MRI of pelvic endometriosis: evaluation of the mr#Enzian classification and the importance of adenomyosis subtypes.

PURPOSE: This study aimed to investigate the utility of the #Enzian classification in magnetic resonance imaging (MRI) for endometriosis assessment, focusing on inter-reader agreement, diagnostic accuracy, and the correlation of adenomyosis with deep endometriosis (DE). METHODS: This IRB- approved retrospective single-center study included 412 women who underwent MRI evaluation for endometriosis between February 2017 and June 2022. Two experienced radiologists independently analyzed MRI images using the #Enzian classification and assessed the type of adenomyosis, if any. The surgical #Enzian classification served as the gold standard for evaluating preoperative MRI results of 45 patients. Statistical analysis was performed to assess inter-reader agreement and diagnostic accuracy. RESULTS: Inter-reader agreement was substantial to excellent (Cohen's kappa 0.75-0.96) for most compartments except peritoneal involvement (0.39). The preoperative MRI showed mostly substantial to excellent accuracy (0.84-0.98), sensitivity (0.62-1.00), specificity (0.87-1.00), positive (0.58-1.00) and negative predictive values (0.86-1.00) for most compartments, except for peritoneal lesions (0.36, 0.17, 1.00, 1.00, 0.26 respectively). A trend with a higher prevalence of concordant DE in women with MR features of external adenomyosis compared to those with internal adenomyosis was visible (p = 0.067). CONCLUSIONS: The mr#Enzian showed mostly high inter-reader agreement and good diagnostic accuracy for various endometriosis compartments. MRI's role is particularly significant in the context of the current paradigm shift towards medical endometriosis treatment. The inclusion of information about the type of adenomyosis in the mr#Enzian classification could enhance diagnostic accuracy and inform treatment planning.

Ozone Therapy for a Soccer Player With Osteitis Pubis: A Case Report.

CONTEXT: Osteitis pubis (OP), which occurs as a result of excessive use of the symphysis pubis and parasymphysis bones, is more common in long-distance runners and kicking athletes, especially football players. Due to the poor results of commonly used treatments for OP, there is a need for investigation of more effective treatments, such as ozone therapy. Ozone therapy is used to treat a variety of diseases, including musculoskeletal conditions. CASE PRESENTATION: A 30-year-old amateur soccer player diagnosed with OP received conservative treatment with traditional physiotherapy and analgesic medications. After 6 months and no resolution of symptoms, the patient presented to the sports medicine outpatient clinic seeking alternative therapy options. MANAGEMENT AND OUTCOMES: The patient received ozone injections in 3 sessions administered at 10-day intervals. At 1, 3, 6 and 12 months after the treatment, the patient's complaints and pain levels were re-evaluated and examined. The patient was able to return to competition at the same level after the first injection. No recurrence was revealed at a minimum of 12 months of follow-up. CONCLUSION: In this article, we present a case in which OP was successfully treated with ozone injection.

The Effect of the Wall Thickness of 3D-Printed Obturator Bulbs on Masticatory Function in Patients with Aramany Class I Defects: A Randomized Crossover Clinical Trial.

PURPOSE: To evaluate the effect of obturator bulb thickness on the masticatory performance and weight of obturator prostheses in edentulous hemimaxillectomy patients. MATERIALS AND METHODS: A randomized, single-blind, three-period crossover trial was conducted with 17 edentulous patients. Each patient was provided with three definitive 3D-printed obturator prostheses. Obturators were divided into three groups: group 1 (G1; 1-mm bulb); group 2 (G2; 2-mm bulb); and group 3 (G3; 3-mm bulb). After fabrication, the weight of each obturator was measured with a digital analytical balance. The patients used each obturator for a period of 2 weeks without a passive period (ie, they did not stop using the obturator). The masticatory function of each obturator was evaluated with an adapted Sato questionnaire and the sieve test. Data were analyzed using one-way ANOVA and Pearson correlation analysis (α = .05). RESULTS: According to the results of the Sato questionnaire and sieve test, G1 demonstrated the highest masticatory function scores (70.88 ± 9.39; 1.06 ± 0.06), while G3 exhibited the lowest scores (48.23 ± 7.69; 0.92 ± 0.05; P < .001). The weight of the obturators was significantly different between groups (G1 = 31.58 ± 1.09 g; G2 = 33.99 ± 1.21 g; G3 = 36.57 ± 1.13 g; P < .001). The correlation between masticatory function and the weight of the obturator was significant (P < .05). CONCLUSIONS: This study revealed that 1-mm obturator bulb thickness was an effective fabrication method for improving masticatory function and reducing the weight of obturator prostheses in edentulous hemimaxillectomy patients.

