Time-study research on maxillofacial prosthetic treatment.

Unreasonable medical fees can cause problems such as increased medical costs, greater medical disparities, decreased medical standards, and physician shortages. To prevent such problems, it is important to set appropriate medical fees, ensure their proper use, and improve the efficiency of medical care. The treatment of patients with maxillofacial defects is generally more expensive compared with general prosthodontic treatment because it involves more materials and requires more frequently follow-ups for longer period. However, the actual time required for maxillofacial prosthetic treatment is unclear. Therefore, in this study, we aimed to clarify the amount of time spent treating maxillofacial prosthetic patients. We analyzed clinical data from patients undergoing routine maxillofacial prosthetic treatment, irrespective of difficulty level, at 8 university hospitals and 2 dental clinics. We also collected data from maxillofacial prosthodontists on the treatment time required for various Japanese health insurance items, including the fabrication of maxillofacial prostheses. The results revealed that some aspects of maxillofacial prosthetic treatment may take longer to perform and are more costly to perform than previously thought, suggesting the need for some adjustments to the health insurance reimbursement system. Maintaining an appropriate balance between expenditures and fees will greatly benefit patients and physicians, ensuring positive health outcomes and a healthy society.

Effect of soft denture liners on complete denture treatments: A systematic review.

PURPOSE: This systematic review examined the effectiveness of soft denture relining (SDR) materials. STUDY SELECTION: A comprehensive search of MEDLINE, Cochrane Library, and ICHUSHI was conducted up to July 26, 2020. Target outcomes were patient satisfaction, oral health-related quality of life (OHRQOL), masticatory ability (MA), denture functional duration, residual ridge resorption (RRR), and microbial contamination. An organization specializing in literature searches performed the reference searches, and two reviewers independently selected the literature sources, extracted the data, and assessed the risk of bias. The reviewers resolved any disagreements concerning the assortment of literature sources through discussion. SDR included acrylic- and silicone-based materials, which were evaluated separately. RESULTS: Reviewers selected 7, 5, 11, 1, 4, and 6 studies to assess patient satisfaction, OHRQOL, MA, functional duration, RRR, and microbial contamination, respectively. The results confirmed that SDR improved patient satisfaction, OHRQOL, MA, and RRR. However, the functional duration of SDR material is shorter than that of hard denture relining (HDR) or acrylic resin material. Furthermore, SDR material is more susceptible to microbial contamination in the long term. The risk of bias for the included studies tended to be high because of specific issues (difficulty in blinding SDR versus HDR). CONCLUSIONS: For patients who wear complete dentures, SDR often provides beneficial outcomes such as pain reduction and recovery from MA. However, caution should be exercised regarding their use owing to insufficient functional duration and the possibility of microbial contamination during long-term use.

Lower bone mineral density and higher bone resorption marker levels in premenopausal women with type 1 diabetes in Japan.

AIMS/INTRODUCTION: Type 1 diabetes is associated with poorer bone quality. Quantitative ultrasound provides an estimate of bone mineral density (BMD) and can also be used to evaluate bone quality, which is associated with an increased fracture risk in people with type 1 diabetes. The aim of this study was to evaluate the association between menopausal status and a bone turnover marker with heel BMD using quantitative ultrasound in women with type 1 diabetes and age- and body mass index-matched controls. MATERIALS AND METHODS: A total of 124 individuals recruited in Kyoto and Osaka, Japan - 62 women with type 1 diabetes (mean age 47.2 ± 17.3 years) and 62 age-, menopausal status-, sex- and body mass index-matched non-diabetic control individuals (mean age 47.3 ± 16.3 years) - were enrolled in this study. Heel BMD in the calcaneus was evaluated using ultrasonography (AOS-100NW, Hitachi-Aloka Medical, Ltd., Tokyo, Japan). A bone turnover marker was also measured. RESULTS: The heel BMD Z-score was significantly lower in premenopausal women with type 1 diabetes than in the premenopausal control group, but not in postmenopausal women with type 1 diabetes. Levels of tartrate-resistant acid phosphatase-5b, a bone resorption marker, were significantly higher in premenopausal women with type 1 diabetes than in the premenopausal control group, but not in postmenopausal women with type 1 diabetes. The whole parathyroid hormone level was significantly lower in both pre- and postmenopausal women with type 1 diabetes. CONCLUSIONS: Lower heel BMD, higher tartrate-resistant acid phosphatase-5b level and lower parathyroid hormone were observed in premenopausal women with type 1 diabetes. Premenopausal women with type 1 diabetes require osteoporosis precautions for postmenopause.

