[Diagnosis of ankylotic deciduous molars using intraoral scans in oligodontic patients]. / Diagnose van ankylotische melkmolaren met intraorale scans bij oligodontiepatiënten.

In this retrospective study, 2 intraoral scans with an interval of at least 1 year were superimposed in 25 oligodontic patients. The differences in vertical eruption (mm) were measured and the orthopantomograms were analyzed for the presence of ankylotic deciduous molars with no successor. The mean eruption of deciduous molars with and without successor was significantly lower than the mean eruption of permanent molars. The eruption of permanent molars was a predictive variable for the eruption of deciduous molars. The number of agenetic elements and the presence of a successor were strongly associated with the eruption of deciduous molars. Also, the mean eruption of deciduous molars with ankylosis was significantly lower than that of deciduous molars without ankylosis. This study showed a strong relationship between the diagnosis of ankylotic deciduous molars and the measurement of negative vertical eruption when monitored by intraoral scans.

Chronic fatigue in childhood cancer survivors is associated with lifestyle and psychosocial factors; a DCCSS LATER study.

BACKGROUND: The purpose of this study was to determine factors associated with chronic fatigue (CF) in childhood cancer survivors (CCS). PATIENTS AND METHODS: Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS (≥5 years after diagnosis) and siblings as controls. Fatigue severity was assessed with the 'fatigue severity subscale' of the Checklist Individual Strength ('CIS-fatigue'). CF was defined as scoring ≥35 on the 'CIS-fatigue' and having fatigue symptoms for ≥6 months. Twenty-four parameters were assessed, categorized into assumed fatigue triggering, maintaining and moderating factors. Multivariable logistic regression analyses were carried out to investigate the association of these factors with CF. RESULTS: A total of 1927 CCS participated in the study (40.7% of invited cohort), of whom 23.6% reported CF (compared with 15.6% in sibling controls, P < 0.001). The following factors were associated with CF: obesity [versus healthy weight, odds ratio (OR) 1.93; 95% confidence interval (CI) 1.30-2.87], moderate physical inactivity (versus physical active, OR 2.36; 95% CI 1.67-3.34), poor sleep (yes versus no, OR 2.03; 95% CI 1.54-2.68), (sub)clinical anxiety (yes versus no, OR 1.55; 95% CI 1.10-2.19), (sub)clinical depression (yes versus no, OR 2.07; 95% CI 1.20-3.59), pain (continuous, OR 1.49; 95% CI 1.33-1.66), self-esteem (continuous, OR 0.95; 95% CI 0.92-0.98), helplessness (continuous, OR 1.13; 95% CI 1.08-1.19), social functioning (continuous, OR 0.98; 95% CI 0.97-0.99) and female sex (versus male sex, OR 1.79; 95% CI 1.36-2.37). CONCLUSION: CF is a prevalent symptom in CCS that is associated with several assumed maintaining factors, with lifestyle and psychosocial factors being the most prominent. These are modifiable factors and may therefore be beneficial to prevent or reduce CF in CCS.

Effectiveness of adhesive containing MDPB: A practice-based clinical trial.

OBJECTIVES: This prospective practice-based trial assessed the longevity of composite restorations made with an adhesive containing an antibacterial monomer compared to a conventional adhesive. METHODS: 9 general practices in the Netherlands were provided with two composite resin adhesives, each for a period of 9 months. Adhesive P contained the quaternary ammonium salt MDPB, and Adhesive S was a control. Patient's age and caries risk, as well as tooth type/number, reason for restoration placement, used restorative material and adhesive, and restored surfaces were recorded. All interventions carried out on these teeth in the 6 years after restoration were extracted from the electronic patient records, along with their date, type, reason, and surfaces. Two dependent variables were defined: general failure, and failure due to secondary caries. All data handling and multiple Cox regression analysis were carried out in R 4.0.5. RESULTS: 11 dentists from 7 practices made 10,151 restorations over a period of two years in 5102 patients. 4591 restorations were made with adhesive P, whereas 5560 were made with adhesive S. The observation period was up to 6.29 years, median observation time was 3.74 years. Cox regression showed no significant difference between the two adhesive materials when corrected for age, tooth type and caries risk, for general failure nor failure due to caries. SIGNIFICANCE: No difference in restoration survival could be shown between composite restorations made using an adhesive containing MDPB and control. Restorations made with the adhesive containing MDPB also did not fail more or less frequently due to secondary caries. This trial is registered on clinicaltrials.gov with identifier NCT05118100.