Mechanical and chemical characterization of contemporary occlusal splint materials fabricated with different methods: a systematic review.

OBJECTIVE: To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties. METHODS: MEDLINE (PubMed), Scopus, and Web of Science searches were conducted for in vitro studies focusing on occlusal splint materials. Two reviewers performed an assessment of the identified studies and data abstraction independently, and this was complimented by an additional hand search. The articles were limited to those in the English language that were published between January 1st, 2012, and December 1st, 2022. RESULTS: The initial search yielded 405 search results of which 274 were selected for full-text review following abstract evaluation. 250 articles that did not meet the inclusion criteria were excluded, and the remaining 25 articles (with 1 article identified from the reference lists of included articles) providing mechanical and chemical values were used in this review. Poly methyl methacrylate (PMMA) -based occlusal splint materials showed the highest values in terms of hardness, wear resistance, flexural strength, flexural modulus, e-modulus, and fracture toughness. The material group with the highest water sorption and water solubility was 3D printed (PR) splint materials. In addition, the lowest degree of double bond conversion was also observed in this group of materials. CONCLUSIONS: The outcome of this review suggests that mechanically and chemically acceptable properties can be attained with PMMA-based occlusal splint materials using both conventional and digital production methods. PR splint materials should not be considered as the primary choice for long-term treatments due to their low mechanical and chemical properties. CLINICAL RELEVANCE: This review provides clinical recommendations for selecting the appropriate material and fabrication method for occlusal splints while taking the patients' needs and the materials´ mechanical and chemical properties into account.

Clinical Performance of 11,646 Dental Implants Using Surgical Guides and Two Different Surgical Approaches: A Systematic Review and Meta-analysis.

Purpose: To assess and quantify survival rates and marginal bone levels (MBLs) of implants placed using guided surgery with a flapless approach vs traditional flap elevation. Materials and Methods: An electronic literature search was conducted in PubMed and the Cochrane Library and refereed by two independent reviewers. Data were synthesized for MBL and survival rates for "flapless" vs traditional "flap" implant placement approach groups. Meta-analyses and nonparametric tests for differences between groups were performed. Rates and types of complications were compiled. The study was conducted under PRISMA 2020 guidelines. Results: A total of 868 records were screened. Full-text review of 109 articles resulted in a total of 57 included studies (50 included for quantitative synthesis and analysis). The survival rate was 97.4% (95% CI: 96.7%, 98.1%) for the flapless approach vs 95.8% (95% CI: 93.3%, 98.2%) for the flap approach; weighted Wilcoxon rank sum test for significance was P = .2339. MBL for the flapless approach was 0.96 mm (95% CI: 0.754, 1.16) vs 0.49 mm (95% CI: 0.30, 0.68) for the flap approach; weighted Wilcoxon rank sum test for significance was P = .0495. Conclusion: The outcomes of this review have suggested that surgical guided implant placement can be used as a reliable method regardless of approach. Additionally, flap and flapless approaches provided similar implant survival rates, but the flap technique provided a slightly better MBL than the flapless approach.

Short-term effect of material type and thickness of occlusal splints on maximum bite force and sleep quality in patients with sleep bruxism: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the short-term effects of hard and soft splints of different thicknesses on maximum bite force (MBF) and sleep quality (SQ) in participants with sleep bruxism (SB). METHODS: One-hundred-fifteen patients were randomly allocated to five groups: Groups H2(Hard splint-2 mm), H3(Hard splint-3 mm), S2(Soft splint-2 mm), S3(Soft splint-3 mm), and C (control). Outcomes were MBF (assessed with a digital gnathodynamometer) and SQ (assessed with the Pittsburgh Sleep Quality Index). Measurements were performed at T0 (before the splints), T1 (1-month follow-up), and T2 (2-months follow-up). Data were analyzed using one-way analysis of variance(ANOVA), Tukey's HSD, and chi-square tests (alpha = 0.05). RESULTS: At T1, the highest MBF values were observed in group H3 (658.01 ± 22.6 N), while the lowest in group S2 (585.45 ± 8.68 N). For T2, the highest values were obtained in H3 group (676.85 ± 21.9 N), and the lowest in group S2 (565.65 ± 10.9 N) (p < 0.05).For SQ, groups S2 and S3 revealed the lowest PSQI values at T1 (9.1; 9.6) and T2 (9; 9.5) (p < 0.001). CONCLUSIONS: The short-term use of both 2 and 3-mm thick soft splints resulted in a decrease in MBF. Improvement in SQ in patients using soft splints was observed in the 1st month and was maintained in the 2nd month. CLINICAL RELEVANCE: This study provides insights on short-term clinical effects as regards to increased sleep quality and regulated maximum bite force as a function of splint material type and the thickness of the splint.

