1
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Bhagania MK, Figueroa R, Mehra P. Same day access: a viable alternative for outpatient clinical care. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:686-690. [PMID: 37640563 DOI: 10.1016/j.oooo.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/23/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To present our experience with a novel, same-day access (SDA) scheduling model for outpatient clinical care in oral and maxillofacial surgery (OMS). STUDY DESIGN The primary outcome variable was OMS patient scheduling in a hospital-based outpatient clinic. Patients were given a specific appointment time to be seen the same day they contacted the clinic. This SDA clinic was compared to previous patient scheduling models for patient satisfaction, appointment wait times, annual clinic volume, no-show rates, and access to care. RESULTS Patient satisfaction increased to 80% with SDA scheduling compared with 20% to 40% with prior models. The average wait time for patients improved to 19 minutes compared with 330 minutes with the walk-in model. Forty patients were scheduled on the same day, and 96% of all patients who called the clinic were seen within 14 days with the SDA approach. Same-day access was the only model that met its volume and budgetary goals. CONCLUSIONS The incorporation of SDA scheduling improves patient satisfaction and is a viable alternative to more traditional scheduling protocols for clinics suffering from volume, revenue, and access to care issues.
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Affiliation(s)
- Manish K Bhagania
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
| | - Ruben Figueroa
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
| | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA.
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2
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Kim J, Henry A, Wilson A, Mehra P. Readmission after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:417-421. [PMID: 37316418 DOI: 10.1016/j.oooo.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To evaluate the readmission rate after orthognathic surgery and identify associated risk factors. STUDY DESIGN Retrospective analysis of patients who underwent orthognathic surgery and had an unexpected hospital admission, with or without return to the operating room (OR), within the first postoperative year. Study variables included sex, age, American Society of Anesthesiologists (ASA) status, type of surgery, concomitant third molar extraction, concomitant genioplasty, duration of surgery, first assistant experience, and duration of hospitalization. Bivariate associations were calculated between variables and readmission status. Chi-square and Fisher's Exact tests were used to compare categorical variables, and a 2-sample t test was used to compare continuous variables. RESULTS There were 701 patients included in the study. The readmission rate was 9.70%. Twelve patients were managed non-surgically, and 56 patients required an OR procedure. The most common reason for readmission without return to the OR was an infection, and for reoperation was hardware removal. Age, sex, type of surgery, third molar extraction, genioplasty, duration of surgery, and experience of first assistant were not found to be predictors for readmission. CONCLUSIONS Only ASA classification and duration of initial hospitalization were significant risk factors for readmission of patients within the first postoperative year after orthognathic surgery.
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Affiliation(s)
- Jaegak Kim
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
| | - Andrew Henry
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
| | - Amelia Wilson
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA.
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3
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Dang RR, Koval PW, Chau V, Weinberg JM, Mehra P. Lifestyle and Career Satisfaction Amongst US-Based Oral and Maxillofacial Surgeons: Results of a Nationwide Survey. Oral Surg Oral Med Oral Pathol Oral Radiol 2022:S2212-4403(22)01245-7. [DOI: 10.1016/j.oooo.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
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4
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Henry A, Mehra P. Reconstruction of the TMJ and condyle in inflammatory arthritis. J Oral Biol Craniofac Res 2022; 12:623-632. [PMID: 36035810 DOI: 10.1016/j.jobcr.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/05/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
Inflammatory arthritis presents a unique destructive process to the temporomandibular joint. This article provides information on the proper diagnosis, treatment planning, and surgical management aimed to provide patients with improvement in pain, function, stability and facial aesthetics. Additionally, it aims to provide a detailed insight on the joint reconstruction options including alloplastic joint replacement, autogenous joint replacement, orthognathic surgery and distraction osteogenesis.
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Affiliation(s)
- Andrew Henry
- Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston Medical Center and Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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5
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Bouloux G, Mehra P, Mercuri L, Warburton G. Letter to the Editor. J Oral Maxillofac Surg 2021; 80:409. [PMID: 34863694 DOI: 10.1016/j.joms.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
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6
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Chau V, Dang R, Mehra P. Lifestyle and Career Satisfaction among U.S-based Oral and Maxillofacial Surgeons: Results of a Nationwide Survey. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Nayar KD, Gupta S, Bhattacharya R, Mehra P, Mishra J, Kant G, Nayar K. P–612 Transdermal testosterone vs. Placebo (lubricant gel) pre-treatment in improving IVF outcomes in diminished ovarian reserve patients (POSEIDON group 3 and 4): a randomised controlled trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
To compare the efficacy of transdermal testosterone with placebo (lubricant gel) in improving IVF outcomes using GnRH antagonist protocol in POSEIDON group 3 and 4 patients.
Summary answer
Patients receiving pre-treatment with testosterone gel had higher mean number of oocytes retrieved and grade A embryos as compared to the patients receiving lubricant gel.