Oral health-related quality of life in patients with oligodontia: A FACE-Q assessment.

OBJECTIVES: The present study aimed to investigate the impact of oligodontia on appearance and on the functional and psychosocial aspects of oral health-related quality of life (OHrQoL) in patients aged 8-29 years. METHODS: 62 patients with oligodontia that were registered at Radboud University Medical Center, Nijmegen, The Netherlands were included. A control group included 127 patients that were referred for a first orthodontic consultation. Participants completed the FACE-Q Dental questionnaire. Regression analyses were performed to explore relationships between OHrQoL and patient-identified gender, age, the number of congenitally missing teeth, active orthodontic treatment, and previous orthodontic treatment. RESULTS: The only clear significant difference between the oligodontia and control groups was that patients with oligodontia scored lower in the domain, 'eating and drinking' (p < 0.001). It was found that, in oligodontia, the greater the number of agenetic teeth, the more difficulties eating and drinking. In fact, the Rasch score was reduced by 1.00 (95% CI: 0.23-1.77; p = 0.012) for each extra agenetic tooth. Older children scored significantly lower than younger ones on five out of nine scales: appearance of the face, smile, and jaws; social function; and psychological function. Females scored significantly lower than males on four scales: appearance of the face, appearance distress, social function, and psychological function. CONCLUSION: These findings suggested that, when treating patients with oligodontia, the number of agenetic teeth, age, and gender should be taken into account. These factors could have negative effects on their self-assessment of appearance, their facial function, and their quality of life. CLINICAL SIGNIFICANCE: The increased difficulty with eating and drinking associated with more agenetic teeth highlighted the importance of functional (re)habilitation.

Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa.

BACKGROUND: Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors. METHODS: An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital. RESULTS: The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities. CONCLUSION: The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.

[Measuring tooth wear with regular intra-oral 3D scanners: for still in the future, or is it already possible?] / Serie: Innovatieve technieken en ontwikkelingen in de mondzorg. Meten van gebitsslijtage met reguliere 3D-scanners: toekomstmuziek, of al mogelijk?

Quantitative tooth wear measurement is a method of increasing importance when measuring tooth wear progression. The Radboud university medical center has developed a protocol that measures height and volumetric differences on regular 3D-scans. Intra-oral scans were made on patients with tooth wear and superimposed. To assess reliability the precision , as well as intra- and inter-rater precision of the protocol was tested. T-tests were performed to determine the structural and random error. Our findings indicate that the method is precise enough to measure height differences in patients with severe tooth wear progression, or tooth wear with an interval longer than 1 year. The method is not precise enough to measure volumetric changes.

Dentition patterns in bilateral cleft lip subphenotypes: multicenter study.