Stress fracture of the manubrium sterni during parallel bar dips.

OBJECTIVE: Stress fractures are common in highly active people, such as athletes or those in the military. They occur frequently in the lower extremities but sternal stress fractures are rare injuries. METHODS: We present a case of a young male who reported no pain and a 'click' sound from the front of the chest while training with parallel bar dips with a grip that was wider than shoulder-width apart. RESULTS: In this case, radiological evaluation was the most helpful tool to diagnose manubrium sterni stress fracture. We advised him to rest but he started exercises immediately because he had to participate in a military camp after the injury. The patient was treated conservatively. The treatment consisted of activity modification and supplemental drugs. CONCLUSION: We report a case of manubrium stress fracture that developed in a young male military recruit.

Evaluation of marginal and internal fit of lithium disilicate and zirconia all-ceramic CAD-CAM crowns using digital impressions: A systematic review.

PURPOSE: A range of materials for single-tooth computer-aided design and computer-aided manufacturing (CAD-CAM) restorations have been introduced that may affect CAM accuracy. This study aimed to review articles evaluating marginal and internal fit of lithium disilicate (LD) and zirconia (Z) crowns fabricated by CAD-CAM systems using intraoral optical scanners (IOS). MATERIALS AND METHODS: Under the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), a systematic review was performed along with an electronic article search in the Medline/Pubmed database. The articles were limited to those in the English language that were published within the past ten years. RESULTS: The initial search resulted in 50 articles and of those, a total of 18 articles were selected for full-text review following abstract evaluation. Eight articles that did not meet the inclusion criteria were excluded and the remaining ten articles, which provided internal and marginal gap values, were used in this review. For LD crowns, marginal gap values ranged between 45µm and 190.2µm. For Z crowns, the values varied between 39µm and 126.4µm. For LD crowns, the internal gap values were between 57.8µm and 475.4µm, and for Z crowns, the values were between 79µm and 205.8µm. CONCLUSION: The outcome of this review suggests that clinically acceptable marginal and internal fit can be attained with LD and Z all-ceramic CAD-CAM crowns using digital impressions. Additionally, it has been found that LD and Z ceramics provide similar marginal gap values, but LD material provides better internal fit than Z.

A novel treatment modality for myogenous temporomandibular disorders using aromatherapy massage with lavender oil: A randomized controlled clinical trial.

OBJECTIVE: To investigate the effect of aromatherapy massage on pain intensity and maximal mouth opening (MMO) in patients with myogenous TMD. METHODS: Ninety-one patients were randomly assigned to three groups: Group L (aromatherapy massage with lavender oil, test), group P (massage with sweet almond oil, placebo), and group C (control). Participants were evaluated at T0 (before the intervention), T1 (immediately after the intervention), and T2 (2-month follow-up). Data were analyzed using one-way ANOVA, Tukey's HSD, and Kruskal-Wallis tests. RESULTS: For T1 and T2, group L showed the greatest MMO values (48.01 ± 0.85 mm; 45.67 ± 0.84 mm), while group C exhibited the lowest values (39.13 ± 0.49 mm; 39.66 ± 0.82 mm) (p < 0.001). For VAS, group L revealed the lowest pain values at T1 (2) and T2 (2) (p < 0.001). DISCUSSION: Aromatherapy massage with lavender oil was effective in the management of painful TMD conditions and limited mouth opening.

A comparison between the efficacy of eccentric exercise and extracorporeal shock wave therapy on tendon thickness, vascularity, and elasticity in Achilles tendinopathy: A randomized controlled trial.