What is known already
Diminished ovarian reserve (DOR) is associated with suboptimal ovarian response, higher cycle cancellation rate and lower clinical pregnancy rate following IVF cycles. Various treatment regimens have been devised for management of such patients and use of adjuvants in the form of oral or transdermal androgen is one of them. Androgens improves follicular response to gonadotropin stimulation as well as increase FSH receptor expression in granulosa cells, in turn leading to better oocyte yield and pregnancy rate. Aim was to compare the effect of transdermal testosterone gel with placebo gel on ART outcome in DOR patients (POSEIDON Group 3 and 4).
Study design, size, duration
A prospective, randomised controlled trial was carried out from 1st September 2019 to 31st October 2020 at a tertiary infertility centre in India. 50 patients fulfilling the criteria of Group 3 and Group 4 of POSEIDON classification were included in the study. Patients with endocrine disorders (thyroid, prolactin), endometrioma, history of surgery on the ovaries, sensitivity to testosterone gel, male factor infertility and deranged liver and renal function tests were excluded.
Participants/materials, setting, methods
Enrolled patients were randomised into two groups of 25 patients each, one group was pretreated (TTG group) with transdermal testosterone gel, 12.5 mg/day from day 6th of previous cycle to day 2nd of stimulation cycle while patients in other group took lubricant gel for the same duration before stimulation with GnRH antagonist fixed protocol followed by fresh Day 3 transfer.
Main results and the role of chance
The baseline characteristics of the two groups were comparable. The primary outcome measures were the number of oocytes retrieved and number of grade A embryos formed (according to Istanbul consensus). The secondary outcome measures were implantation rate, clinical pregnancy rate, miscarriage rate and ongoing pregnancy rate. The mean number of oocytes retrieved in TTG group was 5±1.02 which was significantly higher than placebo group–3.5±1.2, (p < 0.001). The mean number of Grade A embryos were also significantly higher (4.78±0.54 vs 3.00±0.23, p < 0.001) in TTG group. The TTG group had higher implantation rate (28% vs 20%, p = 0.49), clinical pregnancy rate (32% vs 18%, p = 0.41), ongoing pregnancy rate (32% vs 16%, p = 0.38) and lower miscarriage rate (0% vs 20%, p = 0.38), however, these differences were not statistically significant.
Limitations, reasons for caution
The study was done at a single centre with small sample size, replication with more subjects and in different centers is needed.
Wider implications of the findings: Pre-treatment with testosterone gel in DOR patients improves ovarian response to stimulation and results in higher number of oocytes retrieved and good quality embryos resulting in improved clinical pregnancy rates. Transdermal testosterone is advantageous because of better bioavailability, easy application, patient friendly and less adverse effects.
Trial registration number
MCDH/2019/54
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Affiliation(s)
- K D Nayar
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine, New Delhi, India
| | - S Gupta
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine, New Delhi, India
| | - R Bhattacharya
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine, New Delhi, India
| | - P Mehra
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine, New Delhi, India
| | - J Mishra
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine, New Delhi, India
| | - G Kant
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine, New Delhi, India
| | - K Nayar
- Akanksha IVF Centre- Mata Chanan Devi Hospital, Reproductive Medicine, New Delhi, India
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8
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Gong JH, Khurana A, Mehra P, Eltorai AEM. Medicare Reimbursement Trends for Hospital-Based Oral Maxillofacial Surgery Procedures: 2003 to 2020. J Oral Maxillofac Surg 2021; 79:1821-1827. [PMID: 34062131 DOI: 10.1016/j.joms.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate recent trends in Medicare reimbursement rates for common hospital-based oral-maxillofacial surgery procedures. METHODS Physician Fee Schedule Look-Up Tool by the Centers for Medicare and Medicaid Services was searched for reimbursement rates for the 20 most performed oral-maxillofacial surgery procedures between 2003 and 2020. Total percent change, annual percent change, and compound annual growth rate (CAGR) were calculated using the adjusted reimbursement rates over the study period. Annual changes in reimbursement rates before and after 2016 were compared. RESULTS After adjusting for inflation, average reimbursement rates for procedures decreased by 13.4%. Annual percent change and CAGR were -0.79 and -0.88%, respectively. Annual reimbursements decreased more between 2016 to 2020 (-1.83%,) than from 2003 to 2016 (-0.49%; P value = .003). CONCLUSION Inflation-adjusted Medicare reimbursement rates for oral-maxillofacial surgery procedures have decreased from 2003 to 2020. The rate of reimbursement decreases has accelerated in recent years.
