Dentists' clinical decision-making about teeth with apical periodontitis using a variable-controlled survey model in South Korea.
- 作者列表："Lee J","Kang S","Jung HI","Kim S","Karabucak B","Kim E
BACKGROUND:This study, by using a variable-controlled survey model, sought to compare clinical decisions made by dentists with different clinical backgrounds in South Korea regarding teeth with apical periodontitis and to identify factors that influenced decision-making. METHODS:A questionnaire with 36 questions about identical patient information, clinical signs, and symptoms was filled out by participants. Each question referred to a radiograph that had been manipulated using computer software in order to control tooth-related factors. Participants were instructed to record their demographic information and choose the ideal treatment option related to each radiograph. Simple and multivariable logistic regression analyses (p < .05) were used to investigate factors related to the decision to extract the tooth. We divided factors into dentist-related factors (gender, years of experience, and professional registration) and tooth-related factors (tooth position, coronal status, root canal filling status, and size of the periapical radiolucency). Dentists were categorized into three groups, based on professional registration: general dental practitioners (GDPs), endodontists, and other specialists. Simple logistic regression analysis (p < .05) was used to evaluate the tooth-related factors influencing extraction, depending on the dentists' specialty. RESULTS:Participants mostly preferred saving the teeth over extraction. This preference was highest among the endodontists, followed by other specialists and GDPs. Extractions were significantly preferred for molars, teeth with previous root canal fillings, and those with apical lesions greater than 5 mm. CONCLUSIONS:This study suggests that dentists' decision-making regarding teeth with apical periodontitis was associated with their work experience and specialty and influenced by tooth position, root canal filling status, and size of the apical lesion. CLINICAL RELEVANCE:This survey revealed that clinical decision-making related to teeth with apical periodontitis was affected by dentists' specialty and work experience and by tooth-related factors, such as tooth position, root canal filling status, and size of the apical lesion.
背景: 本研究通过使用可变控制调查模型，试图比较韩国不同临床背景的牙医对根尖周炎牙齿的临床决策，并确定影响决策的因素。 方法: 参与者填写了一份关于相同患者信息、临床体征和症状的 36 个问题的问卷。每个问题都涉及使用计算机软件操纵的射线照片，以控制牙齿相关因素。指导参与者记录他们的人口统计学信息，并选择与每张x光片相关的理想治疗方案。采用简单和多变量logistic回归分析 (p <.05) 调查与拔牙决定相关的因素。我们将因素分为牙医相关因素 (性别、年数、专业注册) 和牙齿相关因素 (牙位、冠状位、根管充填状态、和根尖周辐射的大小)。牙医根据专业注册分为三组: 普通牙科医师 (GDPs) 、牙髓病医师和其他专家。采用简单logistic回归分析 (p <.05) 评估影响拔牙的牙齿相关因素，取决于牙科医生的专业。 结果: 与拔牙相比，参与者大多更喜欢保存牙齿。这种偏好在牙髓病专家中最高，其次是其他专家和GDPs。磨牙、既往有根管充填的牙齿和根尖病变大于 5mm的牙齿显著首选拔牙。 结论: 本研究提示，牙科医师对根尖周炎的决策与他们的工作经验和专业有关，并受牙位、根管充填状态的影响。和根尖病变的大小。 临床相关性: 本调查揭示了与根尖周炎牙相关的临床决策受牙科医生的专业和工作经验的影响，受牙齿相关因素的影响，如牙位、根管充填状态，根尖病变的大小。
METHODS:BACKGROUND:The anterior oronasal fistulae neighboring the alveolar cleft could persist or reappear after the alveolar reconstruction with cancellous bone grafting. The persistent symptomatic anterior oronasal fistulae need to be repaired, but surgery remains a challenge in cleft care. Surprisingly, this issue has rarely been reported in the literature. The purpose of this long-term study was to report a single surgeon experience with a therapeutic protocol for persistent symptomatic anterior oronasal fistula repair. METHODS:This is a retrospective study of consecutive patients with Veau type III and IV clefts and persistent symptomatic anterior oronasal fistulae managed according to a therapeutic protocol from 1997 to 2018. Depending on fistula size, patients were treated with local flaps associated with an interpositional graft or two-stage tongue flaps (small/medium or large fistulae, respectively). The surgical outcomes were classified as "good" (complete fistula closure with no symptoms), "fair" (asymptomatic narrow fistula remained), or "poor" (failure with persistent symptoms). RESULTS:Forty-four patients with persistent symptomatic anterior oronasal fistulae were reconstructed with local flaps associated with interpositional fascia or dermal fat grafting (52.3%) or two-stage tongue flaps (47.7%). Most of patients (93.2%) presented "good" outcomes, ranging from 87% to 100% (local and tongue flaps, respectively). Three (6.8%) patients presented symptomatic residual fistula ("poor" outcomes). CONCLUSIONS:For the repair of persistent symptomatic anterior oronasal fistulae, this therapeutic protocol provided satisfactory outcome with low fistula recurrence rate.
METHODS:OBJECTIVE:Methadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS. DESIGN/SETTING:This case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995-2011. PATIENTS:Cases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks' gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview. RESULTS:Among 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1-12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2). CONCLUSIONS:These findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk-benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.
METHODS::Orthopedic treatment to improve deficient maxillary growth of cleft lip and palate patients is an important part of treatment. The success of this treatment is strongly dependent on the time of initiation of therapy. There has been a large controversy in the available literature regarding the skeletal age of these patients. The aim of the present study was to compare the skeletal age of cleft lip and palate patients with normal individuals.37 unilateral and 14 bilateral cleft lip and palate patients and 47 healthy individuals participated in this cross-sectional study. The patients were classified into 8 to 10 and 11 to 14-year-old individuals. Cervical vertebral maturational stage of participants was evaluated in the lateral cephalometry. The skeletal age of cleft lip and palate patients was compared with normal controls. Chi-square was used for statistical analysis. There was not a significant difference in the skeletal developmental stage of unilateral and bilateral cleft compared to their normal peers according to their age and sex. Also, significant difference in skeletal maturational stage of cleft lip and palate patients was not found between boys and girls (P = 0.8). Similarly, no significant difference was found in the skeletal age of the 3 studied groups without considering the age and sex of participants (P = 0.5). Regarding the similar skeletal maturational stage of cleft lip and palate patients with normal controls in our study, their maxillofacial orthopedic treatment can be initiated at similar time to normal peers.