Objectives: This study aims to compare the efficacy of the eccentric exercise (EE) and extracorporeal shock wave therapy (ESWT) on chronic midportion Achilles tendinopathy and evaluate the efficacy of these treatment modalities on tendon thickness, vascularity, and elasticity. Patients and methods: In this randomized controlled trial, a total of 63 patients (40 females, 23 males; mean age: 37.3±12.2; range, 18 to 55 years) with chronic midportion Achilles tendinopathy were enrolled between April 2017 and December 2019. The patients were allocated randomly to two groups: the first group was treated with EE every day for three months with the Alfredson protocol, and the second group received four sessions of ESWT at weekly intervals. The study was terminated at the end of three months. Visual Analog Scales (VAS), Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaires, and ultrasonography measurements were assessed before and after treatment. Patient pain was evaluated at the two-year follow-up. Results: At the three-month follow up, VAS scores decreased, and VISA-A scores increased in both groups (p<0.001). At the two-year-follow-up, VAS scores significantly decreased in the EE group (p<0.001), but the difference was statistically insignificant in the ESWT group (p=0.095). Tendon thickness and stiffness increased in the EE group (p=0.003 and p=0.03, respectively) while the difference was statistically insignificant in the ESWT group after treatment (p=0.173 and p=0.702, respectively). Conclusion: Eccentric exercise and ESWT are efficient in the short term, whereas EE is efficient on tendon pain in the long term. While EE increases tendon thickness and stiffness, ESWT has no effect on these measures.

Clinical performance of lithium disilicate and zirconia CAD/CAM crowns using digital impressions: A systematic review.

PURPOSE: The purpose of this systematic review was to compare the clinical performance of lithium disilicate (LDS) and zirconia (Z) single crowns manufactured by computer-aided design/computer-aided manufacturing (CAD/CAM) systems using intraoral optical scanners (IOS). MATERIALS AND METHODS: An electronic search for articles published between January 2012 and January 2022 in the English language was performed with the Medline/Pubmed database under the guidelines of Preferred Reporting Items for Systemic Reviews and Meta-analysis (PRISMA). The specific search terms used were "zirconia", "lithium disilicate", "CAD/CAM", "intraoral optical scanner", and "survival". RESULTS: The initial electronic search resulted in 278 articles. Most of the resulting articles were excluded, six clinical studies addressing the clinical outcomes of Z and LDS crowns fitted the inclusion criteria and were selected for review. Of these six studies, three were randomised controlled trials, two were retrospective studies, and one was a prospective study. To quantify the clinical performance of the crowns several parameters were recorded, including fractures, endodontic complications, periodontal complications, technical complications, aesthetic complications, and biological complications. It was noted that the most common technical complication of Z and LDS crowns was chipping at a rate of 1.4% and 5% respectively. Regarding Z crowns, aesthetic concerns were the most frequently observed complication. CONCLUSION: The outcomes of this systematic review indicate that Z and LDS crowns display a similar incidence of periodontal and endodontic complications when compared to metal-ceramic crowns, suggesting that these all-ceramic materials are viable alternatives. The incidence of chipping was higher in LDS crowns compared to other materials, while Z crowns were inferior in terms of aesthetics.

The effect of the wall thickness of 3D printed obturator bulbs on masticatory function in patients with Aramany Class I defect: A randomized, crossover clinical trial.

PURPOSE: To evaluate the effect of bulb thickness on the weight of obturator prostheses and masticatory performance in edentulous hemimaxillectomy patients. MATERIALS AND METHODS: A randomized, single-blind, three-period crossover trial was conducted with 17 edentulous patients. All patients were provided with three definitive 3D-printed obturator prostheses each. Obturators were divided into three groups: (1) group 1 (G1; 1-mm bulb); (2) group 2 (G2; 2-mm bulb); and (3) group 3 (G3; 3-mm bulb). After fabrication, the weight of each obturator was measured using a digital analytical balance. The patients used each obturator for a period of 2 weeks without a passive period (ie, they did not stop using the obturator). After using each obturator, masticatory function was evaluated with an adapted Sato questionnaire and the sieve test. Data were analyzed using one-way ANOVA and Pearson correlation analysis (α = .05). RESULTS: According to the results of the Sato questionnaire and sieve test, G1 demonstrated the highest masticatory function scores (70.88 ± 9.39; 1.06 ± 0.06), while G3 exhibited the lowest scores (48.23 ± 7.69; 0.92 ± 0.05) (P < .001). The weight of the obturators was significantly different between groups (G1 = 31.58 ± 1.09 g; G2 = 33.99 ± 1.21 g; G3 = 36.57 ± 1.13 g) (P < .001). The correlation between masticatory function and the weight of the obturator was significant (P < .05). CONCLUSION: This study revealed that using 1-mm obturator bulb thickness was an effective fabrication method for improving masticatory function and reducing the weight of obturator prostheses in edentulous hemimaxillectomy patients.