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Affiliation(s)
- Jung Ho Gong
- Student, Alpert Medical School of Brown University, Providence, RI.
| | - Aditya Khurana
- Student at Mayo Clinic Alix School of Medicine, Rochester, MN
| | - Pushkar Mehra
- Professor, Department of Oral and Maxillofacial Surgery, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Adam E M Eltorai
- Resident, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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9
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Kapadia N, Mehra P, swami R, Tiwari A, Jenasamant S, Rawat G. Echocardiography Surveillance of Rejection after Heart Transplant without Endomyocardial Biopsy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Lane W, Brar B, Mehra P. Utility of Routine Computed Tomography Angiogram Screening for Blunt Carotid Injury in Isolated Mandible Fractures. J Oral Maxillofac Surg 2020; 79:1105.e1-1105.e4. [PMID: 33421418 DOI: 10.1016/j.joms.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Determine the incidence of blunt carotid injury (BCAI) in the blunt trauma induced isolated mandible fracture population and determine the utility of computed tomographic angiography (CTA) screening for BCAI in this population. METHODS A retrospective data review was performed on patients presenting to Boston Medical Center from January 2008 to January 2019 with a diagnosis of mandible fracture. Population selected utilizing ICD-9 and ICD-10 diagnosis codes for mandible fracture and BCAI. Excluded populations were pediatric (less than 18 years) and penetrating carotid injuries. RESULTS A total of 1,508 mandible fractures were identified, with 73% (n = 1,103) being isolated injuries. Five BCAIs were identified, and of these, 1 was associated with an isolated mandible fracture (incidence <0.01%). One of 110 isolated mandible fractures screened for BCAI with the use of CTA was positive (incidence 0.9%). CONCLUSIONS BCAI is a rare finding in isolated mandible fractures. The inclusion of this population as an independent risk factor for BCAI should be questioned. Routine screening with CTA is not warranted.
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Affiliation(s)
- William Lane
- Chief Resident, Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine & Boston Medical Center, Boston, MA
| | - Branden Brar
- Resident, Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine & Boston Medical Center, Boston, MA
| | - Pushkar Mehra
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA; and Chief, Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA.
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11
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Brugnami F, Caiazzo A, Mehra P. Tunnel Regenerative Corticotomy (TURC): A modified approach in surgically-assisted orthodontics. J Oral Biol Craniofac Res 2020; 11:63-65. [PMID: 33376667 DOI: 10.1016/j.jobcr.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
We present a modified surgical technique which encompasses a combination of surgically-assisted accelerated orthodontics and guided bone regeneration for combined surgical and orthodontic management of dental crowding and maxillary transverse deficiency malocclusions with minimally invasive surgery, in a rapid manner, and without the use of general anesthesia.
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Affiliation(s)
| | - Alfonso Caiazzo
- Private Practice of Oral Surgery and Implantology, Salerno, Italy
| | - Pushkar Mehra
- Boston University School of Dental Medicine, Boston, MA, USA
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12
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Henry A, Whitehead S, Mehra P. Decreasing Opioid Usage during Hospitalization in Patients Undergoing Orthognathic Surgery. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Chigurupati R, Panchal N, Henry AM, Batal H, Sethi A, D'innocenzo R, Mehra P, Krishnan DG, Roser SM. Considerations for Oral and Maxillofacial Surgeons in COVID-19 Era: Can We Sustain the Solutions to Keep Our Patients and Healthcare Personnel Safe? J Oral Maxillofac Surg 2020; 78:1241-1256. [PMID: 32479811 PMCID: PMC7246053 DOI: 10.1016/j.joms.2020.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 01/08/2023]
Abstract
Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.
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Affiliation(s)
- Radhika Chigurupati
- Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University Medical Center, and Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA.
| | - Neeraj Panchal
- Assistant Professor and Section Chief, Department of Oral and Maxillofacial Surgery, Philadelphia Veterans Affairs Medical Center, Penn Presbyterian Medical Center, University of Pennsylvania School of Dental Medicine, Philadelphia, PA
| | - Andrew M Henry
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Boston University Medical Center and Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Hussam Batal
- Clinical Associate Professor and Clinical and Financial Director, Department of Oral and Maxillofacial Surgery, Boston University and Boston Medical Center, Boston, MA
| | - Amit Sethi
- Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Richard D'innocenzo
- Clinical Professor and Vice Chairman, Departments of Dentistry and Oral and Maxillofacial Surgery, and Director, Predoctoral Education, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Pushkar Mehra
- Professor, Chair, and Chief, Department of Oral and Maxillofacial Surgery, Boston Medical Center, and Associate Dean of Hospital Affairs, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Deepak G Krishnan
- Associate Professor, Department of Surgery; Chief and Residency Program Director, Section of Oral and Maxillofacial Surgery, University of Cincinnati Medical Center; and Chief, Section of Oral and Maxillofacial Surgery, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, and Chief, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
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14
