Factors associated with the outcome of root canal treatment-A cohort study conducted in a private practice

AIM

To investigate the association of various pre-, intra- and post-operative factors on root canal treatment outcome.

METHODOLOGY

In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1-4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ≤2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra- and post-operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations.

RESULTS

1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7-82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01-0.24]), root PAI (OR = 0.29[0.20-0.42], 0.21[0.13-0.34] and 0.22[0.12-0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21-0.43] and 0.24[0.16-0.37] for diameters of 1-5 mm and ≥6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27-0.97] and OR = 0.45[0.24-0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43-0.94]) and two canals per root (OR = 0.67[0.54-0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08-0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26-0.75] and 0.62[0.40-0.97] respectively), resin sealer (OR = 0.58[0.39-0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21-0.75] against multiple visits). One factor was post-operative: defective coronal restoration (OR = 0.35[0.21-0.56]).

CONCLUSION

The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single-visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration.

Validity, internal consistency reliability and one-year stability of the Slovene translation of the Measure of Processes of Care (20-item version)

BACKGROUND

The Measure of Processes of Care (MPOC) was developed as a self-administered questionnaire for parents to report on behaviours of healthcare providers. The original (MPOC-56) and the 20-item version (MPOC-20) have established reliability and validity, but the instrument must be rechecked whenever translated and applied in a different social and cultural setting. The aim of our study was to evaluate validity, internal consistency reliability and 1-year stability of the Slovene translation of MPOC-20.

METHODS

Parents of children who were admitted as inpatients or outpatients of several hospitals and health centres were invited to participate. MPOC-20, the Client Satisfaction Questionnaire (CSQ-8) and a separate question on stress and worries were sent by mail. Descriptive item analysis was performed. Cronbach's alpha coefficient and corrected item-total correlations were used to assess internal consistency for each of the five MPOC-20 subscales. To evaluate validity, we correlated the MPOC-20 subscale scores with CSQ-8 scores and a stress alleviation rating. Assessment with MPOC-20 was performed again 1 year later and we used paired-samples tests to compare mean scores of both assessments.

RESULTS

Parents of 235 children participated in the study (80% mothers). They reported high general satisfaction as 15 out of the 20 MPOC-20 mean item scores were above 5 (out of 7) and none was below 4. The mean MPOC-20 mean subscale scores were 5.83 (SD 1.10) for Coordinated and Comprehensive Care for Child and Family, 5.62 (SD 1.12) for Respectful and Supportive Care, 5.45 (SD 1.23) for Enabling and Partnership, 5.33 (SD 1.61) for Providing Specific Information about the Child and 4.59 (SD 1.65) for Providing General Information. The ranking order of the mean rating of the MPOC-20 subscales was similar to previous studies. The parents reported that they felt their stress and worries had been notably or slightly reduced through the process of care in the last year in more than two-thirds of the cases. All the MPOC-20 subscales (as well as the CSQ-8 scale) showed high internal consistency: the corrected item-total correlations were far above the lower limit for item's acceptance of 0.3. After 1 year (66 returned questionnaires) none of the mean subscale scores changed statistically significantly (P-values 0.159-0.910).

CONCLUSION

The Slovene translation of the MPOC-20 can be considered as a valid and reliable instrument that shows good stability over a period of 1 year, and as such it can be adopted in clinical practice.

A comparison of the University of New Brunswick Test of Prosthetic Function and the Assessment of Capacity for Myoelectric Control

BACKGROUND

Valid outcome measures are required for gathering evidence on when, how and using which prosthetic components to start prosthetic fitting to children with congenital upper limb deficiencies and those following acquired upper limb amputation. We have been using the University of New Brunswick Test of Prosthetic Function (UNB, which measures skill and spontaneity of prosthetic use) in our country since 1996, and the Assessment of Capacity for Myoelectric Control (ACMC, which was developed for persons using a myoelectric prosthesis) since 2008.

AIM

We wanted to explore whether the UNB and the ACMC measure the same construct (i.e., assess convergent validity), and whether the ACMC can also be used for assessing children and adolescents who use a body-powered upper-limb prosthesis.

DESIGN

Observational.

SETTING

Inpatient.

POPULATION

All the 19 children and adolescents who were visiting the outpatient clinic for rehabilitation of children with upper limb deficiencies and amputations at our institute from January 2010 to December 2011 and had a myoelectric (15 participants) or body-powered prosthesis (4 participants).

