Occlusal caries detection on 3D models obtained with an intraoral scanner. A validation study.

OBJECTIVES: To evaluate the diagnostic performance of visual caries assessment on 3D dental models obtained using an intraoral scanner and to compare it with the performance of the clinical visual inspection. METHODS: Fifty-three permanent posterior teeth scheduled for extraction were randomly selected and included in this study. One to three independent examination sites on the occlusal surface of each tooth were clinically inspected using International Caries Detection and Assessment System (ICDAS) criteria. Afterwards, the examined teeth were scanned intraorally with a 3D intraoral scanner (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark) using white and blue-violet light (415 nm wavelength) to capture the colour and fluorescence signal from the tissues. Six months after the clinical examination, the same examiner conducted the on-screen assessment of the obtained 3D digital dental models at the selected examination sites using modified ICDAS criteria. Both tooth colour and fluorescence texture with high resolution were assessed. Lastly, an independent examiner conducted the histological examination of all teeth after extraction. Using histology as the reference test, Sensitivity (SE), Specificity (SP), Accuracy (ACC), area under the Receiver Operating Characteristic (ROC) curve, and Spearman's correlation coefficient were calculated for the clinical and on-screen ICDAS assessments. RESULTS: The ACC values of the evaluated methods varied between 0.59-0.79 for initial caries lesions and 0.77-0.99 for moderate-extensive caries lesions. Apart from SE values corresponding to caries in the inner half of enamel, no significant difference was observed between clinical visual inspection and on-screen assessment. In addition, no difference was found in the assessment of 3D models with tooth colour alone or supplemented with fluorescence for all the evaluated diagnostic measures. CONCLUSIONS: On-screen visual assessment of 3D digital dental models with tooth colour or fluorescence showed a similar diagnostic performance to the clinical visual inspection when detecting and classifying occlusal caries lesions on permanent teeth. CLINICAL SIGNIFICANCE: 3D intraoral scanning can aid the detection and classification of occlusal caries as part of patient screening and can potentially be used in remote caries assessment for clinical and research purposes.

Visible Occlusal Plaque Index Predicting Caries Lesion Activity.

This study was undertaken to appraise the predictive validity of the Visible Occlusal Plaque Index (VOPI) in assessing occlusal caries lesion activity in adolescents. A total of 618 adolescents aged 10 to 15 y were examined at the beginning of the trial and 511 (82.7%) at the 2-y follow-up. Adolescents and parents answered questionnaires about demographics, oral health behavior, and family sociodemographic variables. The VOPI has a 4-point ordinal scale ranging from no plaque to heavy plaque. Molar teeth were assigned to group VOPI 0-1 (no/thin plaque; n = 2,539) and group VOPI 2-3 (thick/heavy plaque; n = 843). At baseline examination, occlusal surfaces at risk of transition (n = 3,382) were either sound (55%), inactive noncavitated lesions (21%), inactive cavitated lesions (1%), active noncavitated lesions (15%), or active cavitated lesions (7%). The relative risk (RR) for caries lesion transition was estimated. Sound occlusal surfaces with no or thin plaque were significantly more likely to remain sound (RR = 1.3; 95% confidence interval [CI]: 1.1-1.4) than those harboring thick or heavy plaque. Inactive noncavitated occlusal lesions presenting no or thin plaque were significantly less likely to progress to active noncavitated lesions (RR = 0.1; CI: 0.0-0.8) than their counterparts with thick or heavy plaque. Active noncavitated lesions harboring thick and heavy plaque had a significantly lowest chance of becoming sound (RR = 0.7; CI: 0.5-0.9) and a highest risk of remaining active (RR = 1.5; CI: 1.1-1.9). Stepwise logistic regression analyses were run according to surface status at baseline and showed that none of the nonclinical predictors were significant for the outcome. The presence of thick and heavy plaque on occlusal surfaces was a predictor for caries lesion development, progression and activity (P < 0.0001). In conclusion, besides being an additional clinical tool for oral hygiene assessment, the VOPI is a predictor for development, progression, and activity of occlusal caries lesion. This is of particular interest for assessment of occlusal lesions undergoing health-promoting transitions.