OBJECTIVES: Here, we retrospectively investigated cases of bilateral oral clefts (OCs) to determine the clinical relevance of detailed distinction of incomplete cleft lip subphenotypes, based on morphological severity of the cleft, within the categories cleft lip with or without alveolus (CL ± A) and cleft lip, alveolus, and palate (CLAP). We further assessed possible associations between CL subphenotypes (complete vs different incomplete types) and different dentition patterns of the lateral incisor. MATERIALS AND METHODS: Our analysis included 151 non-syndromic Caucasian bilateral OC-patients (8-20 years old) from the Dutch Association for Cleft Palate and Craniofacial Anomalies registry. Six different deciduous and permanent lateral incisor patterns were distinguished: normal position (z/Z), supernumerary lateral incisor (n/N), presence in the anterior (x/X) or posterior (y/Y) segment of the cleft, one in each cleft segment (xy/XY), and agenesis (ab/AB). Logistic regression was performed to show the associations between the CL subphenotypes and dentition patterns of the lateral incisor. RESULTS: One hundred three had complete, while 48 had incomplete CLs. Patterns z/Z and n/N were associated with a submucous/vermillion notch, incomplete CL, and intact alveolus. Patterns x/X, y/Y, and xy/XY were most common in patients with two-thirds to subtotal CL and complete CL. The most severe pattern, ab/AB, was most commonly associated with complete CL. CONCLUSIONS: Based on the morphological severity of the CLs, it can be stated that the more severe the CL in bilateral CL ± A and CLAP, the more severe the abnormal pattern of the dentition. CLINICAL RELEVANCE: Further distinction of incomplete cleft lip subphenotypes (submucous/vermillion notch, one-third to two-thirds CL, two-thirds to subtotal CL) in bilateral CL ± A and CLAP has clinical relevance.

Wear behavior of a microhybrid composite vs. a nanocomposite in the treatment of severe tooth wear patients: A 5-year clinical study.

OBJECTIVE: This study aimed to compare the wear behavior of a microhybrid composite vs. a nanocomposite in patients suffering from severe tooth wear. METHODS: A convenience sample of 16 severe tooth wear patients from the Radboud Tooth Wear Project was included. Eight of them were treated with a microhybrid composite (Clearfil APX, Kuraray) and the other eight with a nanocomposite (Filtek Supreme XTE, 3M). The Direct Shaping by Occlusion (DSO) technique was used for all patients. Clinical records were collected after 1 month (baseline) as well as 1, 3 and 5 years post-treatment. The maximum height loss at specific areas per tooth was measured with Geomagic Qualify software. Intra-observer reliability was tested with paired t-tests, while multilevel logistic regression analyses were used to compare odds ratios (OR) of "large amount of wear". RESULTS: Intra-observer reliability tests confirmed that two repeated measurements agreed well (p > 0.136). For anterior mandibular teeth, Filtek Supreme showed significantly less wear than Clearfil APX; in maxillary anterior teeth, Clearfil APX showed significantly less wear (OR material = 0.28, OR jaw position = 0.079, p < 0.001). For premolar and molar teeth, Filtek Supreme showed less wear in bearing cusps, whereas Clearfil APX showed less wear in non-bearing cusps (premolar: OR material = 0.42, OR bearing condition = 0.18, p = 0.001; molar: OR material = 0.50, OR bearing condition = 0.14, p < 0.001). SIGNIFICANCE: Nanocomposite restorations showed significantly less wear at bearing cusps, whereas microhybrid composite restorations showed less wear at non-bearing cusps and anterior maxillary teeth.

Randomized controlled trial on the performance of direct and indirect composite restorations in patients with severe tooth wear.

OBJECTIVE: The study aimed to evaluate survival and failure behavior of Direct Composite Restorations (DRC) and Indirect Composite Restorations (ICR) on molars and anterior teeth, in a Randomized Controlled Trial (RCT). METHODS: Patients with generalized severe tooth wear were included, and randomly assigned to one of 2 protocols: (1) DCR: All teeth were restored with directly applied micro-hybrid composite restorations (Clearfil AP-X, Kuraray) for load bearing areas and nano-hybrid composite restorations (IPS Empress Direct, Ivoclar Vivadent) for buccal veneers; (2) ICR: First molars were restored with indirect composite 'tabletop' restorations and maxillary anterior teeth were restored with indirect palatal veneer restorations (Clearfil Estenia C&B, cemented with Panavia F, Kuraray). Remaining teeth were restored directly. Restorations were evaluated after 3 years, focusing on clinical acceptability. Statistical analysis was performed using Kaplan Meier curves, Annual Failure Rates (AFRs), and univariate Cox regression analyses (p < 0.05). RESULTS: 41 patients (age: 36.6 ± 6.6y) were evaluated after 3 years (40.0 ± 2.2 m). 408 restorations on first molars and palatal veneers on maxillary anterior teeth were part of this RCT, with 220 DCRs and 188 ICRs. No differences in survival between treatment modality for palatal veneers for any failure criteria were found. Tabletop restorations on first molars showed a considerable higher failure rate for ICR compared to DCR (p = 0.026, HR: 3.37, 95%CI = 1.16-9.81). SIGNIFICANCE: In this RCT, directly applied composite restorations showed superior behavior compared to the indirect composite restorations, when used in the molar region.

