uterine cervix and her colposcopist answered an electronic questionnaire with respect to loop excision under LA. Since we found a high acceptance for LA in patients and colposcopists, we initiated a comparative study LA vs. GA: 322 patients underwent loop excision and selected their mode of anaesthesia: n = 206 LA vs. n = 116 GA. 114 patients of the feasibility study had to undergo loop excision and became part of the comparative study (n = 79 for the LA group, n = 35 for the GA group). All patients received a standardised questionnaire to document their pain score within 24 h after treatment on a visual analogue scale, i.e. VAS, between 0 and 100. 178 patients of the LA group and 80 patients of the GA group completed and returned the questionnaire and form the cohort for our comparison of LA vs. GA. With 191 of these 258 patients, i.e. 74%, a telephone survey was performed to ask for patient satisfaction and the rates of recurrence after a mean interval of 1 year post surgery. We postulate that there will be no clinically relevant significant difference in satisfaction and postoperative pain between patients in the LA group and the GA group.

Results

In the feasibility study , 90% (272 of 303) of patients diagnosed with HSIL or AIS were considered eligible for LA by their colposcopists. 75% (227 of 303) of patients were open to loop excision under LA. In the comparative study , 63 of 206 women of the LA group were interviewed preoperatively: 89% would accept a pain score above 20 during the procedure, 33% a pain score above 50 and 11% of max. 20. Postoperatively, the median VAS pain score for loop excision under local anaesthesia was 13.1 in 178 patients, and pain during injection of local anaesthesia was 20.9 (p < 0.001). The VAS pain score 20 minutes post surgery did not differ significantly between 178 patients after local anaesthesia versus 80 patients after general anaesthesia (p = 0.09). The surgeons estimated the patient's pain significantly less than the patients themselves with an underestimate of -14.63 points on the VAS (p < 0.001). Within 7 days following loop excision under LA, 95.5% of 178 patients would choose local anaesthesia as their preferred method for a potential repeat loop excision, 8.8% of which would like additional painkillers, and 4.5% would choose general anaesthesia.In a telephone follow-up survey of 133 women from the LA group after a mean of 12 months post surgery, 97% were "satisfied" or "very satisfied" with the treatment carried out. For patient satisfaction and postoperative pain, no clinically relevant significant difference was seen between the LA and the GA group.The rate of secondary bleeding (6.7% vs. 8.1%, p = 0.72), recurrence of HSIL/AIS (3.6% vs. 5.2%, p = 0.62), and the distribution of the histopathological R status (R0 89.5% vs. 81.1%, p = 0.73; R1 5.3% vs.12.2%, p = 0.57, Rx 4.1% vs. 5.4%, p = 0.65) showed no significant difference when comparing the LA group versus the GA group.

Conclusion

Following loop excision under local anaesthesia, more than 95% of patients would choose this method again for repeat surgery. One year post surgery, 97% of the patients were "satisfied" or "very satisfied" with the treatment under local anaesthesia. Offering local anaesthesia for loop excision to patients should be mandatory and included in current guidelines.

[Treatment of trauma-related vertebral body fractures of the thoracic and lumbar spine with orthotic devices : A review]

BACKGROUND

Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used.

OBJECTIVE

The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine.

MATERIAL AND METHODS

A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research).

RESULTS

In the case of fractures (AO types A0-A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib-IIa could be assigned, nearly all included studies had a high risk of bias.

CONCLUSION

In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.

Postoperative discomfort after implant placement according to the All-on-4 concept with or without Zygoma implants: A prospective clinical study

OBJECTIVES

The purpose of the study was to assess patients' postoperative discomfort after implantations according to the All-on-4 concept with and without using Zygoma implants.

MATERIAL AND METHODS

Three treatment groups were formed for this prospective study: All-on-4 rehabilitation in the maxilla (group 1, N = 25), All-on-4 rehabilitation in the maxilla using at least two Zygoma implants (group 2, N = 25), and All-on-4 rehabilitation in the mandible (group 3, N = 20). Principal outcome parameters were postoperative pain (100 mm VAS) and perceived swelling (100 mm VAS). Also, the use of analgesics was documented.