METHODS

The participants were assessed by the age-appropriate UNB subtest; 60 assessments were performed in total. Two tests (moving a plastic glass half-full with water from table to the sink, and tying apron at the back) were added to obtain the ACMC scores.

RESULTS

Simple and autocorrelation-adjusted correlation and regression analyses demonstrated that ACMC score is highly positively correlated with UNB spontaneity and skill score in children and adolescents who use a myoelectric prosthesis. Neither of the two associations could be observed in children and adolescents who use a body-powered prosthesis.

CONCLUSION

The results suggest that both tests can be used for assessing children and adolescents who use a myolectric prosthesis, but only the UNB appears to be appropriate for those who use a body-powered prosthesis.

CLINICAL REHABILITATION IMPACT

This small study indicates that either the ACMC or the UNB are applicable for assessing children and adolescents who use a myolectric upper-limb prosthesis because of congenital upper limb deficiencies or acquired upper limb amputation, but only the UNB seems to be applicable for those children or adolescents who use a body-powered prosthesis.

BRCA1/2 status and clinicopathologic characteristics of patients with double primary breast and ovarian cancer

The aim of the study was to analyse the results of BRCA1/2 testing in a group of patients with double primary breast and ovarian cancer (DPBOC) in Slovenia. Additionally, the family history and the clinicopathologic characteristics of BRCA1/2 mutation positive and negative patients with DPBOC were analysed, comparing them to a group of untested patients with DPBOC. For these groups of patients, survival analysis was also performed. From the 52 patients who were invited to genetic counselling and testing, 20 responded positively (38% compliance). BRCA1/2 mutations were found in 60% (12/20): 45% BRCA1 and 15% BRCA2 (9 and 3 patients, respectively). There was significantly higher grade of ovarian cancer and significantly higher rate of multiple primary breast cancer in BRCA1/2 positive group. Additionaly, there was a trend towards higher rate of first-degree family history of breast cancer, a trend towards higher stage of ovarian cancer, and a trend towards breast cancer being the first cancer in BRCA1/2 positive group. According to survival analysis, the tested group was not a representative sample of the larger untested group (of 51 patients), so we estimate that the rate of BRCA1/2 mutations in DPBOC patients is probably less than 60%.

Effects of native human leukocyte interferon-alpha and recombinant human interferon-alpha on P3-X63-Ag8.653 mouse myeloma cell growth

Multiple myeloma (MM) remains largely incurable, although traditional chemotherapy and new compounds have been shown to produce a clinical response. Clinical studies were performed to determine the effectiveness of interferon-alpha (IFN-alpha) in MM, which has also recently been shown to function as a survival factor for MM cells. The effects of different doses of native human leukocyte interferon-alpha (nhIFN-alpha), recombinant human interferon-alpha2a (rhIFN-alpha2a) and recombinant human interferon-alpha2b (rhIFN-alpha2b) on in vitro P3-X63-Ag8.653 mouse myeloma cell growth were compared. A statistically significant dose-dependent reduction in cell viability following cell culture with nhIFN-alpha was observed. On the other hand, a statistically significant increase in cell viability was observed following cell culture with rhIFN-alpha2a and rhIFN-alpha2b, but only in relation to the control group and seemingly without dose dependency. These results highlight the importance of the type of human IFN-alpha used in the treatment and study of MM, and suggest that nhIFN-alpha may have a role in future personalized therapy approaches.

Dynamical tunneling in mushroom billiards

We study the fundamental question of dynamical tunneling in generic two-dimensional Hamiltonian systems by considering regular-to-chaotic tunneling rates. Experimentally, we use microwave spectra to investigate a mushroom billiard with adjustable foot height. Numerically, we obtain tunneling rates from high precision eigenvalues using the improved method of particular solutions. Analytically, a prediction is given by extending an approach using a fictitious integrable system to billiards. In contrast to previous approaches for billiards, we find agreement with experimental and numerical data without any free parameter.

Comparison of the different classification criteria sets for primary Sjögren's syndrome

OBJECTIVE

To assess the comparability of different classification criteria sets for primary Sjögren's syndrome (pSS).

METHODS

In a prospective study we examined all patients with suspected pSS who were admitted to our Department of Rheumatology or referred to our outpatient clinic between 1 January 2001 and 31 December 2002. The Copenhagen, Californian, 1996 European, and American-European consensus group (US-EU) criteria sets were used to assess each patient.