The Cost of Heart Transplant in Iran: A Multicenter Analysis.

Background: Heart transplantation is an established treatment for end-stage heart failure patients, but its cost-effectiveness is under question. Objective: This study aimed to assess the cost of heart transplantation in Iran as a developing country in Asia to contribute to future planning in the region. Methods: This study was conducted in two phases. First, in a retrospective multicenter study, hospital data of heart transplant and hospitalization of three active heart transplant centers in Tehran, Iran, were reviewed from April 2013 to May 2015. Then pre-transplantation, transplantation, and one-year posttransplant costs were calculated according to the ABC (activity-based costing) method in 2016. Results: Data were obtained for 120 patients, among which 95 (79.17%) were males with a mean (SD) age of 35.31±13.41 years. Mean (SD) hospital and ICU length of stay were 17.85±14.91 and 9.74±8.94 days, respectively. A significant correlation existed between the mean of hospital and ICU length of stay (P<0.001, r: 0.754). The mean heart transplant and hospitalization cost was 3445.47±1243.29 USD from 2013 to 2015. Using the activity-based costing method, the cost of pre-transplantation, transplantation, and one-year -post-transplantation were extracted 6.5%, 73.5%, and 20%, respectively, with a total cost of 26232 USD. Conclusion: Compared to other countries, the cost of heart transplantation in Iran is very low. Numerous reasons lead to this difference. Firstly, a heart transplantation surgery is performed in university-based hospitals and is supported by the government. On the other hand, a significant difference exists between personnel costs in Iran compared to other countries.

Sealing Occlusal Dentin Caries in Permanent Molars: 7-Year Results of a Randomized Controlled Trial.

The purpose of this study was to investigate the possibility of postponing restorative intervention of manifest occlusal caries in young, permanent dentition by non-invasive sealing. This RCT-designed study included 521 occlusal lesions in 521 patients aged 6 to 17 y. Based on clinical and radiographic assessments, all lesions required restorative treatment. After randomization (ratio 2:1), 368 resin sealings and 153 composite-resin restorations were performed by 68 dentists in 9 municipalities. The primary aims were to 1) analyze survival of sealings until replacement by restoration, 2) compare longevity of sealings and restorations until retreatments, and 3) compare effectiveness of sealings and restorations to halt caries progression in sealed lesions and beneath restorations. Furthermore, we aimed to identify factors influencing longevity and the effectiveness of sealings and restorations. Treatments were annually controlled, clinically and radiographically. After 7 y, the drop out rate was 8%, and 54% of the treatments were completed due to age. Of the sealings, 48% were retreated, including 31% replaced by restorations; 12% were still functioning. Of the restorations, 7% were repaired/renewed and 20% were still functioning. No endodontics was performed. Kaplan-Meier and Cox regression survival analyses were performed on 341 sealings and 152 restorations in first and second molar teeth. The 7-y survival was 37% (CI, 29% to 45%) for sealings and 91% (CI, 85% to 96%) for restorations (P < 0.001). The median survival time for sealings not replaced by restorations was 7.3 y (CI, 6.4 y to NA). Survival of sealings was increased in patients with low caries risk and/or excellent oral hygiene, second molars compared with first molars, and lesions not extending the middle one-third of the dentin. Survival of sealings was not influenced by municipality, sex, eruption stage or clinical surface cavitation. The results underline that it is possible to postpone or avoid restorative intervention of occlusal dentin caries lesions in young permanent teeth by non-invasive sealing. Knowledge Transfer Statement: The first restoration can ultimately be fatal for a young permanent tooth. A restoration may not be the final treatment but the start of an ongoing treatment with still more loss of tooth substance. The present study shows the possibility of treating occlusal dentin caries lesions with non-invasive resin sealings instead of conventional resin composite restorations in children and adolescents. Improved oral health can be expected.