[Self-reported oral health and oral health behaviour of asylum seekers]. / Zelfgerapporteerde mondgezondheid en mondgezondheidsgedrag van asielzoekers.

In order to assess the oral health and oral health behaviour of asylum seekers in the Netherlands, 542 asylum seekers completed questionnaires. There were questionnaires for the groups children (1-11 years), youths (12-17 years) and adults (18+ years). 4 Categories of questions were asked: 'demographic characteristics', 'complaints and symptoms', 'lifestyle and knowledge' and 'visiting the dentist'. Regression analyses were performed to see which demographic factors influenced oral health. Of the respondents, 42% of the children, 57% of the youths and 86% of the adults reported at least one oral complaint or symptom. Of them 42% of the children, 59% of the youths and 53% of the adults followed the basic recommendation to brush their teeth twice a day. Of those questioned, 45% of the children, 48% of the youths and 28% of the adults went to a dentist for check-ups. When these results are compared to the rest of the Dutch population, asylum seekers scored worse in all categories.

Significant salivary changes in relation to oral mucositis following autologous hematopoietic stem cell transplantation.

The aim of this multicentre, longitudinal study was to determine salivary changes in relation to oral mucositis (OM) in multiple myeloma patients following high-dose melphalan and autologous hematopoietic stem cell transplantation (ASCT). Unstimulated and stimulated whole-mouth saliva samples (UWS and SWS) were collected before ASCT, 1×/wk during the hospitalisation phase, and 3 and 12 months post-ASCT. During the hospitalisation period OM was scored 3×/wk (WHO system). Flow rate, pH, total protein concentration (Nanodrop), albumin, lactoferrin, neutrophil defensin-1 (HNP1), total IgA and S100A8/A9 (ELISA) were determined. Mixed models were used to evaluate differences between ulcerative (u)OM (≥2 WHO, n = 20) and non-uOM (n = 31) groups. Until 18 days after ASCT, flow rate, pH, total IgA and HNP1 levels decreased in UWS and/or SWS, while log lactoferrin levels were significantly increased (UWS: p = 0.016 95% CI [0.36, 3.58], SWS: p < 0.001 95% CI [1.14, 3.29]). Twelve months post-ASCT, salivary protein levels were similar to baseline except for log total IgA, which was higher (UWS: p < 0.001 95% CI [0.49, 1.29], SWS: p < 0.001 95% CI [0.72, 1.45]). No differences between uOM and non-uOM groups were observed. Changes in salivary proteins indicated an inflammatory reaction in salivary glands coinciding with mucosal and systemic reactions in response to high-dose melphalan.

Biopsy outperforms reflectance confocal microscopy in diagnosing and subtyping basal cell carcinoma: results and experiences from a randomized controlled multicentre trial.