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Freilich E, Shemkus M, Zhao Y, Yan S, Mehra P. Opioid Prescription Habits of Oral and Maxillofacial Surgeons: From Training to Practice. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Wardius E, Mobini A, Figueroa R, Mehra P. Outpatient Anesthesia Morbidity and Mortality Experience Among Massachusetts Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg 2019; 77:1602-1610. [DOI: 10.1016/j.joms.2019.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
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16
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Bais M, Mehra P. Lysyl oxidase like-2: potential anabolic agent expressed in hip, knee and temporomandibular joints arthritis. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Caiazzo A, Brugnami F, Mehra P. Can placement of an immediate bone level tapered implant and subperiosteal xenograft help maintain bone architecture in esthetic areas? J Oral Biol Craniofac Res 2019; 9:186-189. [PMID: 31061786 DOI: 10.1016/j.jobcr.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/22/2019] [Accepted: 04/20/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alfonso Caiazzo
- Private Practice of Oral Surgery, Salerno, Italy
- Dept. of Oral & Maxillofacial Surgery, Boston University, Boston, MA, USA
| | | | - Pushkar Mehra
- Professor and Chair, Dept. of Oral and Maxillofacial Surgery, Boston University, Boston, MA, USA
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18
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Mobini A, Mehra P, Chigurupati R. Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery. J Oral Maxillofac Surg 2018; 76:2285-2295. [DOI: 10.1016/j.joms.2018.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 01/14/2023]
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19
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Parsi GK, Alsulaiman AA, Kotak B, Mehra P, Will LA, Motro M. Volumetric changes of the upper airway following maxillary and mandibular advancement using cone beam computed tomography. Int J Oral Maxillofac Surg 2018; 48:203-210. [PMID: 30181009 DOI: 10.1016/j.ijom.2018.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/19/2022]
Abstract
The objective of this project was to retrospectively evaluate changes in volume of different compartments of the upper airway in response to maxillary, mandibular, and bimaxillary advancement surgeries and to predict the extent of volumetric changes associated with these surgical movements. Pre- and post-surgical cone beam computed tomography scans of 36 patients were evaluated for changes in nasal cavity, nasopharyngeal, oropharyngeal, and hypopharyngeal compartments. The amount of movement for each surgery was measured from skeletal landmarks to reference planes and was correlated with volumetric changes. Maxillary advancement of 4.0±2.2mm increased the oropharyngeal volume significantly (41.40%), and mandibular advancement of 3.8±1.6mm also significantly increased the oropharyngeal volume (21.17%). Bimaxillary advancement of 5.1±1.3mm for the maxilla and 6.4±3.1mm for the mandible significantly increased nasopharyngeal (27.45%), oropharyngeal (66.39%), and hypopharyngeal (52.48%) volumes. Furthermore, for every millimeter anterior movement, oropharyngeal volume increased by 2319.2±771.8mm3. Bimaxillary advancement showed a greater increase than isolated maxillary and mandibular advancement in all pharyngeal compartments. Every millimeter of advancement in the bimaxillary group led to a significant increase in oropharyngeal volume, while every millimeter downward movement showed a significant increase in nasopharyngeal volume.
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Affiliation(s)
- G K Parsi
- Department of Orthodontics and Dentofacial Orthopedics, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.
| | - A A Alsulaiman
- Department of Orthodontics and Dentofacial Orthopedics, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA; Department of Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, College of Dentistry, Dammam, Saudi Arabia
| | - B Kotak
- Department of Orthodontics and Dentofacial Orthopedics, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - P Mehra
- Department of Orthodontics and Dentofacial Orthopedics, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - L A Will
- Department of Orthodontics and Dentofacial Orthopedics, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - M Motro
- Department of Orthodontics and Dentofacial Orthopedics, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
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20
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Abstract
PURPOSE Retrospective analysis of the efficacy for two commonly used antibiotic regimens in the management of severe odontogenic infections. PATIENTS AND METHODS Evaluation of records of patients admitted to the Oral and Maxillofacial Surgery service at Boston University Medical Center from 2009 to 2014 with severe infections of odontogenic origin (SOI). Patients were divided into two groups based on the administered intravenous antibiotic: 1) Group I: Clindamycin only and 2) Group II: Penicillin and Metronidazole. Variables evaluated included demographic characteristics, ASA status, and anatomic site of infection risk, length of hospital stay, antibiotic failure, and pharmaceutical treatment cost. RESULTS 78 patients (46 males and 32 females) were included in the study. There were 57 patients in group I (average age 32.6 years) and 21 in Group II (average age 32.8 years). The average white cell count at time of admission count was higher in Group I (19.3) versus Group II (17.4). Antibiotic failure rate was 3.5% in Group I and 4.7% for group 2 patients. CONCLUSION Clindamycin alone and combination of Penicillin with Metronidazole are both effective pharmaceutical regimens for SOI. Clindamycin therapy resulted in shorter hospital stay and lower net treatment costs with a slightly higher success rate.