Fabricating nasal prostheses using four-dimensional facial expression models.

Purpose Patients with facial prostheses face challenges such as maintenance of the prosthesis in place, especially around the margins, because of movement of surrounding facial skin. Conventional facial prostheses are fabricated on stationary models based on two points: neutral expression and smiling expression. We developed four-dimensional (4D) facial expression models which shape facial expressions that change over several points in time using a morphing technique. We fabricated facial prostheses using 4D models and evaluated their accuracy and fit compared with prostheses generated with the two-expression technique.Methods Seven patients with nasal defects or nasal deformities participated in this study. Facial expression morphing prostheses were fabricated based on the 4D scanned data of each patient, using five points between neutral expression (0%) and smiling (100%). Five nasal prostheses, one for each point, were evaluated in each patient objectively and subjectively for accuracy and fit.Results On subjective evaluation, the nasal prostheses fabricated using the 4D facial expression models had better marginal sealing over the range from the neutral expression to smiling, and showed better attachment during facial movement on objective evaluation.Conclusions Facial prostheses fabricated using 4D facial expression models provided better marginal sealing than those fabricated using conventional two-point modeling.

Development of three-dimensional facial expression models using morphing methods for fabricating facial prostheses.

PURPOSE: It is essential to fabricate a best-fit three-dimensional (3D) facial prosthesis model capable of facial expressions. In order for the facial prosthesis to remain in position, especially around marginal areas subject to movement, a new method of making 3D facial expression models using time-series data allowing changes in facial expression by morphing technique was developed. METHODS: Seven normal subjects and seven patients with nasal defects or nasal deformities participated in this study. Three distinct facial expressions (i.e., a neutral expression, smiled, and open mouthed) were digitally acquired with a facial scanner. Prepared template models were transformed to homologous models, which can represent the form as shape data with the same number of point cloud data of the same topology referring to the scanning data. Finally, 3D facial expression models were completed by generating a morphing image based on two sets of homologous models, and the accuracy of the homologous models of all subjects was evaluated. RESULTS: 3D facial expression models of both normal subjects and patients with nasal defects were successfully generated. No significant differences in shape between the scanned models and homologous models were shown. CONCLUSIONS: The high accuracy of this 3D facial expression model in both normal subjects and patients suggests its use for fabricating facial prostheses.

Diagnostic accuracy of the anti-glutamic acid decarboxylase antibody in type 1 diabetes mellitus: Comparison between radioimmunoassay and enzyme-linked immunosorbent assay.

AIMS/INTRODUCTION: The distributer of the anti-glutamic acid decarboxylase antibody assay kit using radioimmunoassay (RIA) recently announced its discontinuation, and proposed an alternative kit using enzyme-linked immunosorbent assay (ELISA). The aim of the present study was to investigate the diagnostic values of the anti-glutamic acid decarboxylase antibody by RIA and ELISA among type 1 diabetes mellitus patients and control participants. MATERIALS AND METHODS: A total of 79 type 1 diabetes mellitus patients and 79 age-matched controls were enrolled and assessed using RIA and ELISA. Sensitivity, specificity, positive predictive values and negative predictive values were calculated for cut-off values (RIA = 1.5 U/mL and ELISA = 5.0 U/mL, respectively). Kappa coefficients were used to test for agreements between the RIA and ELISA methods regarding the diagnosis of type 1 diabetes mellitus. RESULTS: The sensitivity, specificity, positive predictive values, and negative predictive values for diagnosing type 1 diabetes mellitus were 57.0, 97.5, 95.7, and 69.4% by RIA, and 60.8, 100.0, 100.0 and 71.8% by ELISA, respectively. The diagnosis of type 1 diabetes mellitus using the RIA and ELISA methods showed substantial agreement with the kappa values of 0.74 for all participants, and of 0.64 for the acute type; however, there was moderate agreement with the kappa value of 0.56 for the slowly progressive type. CONCLUSIONS: The present study suggests that both anti-glutamic acid decarboxylase antibody by RIA and ELISA was useful for diagnosing type 1 diabetes mellitus. However, in the slowly progressive type, the degree of agreement of these two kits was poorer compared with those in all participants or in the acute type.