BACKGROUND: Reflectance confocal microscopy (RCM) is a noninvasive method for skin assessment, allowing entire lesion evaluation up to the papillary dermis. RCM is a potentially attractive alternative to punch biopsy (PB) in basal cell carcinoma (BCC). OBJECTIVES: To determine the diagnostic accuracy of RCM vs. PB in diagnosing and subtyping BCC, and to study patient satisfaction and preferences. METHODS: Patients with a clinically suspected primary BCC were randomized between RCM and biopsy. Conventional surgical excision or follow-up were used as reference. Sensitivity and specificity for BCC diagnosis and subtyping were calculated for both methods. BCC subtype was stratified based on clinical relevance: aggressive (infiltrative/micronodular) vs. nonaggressive (superficial/nodular) histopathological subtype and superficial vs. nonsuperficial BCC. Data on patient satisfaction and preferences were collected using a questionnaire and a contingent valuation method. RESULTS: Sensitivity for BCC diagnosis was high and similar for both methods (RCM 99·0% vs. biopsy 99·0%; P = 1·0). Specificity for BCC diagnosis was lower for RCM (59·1% vs. 100·0%; P < 0·001). Sensitivity for aggressive BCC subtypes was lower for RCM (33·3% vs. 77·3%; P = 0·003). Sensitivity for nonsuperficial BCC was not significantly different (RCM 88·9% vs. biopsy 91·0%; P = 0·724). Patient satisfaction and preferences were good and highly comparable for both methods. CONCLUSIONS: Biopsy outperforms RCM in diagnosing and subtyping clinically suspected primary BCC. This outcome does not support routine clinical implementation of RCM, as a replacement for PBs in this patient group.

Nasolabial shape and aesthetics in unilateral cleft lip and palate: an analysis of nasolabial shape using a mean 3D facial template.

The aim of this study was to determine the amount of deviation in nasolabial shape in patients with a cleft compared with an average non-cleft face, and to assess whether this difference is related to nasolabial aesthetics. Three-dimensional stereophotogrammetric images of 60 patients with a unilateral cleft were used. To quantify shape differences, four average non-cleft faces were constructed from stereophotogrammetric images of 141 girls and 60 boys. Three-dimensional shape differences were calculated between superimposed cleft faces and the average non-cleft face for the same sex and age group. Nasolabial aesthetics were rated with the modified Asher-McDade Aesthetic Index using a visual analogue scale (VAS). Mean VAS scores ranged from 51.44 to 60.21 for clefts, with lower aesthetic ratings associated with increasing cleft severity. Shape differences were found between cleft faces and the average non-cleft face. No relationship was found for the VAS, age, and sex, except that a lower VAS was related to a higher nose and lip distance between the superimposed cleft and average non-cleft faces for nasal profile (P= 0.02), but the explained variance was low (R2=0.066). In conclusion, except for nasal profile, nasolabial aesthetics were not influenced by the extent of shape differences from the average non-cleft face.

An investigation into the impact of tooth wear on the oral health related quality of life amongst adult dental patients in the United Kingdom, Malta and Australia.

OBJECTIVE: To investigate the relationship between levels of tooth wear scored using the Basic Erosive Wear Examination (BEWE) and the impact on the quality of life of adult dental patients. METHODS: BEWE assessments were performed on 319 new dentate adult patients attending the practices of 5 trained recruiters based in primary care in Malta (120), Australia (118) or the UK (81). Oral impacts on the quality of life were measured using a shortened form of the Oral Health Impact Profile (OHIP-26). Regression analysis were performed, adjusted for age, to estimate the relationship between the variables. Data were expressed as Confidence Intervals (95 % CI), p-values (values <0.05 were considered statistically significant) and adjusted R2 values. RESULTS: Overall, the sample had a mean age of 42.6 ±â€¯17.1 (range, 18-93 years), a mean cumulative BEWE score of 6.7 ±â€¯4.4 and a mean total OHIP-26 score of 1.84 ±â€¯0.59. For the cumulative sextant BEWE scores, 68.0 % of the participants scored ≤ 8, 24.5 % between 9 and 13 and 7.5 %, ≥ 14. A significant association was found between increasing BEWE score and the overall OHIP-26 total score (effect = 0.028; p = 0.002), implying a higher BEWE to be associated with a larger impact of oral conditions on daily life. CONCLUSION: Higher levels of tooth wear were significantly associated with a deteriorating oral-health related quality of life amongst the participants. CLINICAL RELEVANCE: When treatment planning for patients with tooth wear, it is appropriate to consider the psycho-social impact of the condition alongside other clinical findings.