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Affiliation(s)
- Manish Bhagania
- Department of Oral and Maxillofacial Surgery, Boston University, Boston, MA, USA
| | - Wael Youseff
- Private Practice in Oral and Maxillofacial Surgery, Milford, MA, USA
| | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston University, Boston, MA, USA
| | - Ruben Figueroa
- Department of Oral and Maxillofacial Surgery, Boston University, Boston, MA, USA
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Osborn TM, Helal D, Mehra P. Iliac crest bone grafting for mandibular reconstruction: 10-year experience outcomes. J Oral Biol Craniofac Res 2017; 8:25-29. [PMID: 29556459 DOI: 10.1016/j.jobcr.2017.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/03/2017] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate 10-year patient data related to mandibular reconstruction with NVBG at a tertiary academic center. Patients and Methods Sixty patients with mandibular mandibular reconstruction were included. Patients were divided to continuity defect and non-continuity defect. Pathology lesion, immediate reconstruction, smoking habit, medical comorbidities, site and size of the defect, surgical approach, intraoperative perforation, cadaveric bone use, and maxilla-mandibular fixation use were analyzed as factors of influence on success. Success was defined as maintenance of more than 50% of graft for non-continuity defects (NCD) and bone continuity and stability for continuity defect (CD), and absence of infection on last follow up upon clinical and radiographic examination. Complications were classified as minor or major. Results The reconstruction was successful in 28 (87%) of CD patients and 23 (82.1%) of NCD patients. Analyses showed that the size of defect was significantly associated with failure. All 4 failed cases of CD had defects more than 9 cm. Four patients had major complications and 43 minor complication. Conclusions Nonvascularized iliac crest bone grafts are highly successful in mandibular continuity reconstruction for non-Cancer patients and should be considered as first choice for defects less than 9 cm. They are less predictable for defects larger than 9 cm but can be considered in these cases with osteoconductive cribs. Symphysis involvement may or may not be associated with lower success rate if our protocol is followed.
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Affiliation(s)
- Timothy M Osborn
- Dept. of Oral & Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
| | | | - Pushkar Mehra
- Dept. of Oral & Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.,Boston Medical Center, Boston, MA, USA
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Abstract
Temporomandibular joint reconstruction (TMJR) is
often necessary for patients with severe and/or refractory
TMJ disease who have failed conservative treatment. TMJR
aids to improve masticatory function and is associated with
improved quality of life outcomes. Currently, alloplastic
reconstruction is considered as the treatment of choice
in most severe TMJ disorders due to its many advantages
inclusive but not limited to early mobilization, stable longterm
results, and significant improvement in jaw function.
Broadly speaking, two types of TMJR prostheses are
available for reconstruction: 1) stock, and, 2) custommade
prostheses. The purpose of this article is to provide
the reader with a brief overview of the basic principles
and fundamentals of TMJR while referencing pertinent
existing literature.
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Affiliation(s)
- Rushil R Dang
- BDS, DMD Resident, Dept. of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA, USA
| | - Pushkar Mehra
- BDS, DMD, FACS Professor and Chairman, Dept. of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA, USA
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Caiazzo A, Brugnami F, Galletti F, Mehra P. Buccal Plate Preservation with Immediate Implant Placement and Provisionalization: 5-Year Follow-Up Outcomes. J Maxillofac Oral Surg 2017; 17:356-361. [PMID: 30034155 DOI: 10.1007/s12663-017-1054-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Despite socket preservation and/or immediate implant placement, resorption of the buccal plate after dental extraction continues to pose esthetic challenges to clinicians. Buccal plate preservation (BPP) is a technique that has been recently proposed with an aim to reduce the incidence of such resorption. This study was conducted to assess the long-term efficacy of BPP in maintaining the thickness of the buccal cortical plate after immediate implant insertion and provisionalization. Materials and Methods Ten consecutive patients were included in this study. Each patient underwent extraction of a non-restorable tooth, BPPPBPP, single immediate implant placement and immediate provisionalization. Cone beam CT scans were taken 3 months after surgery (T1) and 5 years after surgery (T2) to evaluate the effectiveness and longevity of the BPPPBPP technique in maintaining the augmented bone width. Two distinct measurements were taken for bone evaluation: (a) R1: 1 mm apical to the implant platform and (b) R2: 5 mm apical to the implant platform. The long axis of the implant was used as a fixed reference. Statistical test analysis was conducted using the SPSS software. Student's t test was used to assess statistical significance, and a p value of < 0.05 was considered significant. Results There were six females and four males in the study. The mean age of the sample was 37.6 years (range 23-64 years). At T1, the mean bone thickness of the buccal plate was found to be 2.36 mm at R1 (range: 1.9-3.1), and 2.23 at R2 (range: 1.9-3). At the T2 interval, the mean thickness of the plate was 2.28 mm at R1 (range: 1.7-3) and 2.18 at R2 (range: 1.9-3). The differences in these mean values were not statistically significant. Conclusions BPPPBPP is an effective means for augmentation and maintenance of the buccal cortical plate around an immediately placed and provisionalized dental implant. It is a viable alternative to socket preservation with the added benefit that it allows for immediate implant placement.