Measurement of histological and radiographic depth and width of occlusal caries lesions: a methodological study.

AIM: To develop a measurement method to quantify the depth and width of occlusal caries lesions. MATERIAL AND METHODS: One hundred and ten extracted permanent molars with occlusal caries lesions were selected, then visually scored by ICDAS scoring system and then sectioned mesiodistally, resulting in a facial and a lingual fraction. Digital photos and radiographs were taken from each section. By randomization, one of the sections was chosen for further examinations. First digital photos were taken. Depth and width of the lesions were marked with arrows on the images both before (H(un-col)) and after coloring (H(col)) the sections. The same types of measurements were done on the radiographs (R). The relative dentinal depth and width of the lesions were measured in the same order. RESULTS: Weighted intra- and interexaminer kappa value for ICDAS scorings varied between 0.85 and 0.90. Intraexaminer kappa for dentinal depth in 36 randomized selected teeth was calculated to 0.75 (H(un-col)), 0.91 (H(col)), 0.79 (R) and for dentinal width to 0.84 (H(un-col)), 0.96 (H(col)), 0.84 (R). Significant correlations were found between ICDAS scorings and the measurements of depth and width of lesions in H(un-col), H(col), and R (p < 0.000). The lowest difference was measured between H(un-col) and H(col) in both relative depth and width of the lesion with maximum differences up to 45% (H(un-col)-H(col)) and 73% (H(col)-R). CONCLUSION: It is possible to measure depth and width of occlusal caries lesions by means of histological and radiographic technique with acceptably high reproducibility using this method.

Treatment of proximal superficial caries lesions on primary molar teeth with resin infiltration and fluoride varnish versus fluoride varnish only: efficacy after 1 year.

This split-mouth study aimed to assess the efficacy of resin-infiltrated lesions covered by fluoride varnish (FV) versus FV treatment only of proximal lesions on deciduous molar teeth. The study lasted for 1 year. Children with 2 or more superficial proximal lesions on deciduous molar teeth detected on bitewing radiographs were included. After written parental consent, two lesions in each of 50 children were randomly allocated to one of two treatments: resin infiltration followed by FV (2.26% F) application (test lesion) versus only FV (control lesion). The ICDAS scores of the selected lesions were recorded by 2 clinicians before the treatments (weighted kappa for inter- and intra-examiner agreement >0.79). FV was applied to both test and control lesions 6 and 12 months after the first treatment. After 1 year ICDAS scores were obtained for 42 children and radiographs for 39. One external examiner not familiar with the study scored the radiographs twice (weighted kappa 0.88). Baseline mean age of the children was 7.17 +/- (SD) 0.68 and mean def-s was 8.1 +/- (SD) 6.9. After 1 year the ICDAS scores of 31% of the test lesions and 67% of the control lesions had progressed (p < 0.01). Radiographically, 23% of the test lesions and 62% of the control lesions had progressed (p < 0.01). Thus, the clinical and radiographic therapeutic effect of both resin infiltration/FV over FV alone was >35% and significant. To conclude, resin infiltration in conjunction with fluoride varnish seems promising for controlling proximal lesion progression on deciduous molar teeth.

[Evaluation of the therapeutic benefit of 41.8 degrees C whole body hyperthermia plus ifosfamide, carboplatin and etoposide (ICE) for patients with malignant pleural mesothelioma using the Modified Brunner-Score (MBS)]. / Bewertung des therapeutischen Gewinns von Patienten mit Pleuramesotheliom unter Therapie mit 41,8 degrees C Ganzkörperhyperthermie plus Ifosfamid, Carboplatin und Etoposid (ICE) anhand des Modifizierten Brunner-Score (MBS).