[Risk factors for class II dental restoration survival:a practice-based study]. / Risicofactoren voor klasse II-restauratieoverleving: een praktijkgebaseerd onderzoek.

The aim of this practice-based cohort study was to determine the performance and influence of possible variables in class II restorations related to practice, patient, tooth, and restoration. To do this, electronic patient files from 11 general practices in the Netherlands were collected, and 31,472 restorations placed between January 2015 and October 2017 were analysed. The observation time of restorations varied from 0 to 2.7 years, resulting in a mean annual failure rate (AFR) of 7.8% at 2 years. However, wide variation in AFRs existed among the operators, varying between 3.6% and 11.4%. An excess of patient-related variables, such as age, general health, periodontal status, caries risk and the presence of parafunctional habits and tooth or restoration-related factors, increases the risk of reintervention. Restorations placed due to fracture were more prone to fail than restorations placed due to caries. This study demonstrated that a wide variety of risk factors on the practice, patient, and tooth levels influences the survival of class II restorations.

Flaplessly placed 2.4-mm mini-implants for maxillary overdentures: a prospective multicentre clinical cohort study.

Studies on flaplessly placed, one-piece mini dental implants (MDIs) supporting overdentures in the maxilla are scarce. This prospective multicenter cohort study evaluated the outcomes (over 2 years) of five to six MDIs placed in the maxilla for overdentures. Study patients were ≥50 years old, with an edentulous maxilla and dentate/fixed prosthesis in the mandible. Dentures were provisionalized with the final connection at 6 months. Implant/prosthetic survival was evaluated, and postoperative discomfort and patient satisfaction were assessed (rating scale). Of 185 MDIs placed in 31 patients, 32 failed in 16 patients (17.3%); 22/83 in female patients and 10/102 in male patients. Kaplan-Meier analysis showed survival percentages of 86.3% (6 months), 84.0% (1year), and 82.3% (2 years). Two patients lost five or six MDIs resulting in two prosthetic failures (6.5%). Implant loss was significantly affected by sex, but not by smoking or location. The worst treatment combination was a torque value >25N·cm with an antagonist implant overdenture. The mean pain score was 4.1±2.8 on day 1 and 1.1±1.7 on day 7. The mean final satisfaction score was 8.6±1.7. The majority (96%) of the patients would recommend this treatment. Despite higher MDI failure in the maxilla compared to the mandible, prosthetic survival was acceptable and patient satisfaction was high, suggesting this to be a valuable treatment alternative.

Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study.

BACKGROUND: Postoperative pulmonary complications after major abdominal surgery are associated with adverse outcome. The diagnostic accuracy of chest X-rays (CXR) to detect pulmonary disorders is limited. Alternatively, lung ultrasound (LUS) is an established evidence-based point-of-care diagnostic modality which outperforms CXR in critical care. However, its feasibility and diagnostic ability for postoperative pulmonary complications following abdominal surgery are unknown. In this prospective observational feasibility study, we included consecutive patients undergoing major abdominal surgery with an intermediate or high risk developing postoperative pulmonary complications according to the Assess Respiratory risk In Surgical patients in CATalonia (ARISCAT) score. LUS was routinely performed on postoperative days 0-3 by a researcher blinded for CXR or other clinical findings. Then, reports were drawn up for LUS concerning feasibility and detection rates of postoperative pulmonary complications. CXRs were performed on demand according to daily clinical practice. Subsequently, we compared LUS and CXR findings. RESULTS: A total of 98 consecutive patients with an ARISCAT score of 41 (34-49) were included in the study. LUS was feasible in all patients. In 94 (95%) patients, LUS detected one or more postoperative pulmonary complications during the first four postoperative days. On day 0, LUS detected 31 out of 43 patients (72.1%) with one or more postoperative pulmonary complications, compared to 13 out of 36 patients (36.1%) with 1 or more postoperative pulmonary complications detected with CXR RR 2.0 (95 CI [1.24-3.20]) (p = 0.004). The number of discordant observations between both modalities was high for atelectasis 23 (43%) and pleural effusion 29 (54%), but not for pneumothorax, respiratory infection and pulmonary edema 8 (15%), 3 (5%), and 5 (9%), respectively. CONCLUSIONS: This study shows that LUS is highly feasible and frequently detects postoperative pulmonary complications after major abdominal surgery. Discordant observations in atelectasis and pleural effusions for LUS and CXR can be explained by a superior diagnostic ability of LUS in detecting these conditions. The effects of LUS as primary imaging modality on patient outcome should be evaluated in future studies.