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Affiliation(s)
- Alfonso Caiazzo
- Private Practice in Oral Surgery, Salerno, Italy
- 2Department of Oral and Maxillofacial Surgery, Boston University, 100 East Newton Street, Suite G-407, Boston, MA 02118 USA
| | | | | | - Pushkar Mehra
- 2Department of Oral and Maxillofacial Surgery, Boston University, 100 East Newton Street, Suite G-407, Boston, MA 02118 USA
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Giglou K, Batal H, Mehra P. Does Sagittal Root Position Affect Buccal or Palatal Bone Thickness in the Anterior Esthetic Zone? J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Arya V, Kadagad P, Alvarez W, Chigurupati R, Mehra P. Temporomandibular Disorders in Orthognathic Surgery Patients. J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Henry C, Mehra P. TMJ Reconstruction in Patients with Autoimmune Disease. J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alshenibr W, Tashkandi MM, Alsaqer SF, Alkheriji Y, Wise A, Fulzele S, Mehra P, Goldring MB, Gerstenfeld LC, Bais MV. Anabolic role of lysyl oxidase like-2 in cartilage of knee and temporomandibular joints with osteoarthritis. Arthritis Res Ther 2017; 19:179. [PMID: 28764769 PMCID: PMC5540418 DOI: 10.1186/s13075-017-1388-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/17/2017] [Indexed: 01/14/2023] Open
Abstract
Background Lysyl oxidase like-2 (LOXL2) is a copper-dependent amine oxidase. Our previous studies showed that LOXL2 is elevated during mouse fracture healing. The goal of this study was to evaluate the potential of LOXL2 to act as an anabolic agent in cartilage affected by osteoarthritis (OA). Methods LOXL2 was visualized in tissues from human knee and hip joints and temporomandibular joints (TMJ) by immunofluorescence. The activity of LOXL2 in human articular and TMJ chondrocytes was assessed by cell-based assays, microarray analysis, and RT-qPCR, and LOXL2-mediated activation of NF-κB and extracellular signal-related kinase (ERK) signaling pathways was measured by western blotting. To examine LOXL2-induced effect in vivo, we implanted Matrigel-imbedded human chondrocytes into nude mice and exposed them to exogenous LOXL2 for 6 weeks. Finally, LOXL2-induced effects on collagen type 2 α1 (COL2A1) and phospho-SMAD2/3 were evaluated by immunofluorescence analysis. Results LOXL2 staining was detected in damaged regions of human TMJ, hip and knee joints affected by OA. Stimulation with transforming growth factor (TGF)-β1 upregulated LOXL2 expression, while pro-inflammatory cytokines IL-1β and TNF-α downregulated LOXL2, in human chondrocytes. Viral transduction of LOXL2 in OA chondrocytes increased the mRNA levels of chondroitin sulfate proteoglycan (CSPG4), aggrecan (ACAN), sex determining region Y-box containing gene 9 (SOX9), and COL2A1 but reduced the levels of extracellular matrix (ECM)-degrading enzymes matrix metalloproteinase (MMP)1, MMP3, and MMP13. Further, forced expression of LOXL2 promoted chondrogenic lineage-specific gene expression, increased the expression of COL2A1 in the presence of TNF-α, and inhibited chondrocyte apoptosis. LOXL2 expression also inhibited IL-1β-induced phospho-NF-κB/p65 and TGF-β1-induced ERK1/2 phosphorylation. Matrigel constructs of human chondrocytes from the knee joint and TMJ implanted in nude mice showed anabolic responses after LOXL2 transduction, including increased expression of SOX9, ACAN, and COL2A1. Finally, immunofluorescence staining revealed co-localization of LOXL2 with SOX9 in the nuclei of cells in the implants, decreased phospho-SMAD2/3, and increased COL2A1 staining. Conclusion Our results suggest that although LOXL2 is upregulated in cartilage affected by OA, this may be a protective response that promotes anabolism while inhibiting specific catabolic responses in the pathophysiology of OA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1388-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Weam Alshenibr
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, W-216, 700 Albany Street, Boston, MA, 02118, USA
| | - Mustafa M Tashkandi
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, W-216, 700 Albany Street, Boston, MA, 02118, USA
| | - Saqer F Alsaqer
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, W-216, 700 Albany Street, Boston, MA, 02118, USA
| | - Yazeed Alkheriji
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, W-216, 700 Albany Street, Boston, MA, 02118, USA
| | - Amelia Wise
- Department of Orthopaedic Surgery, School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Sadanand Fulzele
- Department of Orthopaedic Surgery and Institute of Regenerative and Reparative Medicine, Georgia Regents University, Augusta, GA, 30912, USA
| | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, 100 East Newton Street, Boston, MA, 02118, USA
| | - Mary B Goldring
- Hospital for Special Surgery Research Institute, Weill Cornell Medical College, New York, NY, 10021, USA.,Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Louis C Gerstenfeld
- Department of Orthopaedic Surgery, School of Medicine, Boston University, Boston, MA, 02118, USA
| | - Manish V Bais
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, W-216, 700 Albany Street, Boston, MA, 02118, USA.