Innovative Approach for Interim Facial Prosthesis Using Digital Technology.

Despite the important role of facial prosthetic treatment in the rehabilitation of head and neck cancer patients, delay in its implementation can be unavoidable, preventing patients from receiving a prompt facial prosthesis and resuming a normal social life. Here, we introduce an innovative method for the fabrication of an interim facial prosthesis. Using a 3D modeling system, we simplified the fabrication method and used a titanium reconstruction plate for facial prosthesis retention. The patient received the facial prosthesis immediately after surgery and resumed a normal social life earlier than is typically observed with conventional facial prosthetic treatment.

The relationship between the frequency of self-monitoring of blood glucose and glycemic control in patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion or on multiple daily injections.

AIMS/INTRODUCTION: We investigated the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycemic control in type 1 diabetes mellitus patients on continuous subcutaneous insulin infusion (CSII) or on multiple daily injections (MDI) using data management software. MATERIALS AND METHODS: We recruited 148 adult type 1 diabetes mellitus patients (CSII n = 42, MDI n = 106) and downloaded their SMBG records to the MEQNET™ SMBG Viewer software (Arkray Inc., Kyoto, Japan). The association between the SMBG frequency and the patients' hemoglobin A1c (HbA1c) levels was analyzed using the χ(2)-test and linear regression analysis was carried out to clarify their relationship. RESULTS: The odds ratio of achieving a target HbA1c level of <8% (63.9 mmol/mol) was significantly higher in subjects with SMBG frequencies of ≥3.5 times/day compared with those with SMBG frequencies of <3.5 times/day in the CSII group (odds ratio 7.00, 95% confidence interval 1.72-28.54), but not in the MDI group (odds ratio 1.35, 95% CI 0.62-2.93). A significant correlation between SMBG frequency and the HbA1c level was detected in the CSII group (HbA1c [%] = -0.24 × SMBG frequency [times/day] + 8.60 [HbA1c {mmol/L} = -2.61 × SMBG frequency {times/day} + 70.5], [r = -0.384, P = 0.012]), but not in the MDI group. CONCLUSIONS: A SMBG frequency of <3.5 times per day appeared to be a risk factor for poor glycemic control (HbA1c ≥8%) in type 1 diabetes mellitus patients on CSII.

Finite element study on the effect of abutment length and material on implant bone interface against dynamic loading.

PURPOSE: Finite element study on the effect of abutment length and material on implant bone interface against dynamic loading. MATERIALS AND METHODS: Two dimensional finite element models of cylinderical implant, abutments and bone made by titanium or polyoxymethylene were simulated with the aid of Marc/Mentat software. Each model represented bone, implant and titanium or polyoxymethylene abutment. Model 1: Implant with 3 mm titanium abutment, Model 2: Implant with 2 mm polyoxymethylene resilient material abutment, Model 3: Implant with 3 mm polyoxymethylene resilient material abutment and Model 4: Implant with 4 mm polyoxymethylene resilient material abutment. A vertical load of 11 N was applied with a frequency of 2 cycles/sec. The stress distribution pattern and displacement at the junction of cortical bone and implant was recorded. RESULTS: When Model 2, 3 and 4 are compared with Model 1, they showed narrowing of stress distribution pattern in the cortical bone as the height of the polyoxymethylene resilient material abutment increases. Model 2, 3 and 4 showed slightly less but similar displacement when compared to Model 1. CONCLUSION: Within the limitation of this study, we conclude that introduction of different height resilient material abutment with different heights i.e. 2 mm, 3 mm and 4 mm polyoxymethylene, does not bring about significant change in stress distribution pattern and displacement as compared to 3 mm Ti abutment. Clinically, with the application of resilient material abutment there is no significant change in stress distribution around implant-bone interface.