Risk Factors for Dental Restoration Survival: A Practice-Based Study.

To improve patient dental care, it is necessary to identify possible risk factors for the failing of restorations. This practice-based cohort study investigated the performance and influence of possible risk factors at the level of the practice, patient, tooth, and restoration on survival of direct class II restorations. Electronic patient files from 11 Dutch general practices were collected, and 31,472 restorations placed between January 2015 and October 2017 were analyzed. Kaplan-Meier statistics were performed; annual failure rates (AFRs) were calculated; and variables were assessed by multivariable Cox regression analysis. The observation time of restorations varied from 0 to 2.7 y, resulting in a mean AFR of 7.8% at 2 y. However, wide variation in AFRs existed among the operators, varying between 3.6% and 11.4%. A wide range of patient-related variables is related to a high risk for reintervention: patient age (elderly: hazard ratio [HR], 1.372), general health (medically compromised: HR, 1.478), periodontal status (periodontal problems: HR, 1.207), caries risk and risk for parafunctional habits (high: HR, 1.687), restorations in molar teeth (HR, 1.383), restorations placed in endodontically treated teeth (HR, 1.890), and multisurface restorations (≥4 surfaces: HR, 1.345). Restorations placed due to fracture were more prone to fail than restorations placed due to caries. When patient-related risk factors were excluded, remaining risk factors considerably changed in their effect and significance: the effect of operator, age of the patient, and endodontic treatment increased; the effect of the diagnosis decreased; and the socioeconomic status became significant (high: HR, 0.873). This study demonstrated that a wide variation of risk factors on the practice, patient, and tooth levels influences the survival of class II restorations. To provide personalized dental care, it is important to identify and record potential risk factors. Therefore, we recommend further clinical studies to include these patient risk factors in data collection and analysis.

Three dimensional maxillary growth modeling in newborns.

OBJECTIVES: The aim of this study was to develop an accurate and intuitive semi-automatic segmentation technique to calculate an average maxillary arch and palatal growth profile for healthy newborns in their first year of life. MATERIALS AND METHODS: Seventy babies born between 1985 and 1988 were included in this study. Each child had five impressions made in the first year after birth that were digitalized. A semi-automatic segmentation tool was developed and used to assess the maxillary dimensions. Finally, random effect models were built to describe the growth and build a simulation population of 10,000 newborns. The segmentation was tested for inter- and intra-observer variability. RESULTS: The Pearson correlation coefficient for each of the variables was between 0.94 and 1.00, indicating high inter-observer agreement. The paired sample t test showed that, except for the tuberosity distance, there were small, but significant differences in the landmark placements between observers. Intra-observer repeatability was high, with Pearson correlation coefficients ranging from 0.87 to 1.00 for all measurements, and the mean differences were not significant. A third or second degree growth curve could be successfully made for each parameter. CONCLUSIONS: These findings indicated this method could be used for objective clinical evaluation of maxillary growth. CLINICAL RELEVANCE: The resulting growth models can be used for growth studies in healthy newborns and for growth and treatment outcome studies in children with cleft lip and palate or other craniofacial anomalies.