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Mehra P. Management of temporomandibular joint-related progressive facial asymmetries. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Mehra P, Giri J. Rice and chickpea GDPDs are preferentially influenced by low phosphate and CaGDPD1 encodes an active glycerophosphodiester phosphodiesterase enzyme. Plant Cell Rep 2016; 35:1699-1717. [PMID: 27108120 DOI: 10.1007/s00299-016-1984-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
Rice and chickpea GDPD s are transcriptionally influenced by mineral deficiencies; especially, by phosphate starvation and CaGDP1 encodes an active glycerophosphodiester phosphodiesterase enzyme. Glycerophosphodiester phosphodiesterases (GDPDs) are enzymes involved in the degradation of glycerophosphodiesters into sn-glycerol-3-phosphate and corresponding alcohols. These phospholipid remodeling genes have been suggested to play important roles in phosphate homeostasis. However, comprehensive information about the role of GDPDs under low phosphate (P) and other nutrient deficiencies (N, K, Fe, Zn) in rice and chickpea is missing. Here, we identified 13 OsGDPDs and 6 CaGDPDs in rice and chickpea, respectively, and partly characterized their roles in multiple nutrient stresses. Expression profiling after 7 and 15 days of deficiency treatments revealed unique and overlapping differential expression patterns of OsGDPDs and CaGDPDs under different nutrient stresses. Principal component analysis on the expression patterns of OsGDPDs and CaGDPDs revealed their preferential role in P starvation. Some of the GDPDs were also induced by N, K, Fe and Zn deficiency in temporal manner in both crops suggesting their roles in multiple nutrient stresses. Biochemical characterization of highly responsive chickpea GDPD, CaGDPD1, confirmed its in vitro GDPD activity and revealed its optimal temperature, pH and cofactor requirements. Further, CaGDPD1 showed its accumulation in ER and endomembranes. We hereby propose CaGDPD1 and various OsGDPDs as low P responsive marker genes in chickpea and rice, respectively. Our data uphold role of GDPDs in multinutrient responses and suggest them as candidates for rice and chickpea improvement for tolerance to various nutrient deficiencies.
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Affiliation(s)
- P Mehra
- National Institute of Plant Genome Research, Aruna Asaf Ali Marg, New Delhi, 110067, India
| | - J Giri
- National Institute of Plant Genome Research, Aruna Asaf Ali Marg, New Delhi, 110067, India.
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Mehra P, Arya V, Henry C. Temporomandibular Joint Condylar Osteochondroma: Complete Condylectomy and Joint Replacement Versus Low Condylectomy and Joint Preservation. J Oral Maxillofac Surg 2016; 74:911-25. [DOI: 10.1016/j.joms.2015.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
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Mehra P, Nadershah M, Chigurupati R. Is Alloplastic Temporomandibular Joint Reconstruction a Viable Option in the Surgical Management of Adult Patients With Idiopathic Condylar Resorption? J Oral Maxillofac Surg 2016; 74:2044-54. [PMID: 27186870 DOI: 10.1016/j.joms.2016.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR. PATIENTS AND METHODS A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse. RESULTS Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was -10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions. CONCLUSIONS Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.
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Affiliation(s)
- Pushkar Mehra
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston; Chief, Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA.
| | - Mohammed Nadershah
- Former Resident, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine and Boston Medical Center, Boston, MA; Assistant Professor, Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Radhika Chigurupati
- Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA
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Masters K, Hilchey Masters M, Towne B, Mehra P, Rebhun C. The “Same Day Access” Clinic Model: A New Alternative. J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.joms.2015.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33
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Brattain A, D'Innocenzo R, Mehra P, Rebhun C. Standardizing Post-Anesthesia Discharge Criteria in an Office Setting. J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.joms.2015.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Norris O, Mehra P, Salama A. Maxillofacial Gunshot Injuries at an Urban Level I Trauma Center—10-Year Analysis. J Oral Maxillofac Surg 2015; 73:1532-9. [DOI: 10.1016/j.joms.2015.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 03/14/2015] [Accepted: 03/14/2015] [Indexed: 11/25/2022]
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35
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Mehra P, Arya V. Temporomandibular Joint Arthrocentesis: Outcomes Under Intravenous Sedation Versus General Anesthesia. J Oral Maxillofac Surg 2015; 73:834-42. [DOI: 10.1016/j.joms.2014.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 11/16/2022]
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Abstract
Adequate quality and quantity of soft tissue plays an integral part in the esthetic outcome of dental implants. Adequate band of attached tissue decreases the incidence of mucositis and improves hygiene around implants. This article discusses a variety of techniques for soft tissue augmentation. Soft tissue grafting can be achieved at various stages of implant therapy. Epithelial connective tissue grafts are commonly used to increase the band of attached tissue. Subepithelial connective tissue grafts are great for increasing soft tissue thickness and improving the gingival biotype.
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Affiliation(s)
- Hussam Batal
- Oral and Maxillofacial Surgery, Boston University, 100 East Newton Street, G407, Boston, MA 02118, USA.
| | | | - Pushkar Mehra
- Oral and Maxillofacial Surgery, Boston University, 100 East Newton Street, G407, Boston, MA 02118, USA
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38
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Neely M, Jones JA, Rich S, Gutierrez LS, Mehra P. Effects of cuts in Medicaid on dental-related visits and costs at a safety-net hospital. Am J Public Health 2014; 104:e13-6. [PMID: 24825223 DOI: 10.2105/ajph.2014.301903] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We used data from Boston Medical Center, Massachusetts, to determine whether dental-related emergency department (ED) visits and costs increased when Medicaid coverage for adult dental care was reduced in July 2010. In this retrospective study of existing data, we examined the safety-net hospital's dental-related ED visits and costs for 3 years before and 2 years after Massachusetts Health Care Reform. Dental-related ED visits increased 2% the first and 14% the second year after Medicaid cuts. Percentage increases were highest among older adults, minorities, and persons receiving charity care, Medicaid, and Medicare.