Fabrication of an orbital prosthesis using a noncontact three-dimensional digitizer and rapid-prototyping system.

Conventionally, fabricating a facial prosthesis requires complicated steps and sophisticated skills. Particularly, the facial impression can be uncomfortable for the patient and can cause compression because of the weight of the material. The new approach presented in this report could simplify the fabrication of facial prostheses using a noncontact three-dimensional digitizer and binder multinozzle inkjet printer, without computed tomography or making a conventional impression. Treatment time was reduced, and the patient expressed satisfaction after 6 months follow-up.

Contrast-enhanced multiphase dynamic ultrasonography for the characterization of liver tumors.

PURPOSE: The purpose of the study was to introduce our protocol for contrast-enhanced multiphase dynamic ultrasonography (US) and examine the effectiveness of this method for characterizing liver tumors. METHODS: The subjects were 142 patients with liver tumors. The final diagnoses were 58 hepatocellular carcinomas (HCCs), 4 cholangiocellular carcinomas (CCCs), 14 metastases, 29 hemangiomas, 6 cases of focal nodular hyperplasia (FNH), and 31 other benign lesions. The contrast agent used was Levovist. A wide-band pulse inversion harmonic imaging mode was employed. Multiphase dynamic US was achieved by changing the sound transmission interval automatically from 0.3 s to 15.0 s according to a preset menu. Early arterial-phase images were observed at the short interval, and an equilibrium-phase image was observed at the longest interval. After a series of vascular images, a postvascular liver parenchymal image was obtained. Based on previously published criteria, the most compatible diagnosis was noted. The accuracy of this multiphase dynamic US technique for diagnosing focal liver lesions was examined by comparing our results with the final diagnosis based on a prospective study. RESULTS: The overall accuracy of all 142 cases was 93.7%. The sensitivity, specificity, and positive predictive value were, respectively, 100%, 92.9%, and 90.6% for HCC; 88.9%, 97.6%, and 84.2% for metastasis or CCC; 89.7%, 100%, and 100% for hemangioma; and 83.3%, 100%, and 100% for FNH. CONCLUSION: Contrast-enhanced multiphase dynamic US is a highly accurate, safe diagnostic tool for characterizing liver tumors.

[A strategy for assessing environmental influence on airway allergy using a regression binary tree-based method].

OBJECTIVE: To clarify the living environment factors that increase the risk of allergic sensitization to house dust mites, we applied a regression binary tree-based method (CART, Classification & Regression Trees) to an epidemiological study on airway allergy. The utility of the tree map in personal sanitary guidance for preventing allergic sensitization was examined with respect to feasibility and validity. SUBJECTS AND METHODS: A questionnaire was given to 386 healthy adult women, asking them about their individual living environments. Also, blood samples were collected to measure Dermatophagoides pteronyssinus (Dp)-specific IgE, the presence/absence of Dp-sensitization being expressed as positive/negative. The questionnaire consisted of nine items on (1) home ventilation by keeping windows open, (2) personal or family smoking habits, (3) use of air conditioners in hot weather, (4) type of flooring (tatami/wooden/carpet) in the living room, (5) visible mold proliferation in the kitchen, (6) type of housing (concrete/wooden), (7) residential area (heavy or light traffic area) (8) heating system (use of unventilated combustion appliances), and (9) frequency of cleaning (every day or less often). There also were queries on the past history of airway allergic diseases, such as bronchial asthma and allergic rhinitis. CART and a multivariate logistic regression analysis (MLRA) were performed. The subjects were first classified into two groups, with and without a history of airway allergic diseases (Groups WPH and WOPH). In each group, the involvement of living environment factors in Dp-sensitization was examined using CART and MLRA. RESULTS: In the MLRA study, individual living environment factors showed promotional or suppressive effects on Dp-sensitization with differences between the two groups. With respect to the CART results, the two groups were first split by the factor that had the most significant odds ratio for MLRA. In Group WPH, which had a Dp-sensitization risk of 19.5%, the first split was by the factor of visible mold proliferation in the kitchen into the factor-present group with a risk value of 45.5% and the factor-absent group with 13.5%. The mold proliferation group was split with reference to frequent cleaning, and the risk rose to 75% in the factor-absent group and to 100% when family smoking habits were reported. Group WOPH (the risk: 10.8%) was first split into two groups according to the use of air conditioners in hot weather for more than 6 hours a day or less, which showed risk values of 16.7% and 6.9%, respectively. The risk of the group that intensively used air conditioners fell to 8.3% with tatami as flooring in the living room, and, if others, rose to 20.8%. The risk of the factor-lacking group fell to 4.0% without wooden flooring. CONCLUSIONS: CART analysis enables us to express complex relationships between living environment factors and Dp-sensitization simply by a binary regression tree, pointing to preventive strategies that can be flexibly changed according to the individual living environments of the subjects.