RESULTS

Ninety out of 222 patients (41%) were diagnosed with pSS by fulfilling at least one classification criteria set. The highest number of patients who were diagnosed with pSS fulfilled the European criteria set (36%), followed by the Copenhagen (28%), the US-EU (26%), and the Californian (9%) criteria sets. On average, the group of patients fulfilling the Californian criteria set were 5.6 years older than the patients in the other three groups (p < 0.05). In addition, the disease duration before diagnosis was 2.6 years longer than in the other three groups. The groups of patients fulfilling either the Californian or the US-EU criteria sets had a higher prevalence of leucopaenia (p < 0.05). Those fulfilling the US-EU criteria set also had a higher prevalence of arthritis (p < 0.05). No significant differences were found in the prevalence of the other clinical and laboratory parameters studied.

CONCLUSIONS

Different patients are diagnosed with pSS if different classification criteria sets are used. Therefore, studies based on different classification criteria sets for diagnosing pSS are not directly comparable.

Fracture-related and implant-specific factors influencing treatment results of comminuted diaphyseal forearm fractures without bone grafting

INTRODUCTION

Recommendations regarding the application of primary autologous bone grafting in the surgical treatment of comminuted diaphyseal forearm fractures are conflicting. Some recent studies suggested that there is no difference in the union rate between simple and comminuted forearm fractures and that the use of bone grafting in the treatment of these fractures is therefore not necessary. Our hypothesis was that among comminuted forearm fractures there is a small group of fractures with a very large extent of comminution that heal with a significantly lower union rate and a prolonged time to union compared with other fractures. We believe that in these fractures bone grafting could help to reduce the time to union and further decrease the rate of nonunion.

MATERIALS AND METHODS

We reviewed the results of the treatment of 214 consecutive patients who sustained 319 diaphyseal fractures of forearm bones. To prove our hypothesis, union rate and time to union in fractures with different extents of comminution were compared. All fractures were treated by open reduction and internal fixation with plates without the use of bone grafting. In addition, the study evaluated other factors that could influence the union rate and time to union in observed fractures.

RESULTS

Separate analysis of union rate and time to union in fracture groups with different extents of comminution confirmed our hypothesis only partially. Although we proved that fractures with bone loss greater than two-thirds of the diameter of the diaphysis had a significantly prolonged time to union, we could not demonstrate a significant difference in the union rate between groups. Based on these findings, we believe that primary autologous bone grafting of comminuted diaphyseal forearm fractures is not necessary in most cases. If used, its application should be reserved only for fractures where the bone loss exceeds two-thirds of the diameter of the diaphysis. Such fractures are rare; in our study, they accounted for only 5% of all fractures.

CONCLUSION

The most important factors found to influence the union rate and time to union were stability of fixation and type of plate used for fixation.

Polyethylene wear in total hip prostheses: the influence of direction of linear wear on volumetric wear determined from radiographic data

PURPOSE

To develop a new mathematical model for calculating the volumetric wear of polyethylene cups from known values of the radius of the prosthesis head, the extent of linear wear and the direction of linear wear determined from standard antero-posterior radiographs.

METHOD

A new mathematical model was developed. The results of this new mathematical model were compared with the results obtained using the standard, frequently used mathematical model, which takes into consideration only the radius of the prosthesis head and the extent of linear wear of the polyethylene cups. The results of both mathematical models were further compared with the results obtained by direct measurement of volumetric wear using the fluid displacement method.

RESULTS

Comparison of the mathematical models shows that the average volumetric wear calculated using the new mathematical model is 8.5% smaller than the average volumetric wear determined by the fluid displacement method, while the average volumetric wear calculated by standard mathematical model is 17.5% higher. The results of the new mathematical model are, thus, notably less biased than those of the standard one.

CONCLUSION

In calculating the volumetric wear from antero-posterior radiographs, not only the radius of the prosthesis head and the extent of the linear wear but also the direction of the latter has to be considered.

Decisions at hand: a decision support system on handhelds

One of the applications of clinical information systems is decision support. Although the advantages of utilizing such aids have never been theoretically disputed, they have been rarely used in practice. The factor that probably often limits the utility of clinical decision support systems is the need for computing power at the very site of decision making--at the place where the patient is interviewed, in discussion rooms, etc. The paper reports on a possible solution to this problem. A decision-support shell LogReg is presented, which runs on a handheld computer. A general schema for handheld-based decision support is also proposed, where decision models are developed on personal computers/workstations, encoded in XML and then transferred to handhelds, where the models are used within a decision support shell. A use case where LogReg has been applied to clinical outcome prediction in crush injury is presented.