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Affiliation(s)
- Martha Neely
- The authors are with the Boston University Henry M. Goldman School of Dental Medicine, Boston, MA. Pushkar Mehra is also with Boston Medical Center, Boston
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O'Riordan W, Green S, Mehra P, De Anda C, Fang E, Prokocimer P. Tedizolid Phosphate for the Management of Acute Bacterial Skin and Skin Structure Infections: Efficacy Summary. Clin Infect Dis 2013; 58 Suppl 1:S43-50. [DOI: 10.1093/cid/cit617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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40
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Das D, Tulkens PM, Mehra P, Fang E, Prokocimer P. Tedizolid Phosphate for the Management of Acute Bacterial Skin and Skin Structure Infections: Safety Summary. Clin Infect Dis 2013; 58 Suppl 1:S51-7. [DOI: 10.1093/cid/cit618] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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41
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Norris O, Steuer M, Mehra P, Cottrell D. Endosseous Implants in Non-vascularized Bone Grafts: Outcome Analysis. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Velazquez M, Mehra P. Iliac Crest Bone Grafting for Mandible Reconstruction: 10-Year Experience Outcomes. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Caiazzo A, Brugnami F, Mehra P. Buccal plate preservation with immediate post-extraction implant placement and provisionalization: Preliminary results of a new technique. Int J Oral Maxillofac Surg 2013; 42:666-70. [DOI: 10.1016/j.ijom.2012.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 09/25/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
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44
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Mehra P. Poster 81: Osteochondroma of the Mandibular Condyle: Conservative Vs Aggressive Treatment. J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.joms.2012.06.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Brugnami F, Caiazzo A, Mehra P. Piezosurgery-assisted, flapless split crest surgery for implant site preparation. J Maxillofac Oral Surg 2012; 13:67-72. [PMID: 24644400 DOI: 10.1007/s12663-012-0377-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/21/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Bucco-lingual resorption of the alveolar ridge can, at times, be predictably corrected at the time of implant placement. Among the different options available to achieve this are a group of surgical techniques described as split crest or split ridge procedures. Most of these procedures require the use of a mallet and some type of chisels and/or osteotomes; they are very technique-sensitive and can be uncomfortable for patients. Recently, alternative tools to split the crest have been presented, and these include the newer bone expanders and the piezoelectric scalpel. A flapless approach to implant dentistry has become popular with the aim to alleviate post treatment side effects, accelerate healing and avoid bone resorption caused by flap elevation. METHODS We present a technique combining the use of a piezoelectric scalpel and a tapered bone expander in a flapless fashion as a novel way to perform split crest procedures with an aim to optimize outcomes and acceptability by patients. RESULTS All implants were successfully placed and the resorbed ridge expanded in the same setting. Findings were confirmed by postoperative cone beam cat scan (CBCT) evaluation. CONCLUSIONS This new technique is a predictable approach for split crest procedures and has high acceptability by patients and is technically simple for surgeons.
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Affiliation(s)
| | | | - Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, 100 East Newton Street, G-407, Boston, MA 02118 USA
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Abstract
This study evaluated serum nutrients in 23 patients who had previous Proplast/Teflon implants to their temporomandibular joints (TMJ) and continued to remain in chronic, severe, irresolvable pain despite subsequent surgical reconstruction. All of the patients were women, and their average age was 40.6 years (range, 28-55 years). Standard blood assays were performed for beta-carotene (vitamin A), folate, serum iron, ferritin, zinc, magnesium, and vitamins B1, B6, B12, and C. Each patient was deficient in at least one of these 10 elements, with an average of 3.3 elements. Some factors that may be responsible for the deficiency state include inadequate nutritional intake, malabsorption, utilization dysfunction, increased requirements, or drug interactions. In conclusion, the patient who has had multiple, complex TMJ operations with a history of TMJ Proplast/Teflon implants and poor treatment results may be suffering from an unrecognized malnutrition state, substantially adding to the patient's morbidity. Nutritional evaluations, dietary counseling, and appropriate medical management may improve the treatment outcomes for these patients.
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Affiliation(s)
- Pushkar Mehra
- Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center Baylor College of Dentistry and Baylor University Medical Center, Dallas, Texas, USA
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Mehra P. Location of post – parotid branches of facial nerve. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Mehra P. Alloplastic, patient-fitted TMJ reconstruction in patients with autoimmune/connective tissue disease. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mehra P. Innovation in oral maxillofacial surgery. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mehra P, Reebye U, Cottrell D, Nadershah M. Pharmacological Manipulation of Prostaglandins in Third Molar Surgery. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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