[Potential risk factors aggravating airway allergy--aspects of involvement of airtight housing and passive smoking].

OBJECTIVES: The involvement of tightly insulated housing conditions and passive smoking in atopic sensitization, a major risk factor for airway allergy, was examined with nonsmoking adult women and school-age children. SUBJECTS AND METHODS: The subjects were 382 nonsmoking healthy adult women (housewives) who underwent medical examinations for prevention of adult diseases conducted in a district of Osaka from 1995 to 1997, and 214 elementary school-children 9-12 years old living in an urban district of Osaka who underwent medical examinations at a health center in April, 2000 to prevent allergic diseases. We also examined the correlation between tightly insulated housing conditions and the amount of passive smoking based on family smoking habits with 170 children under 12 years old who had been under the care of a hospital pediatrics department between December, 1993 and May, 1994. A questionnaire was administered to all subjects to survey the housing structure (concrete/wooden housing), family smoking habits and visible mold proliferation in the kitchen in relation to airtight housing conditions, passive smoking and exposure to inhalant allergens. Atopic sensitization was assessed by positivity for serum house dust mite-specific IgE, and passive smoking was defined as a urinary cotinine level of more than 6 ng/mgCr. RESULTS: 1. Among the three factors, indoor mold proliferation and family smoking habits were positively and synergistically related with atopic sensitization to house dust mites. 2. Airtight conditions of concrete housing showed a promotional effect on passive smoking for housewives, but a suppressive effect for school-age children. 3. Taking into account the above results, the promotional effects of passive smoking on atopic sensitization appeared predominantly in the concrete housing-residence group of housewives and the wooden housing-residence group of school-age children. 4. Effects of visible mold proliferation in the kitchen on atopic sensitization appeared predominantly in wooden housing-residence group of housewives. CONCLUSIONS: The results suggest that involvement of the three factors in atopic sensitization is due to increased exposure to indoor inhalant allergens or enhanced IgE-antibody production (adjuvant effects of tobacco smoke) and the extent of their inpact varies depending on the individual life styles of the housewives and school-age children.

The pattern of tongue pressure against the palate during articulating glossal sounds in normal subjects and glossectomy patients.

The purpose of the present study was to measure tongue pressure with the aim of characterizing the pattern of linguopalatal contact during articulating glossal sounds in normal subjects and glossectomy patients. Tongue pressures against the palate were evaluated in 13 normal subjects and 5 glossectomy patients by using three parameters: the duration from the onset of linguopalatal contact to the time of maximum pressure, the maximum pressure, and anterior posterior ratio of the maximum pressure. Three glossal sounds, [ti], [t [symbol: see text] i], and [[symbol: see text] i], which have tendency of mishearing in glossectomy patients, were selected for test sounds. A unique characteristic was demonstrated in normal subjects. The score of the maximum pressure showed an apparent order among the three sounds, while the durations revealed the opposite order. Anterior posterior ratio of the maximum pressure also showed some relationship among three sounds. In glossectomy patients, these characters were not found. The loss of tongue volume or deterioration of tongue mobility causes these results.