RESULTS

The worst postoperative pain of 21.3 (SD 18.9) VAS was observed in group 2, but there was no statistically significant difference between the groups (mixed ANOVA p = .791). The postoperative total intake of painkillers was significantly higher in group 2 than in the other groups (p < .001). On postoperative day 28, the mean pain scores in all groups declined to values below 5 VAS. Postoperative perceived swelling in group 2 was significantly more severe than it was in group 1 and 3 (p < .001).

CONCLUSIONS

The use of Zygoma implants in All-on-4 surgical interventions had an essential effect on postoperative swelling, but less so on postoperative pain. The slightly increased, but statistically not significantly different postoperative pain in group 2 was compensated by an overall higher postoperative intake of painkillers compared to the other groups.

Transoral submandibulotomy for deep hilar submandibular gland sialolithiasis

OBJECTIVES/HYPOTHESIS

To assess the long-term results after transoral submandibulotomy for stones located in the deep hilar and intraparenchymal submandibular region.

STUDY DESIGN

Retrospective cohort analysis.

METHODS

Retrospective evaluation including all patients treated with transoral submandibulotomy for sialolithiasis at a tertiary referral center.

RESULTS

Complete stone removal at the first transoral surgical treatment was achieved in 185 of 234 patients (79.1%). One hundred seventy-five of the 234 patients were followed up for a mean of 31.2 ( ± 20.5) months. During the follow-up period, 140 of the 175 patients (80.0%) became symptom free after one operation. In patients with residual symptoms, no further treatment was needed in 12 patients (6.9%) due to the mildness of the symptoms; 23 patients (13.1%) received further therapy, which was successful in 15 cases. Submandibulectomy only had to be performed in 3.4% of the patients with follow-up (6/175). In a questionnaire survey, 91.4% of the patients stated that they would be prepared to have the same operation again.

CONCLUSIONS

These findings show that transoral removal of submandibular sialoliths located in the deep hilum or adjacent intraglandular parenchyma is an effective treatment that can be assisted by additional measures. The techniques described show high success rates, good long-term results, low complication rates, and they avoided the need for submandibulectomy in >95% of cases.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:2038-2044, 2017.

Differential tolerance to morphine antinociception in assays of pain-stimulated vs. pain-depressed behavior in rats

In preclinical research on pain and analgesia, noxious stimuli can stimulate expression of some behaviors (e.g. withdrawal reflexes) and depress others (e.g. feeding, locomotion, and positively reinforced operant responding). Tolerance to morphine antinociception is a robust and reliable phenomenon in preclinical assays of pain-stimulated behavior, but development of morphine tolerance in assays of pain-depressed behavior has not been studied. This study compared morphine antinociceptive tolerance in parallel assays of pain-stimulated and pain-depressed behavior in male Sprague-Dawley rats. Intraperitoneal injection of dilute lactic acid served as a noxious stimulus to stimulate a stretching response in one group of rats and to depress operant responding for electrical brain stimulation (intracranial self-stimulation; ICSS) in another group of rats. Antinociception produced by morphine (1.0 mg/kg) was determined after a regimen of chronic treatment with either saline or morphine in separate subgroups of rats in each procedure. In rats receiving chronic saline, acid alone stimulated a stretching response and depressed ICSS, and both acid effects were blocked by 1.0 mg/kg morphine. Rats receiving chronic morphine displayed hyperalgesic responses to the acid noxious stimulus in both procedures. Complete tolerance developed to morphine antinociception in the assay of acid-stimulated stretching, but morphine retained full antinociceptive effectiveness in the assay of acid-depressed ICSS. These results suggest that morphine antinociception in an assay of pain-depressed behavior is relatively resistant to tolerance. More broadly, these results suggest that antinociceptive tolerance can develop at different rates or to different degrees for different measures of antinociception.