Higher reconstruction failure and less patient-reported satisfaction after post mastectomy radiotherapy with immediate implant-based breast reconstruction compared to immediate autologous breast reconstruction.

PURPOSE: To improve shared decision making, clinical- and patient-reported outcomes between immediate implant-based and autologous breast reconstruction followed by postmastectomy radiotherapy (PMRT) were compared. METHODS: All women with in situ and/or invasive breast cancer who underwent skin sparing mastectomy with immediate breast reconstruction (IBR) (autologous- or implant based, one- or two staged) followed by PMRT in the Utrecht region between 2012 and 2016 were selected from the Netherlands Cancer Registry, of which 112 (59%) agreed to participate. The primary outcome was reconstruction failure after the start of radiotherapy, and secondary outcomes were patient-reported outcomes measured with BREAST-Q. RESULTS: 109 patients underwent skin-sparing mastectomy, of which 29 (27%) underwent immediate autologous reconstruction and 80 (73%) received immediate implant-based reconstruction. After PMRT, reconstruction failure occurred in 17 patients (21%) with implant-based reconstruction, while no failure was seen in the autologous group (p = 0.04). Mean patient-reported 'Satisfaction with Breasts' (50.9 vs. 63.7, p = 0.001) and 'Sexual Well-being' (46.0 vs. 55.5, p = 0.037) were lower after implant-based reconstruction compared to autologous reconstruction. Thirteen patients with autologous flaps underwent surgical cosmetic corrections compared to ten patients in the implant group (45 vs. 13%, p = 0.001). IBR and PMRT in this study resulted in a high rate of severe capsular contraction in implant-based reconstruction (16.9%) and fibrosis in autologous reconstruction (13.8%). CONCLUSIONS: Patients treated with PMRT and one or two stage immediate implant-based reconstruction were at greater risk of developing reconstruction failure and were less satisfied when compared to one or two stage immediate autologous reconstruction. Since fairly high complication rates in both reconstruction methods after PMRT are observed, it raises the question whether immediate breast reconstruction should be considered at all when PMRT is indicated. Patients considering or potential candidates for IBR should be informed about the consequences of PMRT and especially when opting for autologous reconstruction one should possibly perform reconstruction in a secondary setting.

The Hall Technique 10 years on: Questions and answers.

It is ten years since the first paper on the Hall Technique was published in the British Dental Journal and almost 20 years since the technique first came to notice. Dr Norna Hall a (now retired) general dental practitioner from the north of Scotland had, for many years, been managing carious primary molar teeth by cementing preformed metal crowns over them, with no local anaesthesia, tooth preparation or carious tissue removal. This first report, a retrospective analysis of Dr Hall's treatments, caused controversy. How could simply sealing a carious lesion, with all the associated bacteria and decayed tissues, possibly be clinically successful? Since then, growing understanding that caries is essentially a biofilm driven disease rather than an infectious disease, explains why the Hall Technique, and other 'sealing in' carious lesion techniques, are successful. The intervening ten years has seen robust evidence from several randomised control trials that are either completed or underway. These have found the Hall Technique superior to comparator treatments, with success rates (no pain or infection) of 99% (UK study) and 100% (Germany) at one year, 98% and 93% over two years (UK and Germany) and 97% over five years (UK). The Hall Technique is now regarded as one of several biological management options for carious lesions in primary molars. This paper covers commonly asked questions about the Hall Technique and speculates on what lies ahead.

The opinion of children and their parents about four different types of dental restorations in a public health service in Brazil.

AIM: To investigate the opinion of children and their parents of four different types of restoration placed in primary molars. METHODS: A mixed method study in which both children and their parents were involved. In the quantitative study, children and parents gave their opinion using a face scale about four different types of restoration immediately after placement, evaluating how satisfied they were. In the qualitative part, children and their parents were interviewed to report their preference among the four types of restoration using dental models and photos. RESULTS: In the quantitative study, 1045 restorations were placed, being conventional restorations (198 with amalgam and 205 with composite resin) and atraumatic interventions [408 with glass ionomer: ART, atraumatic restorative treatment, and 234 with preformed metal crowns (PMCs): Hall technique]. Almost all participants (children and parents) gave a positive opinion (from 94.9 to 100%) on the four types of restoration placed in the children's teeth. There was no statistical significant difference in opinion in terms of acceptance of the four types of restoration placed (Chi square test, p value > 0.05). In the qualitative approach, 18 children and 11 parents were interviewed. If they could choose, children (16/18) preferred the PMCs, while parents (10/11) preferred aesthetic materials such as composite resin and glass ionomer cement. CONCLUSIONS: A high degree of satisfaction was observed with children and their parents in the four types of restoration after placement. However, if it could be chosen in advance, children prefer the PMCs and parents a tooth-coloured material.