BACKGROUND: We performed a phase-II-study combining 41.8 degrees C whole body hyperthermia with ICE chemotherapy, i. e., ifosfamide (5 g/m (2) on day 1), carboplatin (300 mg/m (2) on day 1) and etoposide (150 mg/m (2) on days 2 and 3), administered every 4 weeks, to assess the treatment benefit for patients with malignant pleural mesothelioma. To date this is mainly done by measurement of response rates and overall survival, as it can be widely found in the literature. In fewer cases there is also a quality of life assessment. Here we describe an instrument well-capable for a more comprehensive statement on the therapeutic benefit by linking several study end points including quality of life assessment, the Modified Brunner-Score (MBS). MATERIAL AND METHODS: The Modified Brunner Score (MBS) was used for this assessment. MBS integrates progression free survival, change of physical performance (WHO-index), a quality of life self-assessment by the patient and toxicity. A positive score means a therapy benefit and vice versa. RESULTS AND CONCLUSIONS: Of 27 chemonäive, non-metastatic patients enrolled, 22 were evaluable for assessment. Overall survival and progression free survival for all patients was 76 weeks (95 % CI 65.4 weeks - 87.8 weeks) and 29.6 weeks (95 % CI 24.4 weeks - 34.7 weeks) respectively. Major treatment toxicities included grade 3/4 neutropenia and thrombocytopenia and affection of the GI tract, like mucositis, nausea and vomiting. Mean Improvement of Performance Index (WHO) was 0.29 points. The MBS showed a score of 4.21 points (- 4.43 - 16.45 range) for the overall study group. 16 of 22 evaluable patients achieved a positive score. MBS is a suitable tool to evaluate the treatment benefit especially in non-standard therapy approaches. For WBH plus ICE, it showed a beneficial effect on overall quality of life in the majority of patients.

A Systemic Hyperthermia Oncologic Working Group trial. Ifosfamide, carboplatin, and etoposide combined with 41.8 degrees C whole-body hyperthermia for metastatic soft tissue sarcoma.

BACKGROUND: Based on earlier clinical and preclinical studies, we conducted a phase II trial in metastatic sarcoma patients of the combination of 41.8 degrees C (x60 min) radiant heat (Aquatherm) whole-body hyperthermia (WBH) with 'ICE' chemotherapy. The ICE regimen consists of ifosfamide (5 g/m(2)), carboplatin (300 mg/m(2)) and etoposide (100 mg/m(2)), concurrent with WBH, with etoposide also on days 2 and 3 post-WBH. METHODS: Therapy was delivered every 4 weeks for a maximum of 4 cycles. All patients received filgrastim or lenograstim. RESULTS: Of 108 patients enrolled as of September 2001, 95 are evaluable for response. Of the evaluable patients (mean ECOG performance status approximately 1; mean age 42.3; 58% male) 33 had no prior therapy for metastatic disease, and 62 were pretreated (mean: 1.5 prior regimens). The overall response rate was 28.4% (4 complete remissions and 23 partial remissions) with stable disease (SD) in 31 patients. For no prior therapy, the response rate was 36%; in pretreated patients it was 24%. The median overall survival by Kaplan-Meier estimates was 393 days (95% CI 327, 496); the median time to treatment failure was 123 days (95% CI 77, 164). The major toxicity (287 cycles) was grade 3 or 4 neutropenia and thrombocytopenia seen in 79.7 and 60.6% of treatments respectively; there were 7 episodes of infection (grade 3/4) with 2 treatment-related deaths, bot involving disease progression and ureteral obstruction. CONCLUSION: These results are consistent with continued clinical investigation of this combined modality approach.

Ifosfamide, carboplatin and etoposide combined with 41.8 degrees C whole body hyperthermia for malignant pleural mesothelioma.