The fixation of a collagen type I/III membrane in the distal radioulnar joint of a human cadaver model.

Damage to the cartilage of the distal radioulnar joint frequently leads to pain and limitation of movement, therefore repair of this joint cartilage would be highly desirable. The purpose of this study was to investigate the fixation of scaffold in cartilage defects of this joint as part of matrix-assisted regenerative autologous cartilage techniques. Two techniques of fixation of collagen scaffolds, one involving fibrin glue alone and one with fibrin glue and sutures, were compared in artificially created cartilage defects of the distal radioulnar joint in a human cadaver. After being subjected to continuous passive rotation, the methods of fixation were evaluated for cover of the defect and pull out force. No statistically significant differences were found between the two techniques for either cover of the defect or integrity of the scaffold. However, a significantly increased mean pull out force was found for the combined procedure, 0.665 N (0.150 to 1.160) versus 0.242 N (0.060 to 0.730) for glue fixation (p = 0.001). This suggests that although successful fixation of a collagen type I/III scaffold in a distal radioulnar joint cartilage defect is feasible with both forms of fixation, fixation with glue and sutures is preferable.

Four-corner arthrodesis using the Quad memory staple.

Range of motion, pain, consolidation and complications were evaluated for nine patients who underwent four-corner arthrodesis using the Quad Memory Staple (QMS) at a mean follow-up of 44 months. The mean pre-operative range of motion was 50 degrees extension, 62 degrees flexion, 9 degrees radial deviation and 24 degrees ulnar deviation. The postoperative range of motion was similar to previous studies at 32 degrees extension, 31 degrees flexion, 15 degrees radial deviation and 20 degrees ulnar deviation. The grip strength was 28 kg pre-operatively and 26 kg postoperatively. The mean pain score improved from 41 to 23 and the Disabilities of Arm, Shoulder, and Hand (DASH) score from 24 to 20. Non-union, haematoma and wound infection were not seen and eventually all four-corner fusions were consolidated. The main advantages of the QMS are its compressive property and the simple fixation technique. It gives good stability, enables early rehabilitation and avoids the risks of pin fixation methods.

Pain related to different ways of minimal intervention in the treatment of small caries lesions.

Pain during invasive treatment of dental caries is a common phenomenon, if no local analgesia has been used before cavity preparation. Atraumatic restorative technique (ART) is a suggested procedure which is at least less traumatic for the patient. Although the ART approach has been received well by both children and adults who belong to population groups hardly ever exposed to regular oral health care, it has not yet been proven that this particular procedure really causes less pain, compared to more conventional techniques with rotating instruments. In the present study, pain was reported in connection with tooth restoration in 19.3 percent of the cases, when the ART technique was used, which is significantly less than with a conventional restorative technique (35.7 percent). Finally the results show a clear relationship in the pain reports between the first and the following treatments in both ART and the conventional technique groups.

15-year evaluation of Class II amalgam restorations.

In a clinical trial, 1544 Class II amalgam restorations were inserted. In this study 1213 restorations were evaluated after 15 years and the reasons for replacement were registered. Attention was also paid to patient drop-out and patients' variables such as gender, filling degree, type of tooth (premolar vs molar), type of restoration (MO or DO vs MOD), jaw (upper vs lower) and the patients' operator. Furthermore, replacement rates of three alloys applied in comparable circumstances (n = 394) are reported. Of the restorations, 214 (17.6%) were replaced during the trial period. Factors influencing the replacement rates are gender, type of restoration and operator. Factors such as type of tooth and type of alloy seemed to have no influence on the replacement rates in this study.

[Veterinary dentistry (5). Instruments for extractions in pets]. / Veterinaire tandheelkunde (5). Instrumentarium voor extracties bij gezelschapsdieren.

The increasing dental care of companion animals requires good instruments. The instruments needed to perform extractions well are described in this article. Research into the use of the most appropriate (used in humans) instruments has led to the establishment of a set of instruments for use for simple and complicated extractions in dogs and cats.