We performed a phase II study combining 41.8 degrees C whole body hyperthermia with ICE chemotherapy, i.e. ifosfamide (5 g/m(2)), carboplatin (300 mg/m(2)) and etoposide (150 mg/m(2) on days 2 and 3), administered every 4 weeks, for patients with malignant pleural mesothelioma. Of 27 chemonäive, non-metastatic patients enrolled, 25 patients were evaluable for response. Overall response rate was 20% (five partial remissions; 95% CI 8.9-39.1%). Median survival time from the start of treatment for all patients was 76.6 weeks (95% CI 65.4-87.8 weeks). Progression free survival for all patients measured 29.6 weeks (95% CI 24.4-34.7 weeks). One year overall survival was 68% and 2 year overall survival was 20%. Major treatment toxicities included grade 3/4 neutropenia and thrombocytopenia in 74 and 33% of treatment cycles, respectively. One patient died due to sepsis. These promising results are consistent with continued clinical investigation; a phase III clinical trial with whole body hyperthermia as the independent variable has been initiated.

Invasiveness of human pleural mesothelioma cells is influenced in vitro by the three-dimensional structure of the ECM and its composition.

The grade of malignancy of a neoplasm is influenced by the invasive and metastatic potential of the tumor cells. The extracellular matrix of tissues is known to interact with many aspects of the biological behavior of tumor cells, such as differentiation and invasiveness. Therefore we studied the influence of the extracellular matrix on the morphology and invasiveness of the human biphasic pleural mesothelioma cell line MSTO-211H in vitro. The major components of the two strata encountered by a pleural mesothelioma cell leaving the epithelial community were mimicked by plating cells either on collagen I, the major component of the underlying stratum fibrosum, being encountered by cells under pathological conditions or on reconstituted basement membrane (Matrigel) in order to simulate the basement membrane of the stratum serosum of the mesothelium, which is the matrix cells have contact to under physiological conditions. Growth on collagen I leads to cell separation and invasion into the matrix, whereas growth of MSTO-211H cells on Matrigel results in the formation of a huge and dense network of cells extending throughout the whole plating area. The morphology of cell contacts between the two populations varies impressively. While cells on collagen I hardly find to each other in groups, and if so, with a broad intercellular cleft, Matrigel induces the tight approach of membranes of neighbouring cells with formation of syncytium-like structures. Administration of the main ECM components laminin and collagen IV alone and together in equimolar concentrations as present in Matrigel, does not result in any morphological changes when compared to cells growing on plastic substrates or on collagen I. Therefore, collagen I increases cell separation and invasiveness whereas an intact basement membrane seems to prevent the cells from separating and spreading, thus lowering their invasive potential.

[Chemotherapy in combination with whole-body hyperthermia in advanced malignant pleural mesothelioma]. / Chemotherapie in Kombination mit Ganzkörperhyperthermie bei fortgeschrittenem malignem Pleuramesotheliom.

HISTORY AND CLINICAL FINDINGS: A 57-year-old man presented with dyspnoea, cough, fatigue and weight loss. He had been exposed to asbestos 30 years ago. Physical examination was unremarkable apart from a suspected pleural effusion. INVESTIGATIONS: Computed tomography (CT) of the thorax showed multiple pleural masses with pleural effusion on the left side. CT of the abdomen and bronchoscopy were normal. The patient underwent explorative thoracoscopy; biopsies were taken, and diffuse malignant pleural mesothelioma was demonstrated. TREATMENT AND COURSE: The patient was evaluated at the University Hospital Lübeck for Phase II experimental therapy with whole-body hyperthermia (WBH). The pretreatment evaluation revealed normal cardiorespiratory function and a normal contrast-enhanced CT of the brain. The patient's haematologic profile and electrolytes were normal. The WBH-radiant heat device (RHD) used for therapy was Aquatherm provided by the Cancer Research Institute (CRI, New York, USA). The patient received ifosfamide (5 g/m2, day 1), carboplatin (300 mg/m2, day 1), etoposide (150 mg/m2, days 2-3) combined with WBH at 41.8 degrees C (for 60 minutes). Two cycles were applied without complications and a partial remission of the disease was observed. CONCLUSION: Radiant heat whole body hyperthermia, in conjunction with a defined anticancer treatment and pharmacological approach to sedation, was a safe and effective palliative treatment in this patient.