Effects of Various Laser Treatments on Surface Characterization and Repair Bond Strength of Zirconia-Reinforced Lithium Silicate Ceramics.

PURPOSE: To evaluate the effects of two different lasers and their use in combination with hydrofluoric acid (HF) etching on the surface roughness of zirconia-reinforced lithium silicate (ZLS) ceramics and their shear bond strength (SBS) to composite resin. MATERIALS AND METHODS: The five study groups were as follows: (1) Group H = HF etching; (2) Group N = Nd:YAG (neodymium: yttrium-aluminum-garnet) laser; (3) Group NH = Nd:YAG laser + HF gel; (4) Group E = Er:YAG (erbium: yttrium-aluminum-garnet) laser; and (5) Group EH = Er:YAG laser + HF gel. Surface roughness was assessed using a noncontact profilometer, and SBS tests were conducted with a universal testing machine. RESULTS: The mean SBS values were 16.23 ± 1.77 MPa for Group H, 17.1 ± 1.65 MPa for Group N, 16.65 ± 1.11 MPa for Group NH, 8.08 ± 1.12 MPa for Group E, and 11.58 ± 0.82 MPa for Group EH. There were significant differences between groups E and EH (P < .001), but no significant differences (P > .05) among the other groups. CONCLUSION: Clinicians may prefer Nd:YAG laser or the combination of Nd:YAG and HF to intraorally repair fractured areas.

Effect of low-level gallium aluminum arsenide laser therapy on the chewing performance and pain perception of patients with systemic lupus erythematosus: A randomized controlled clinical trial.

OBJECTIVE: To evaluate the effect of low-level laser therapy (LLLT) on pain intensity (PI) and chewing performance (CP) in systemic lupus erythematosus (SLE) patients with myogenic temporomandibular disorder (TMD). METHODS: Ninety-one patients were randomly allocated to three groups: Group L (intervention), Group P (placebo), and Group C (control). Outcomes were PI (assessed with visual analog scale (VAS)) and CP (assessed with the geometric mean diameter (GMD) of crushed test food). Measurements were performed at T0 (before the LLLT), T1 (immediately after the LLLT), and T2 (1-month follow-up). Data were analyzed using Generalized Linear Models, Kruskal-Wallis, and Friedman tests. RESULTS: For T1 and T2, Group L demonstrated the lowest values for both GMD (6283.7 ± 257.2 µm; 6382.7 ± 303.7 µm) and VAS (5;6) (p < 0.001). CONCLUSION: LLLT was an effective therapeutic approach in reducing pain and improving CP for one month in SLE patients with myogenic TMD.

Can polylactic acid be a CAD/CAM material for provisional crown restorations in terms of fit and fracture strength?

This study aimed to evaluate polylactic acid (PLA) as a provisional crown material. Lower right first molar phantom tooth was used for the fabrication of 60 crowns. Samples were divided into three groups (n=20) according to the material: Group PL (PLA), Group PM (polymethyl methacrylate), and Group PE (polyetheretherketone). Each group was investigated for internal and marginal fit, fracture strength, and fracture mode. Data were analyzed using ANOVA, chi-squared test, and Tukey's tests (p≤0.05). The average marginal gap value of each group was: PE 56.00±4.67 µm, PM 61.15±4.44 µm, and PL 60.40±2.85 µm (p<0.001). The average internal gap value for each group was: PE 128.90±8.39 µm, PM 132.40±7.51 µm, and PL 130.75±9.76 µm (p=0.442). The average fracture strength of each group was: PE 840.90±13.23 N, PM 733.30±9.00 N, and PL 664.50±10.79 N (p<0.001). Results demonstrated that PLA may be a good option as a provisional crown material.

Orofacial manifestations and dental management of systemic lupus erythematosus: A review.

Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease with numerous clinical manifestations. There is no consensus about the ideal oral management for this group of patients to date. This review aimed to describe the broad spectrum of orofacial and clinical manifestations and their therapeutic approaches. Studies concerning orofacial manifestations of SLE and dental treatment modalities were selected by a literature search (1978-2019) using Google Scholar, PubMed/MEDLINE electronic databases. The initial search strategy provided a total of 129 articles, and of these, 30 were included for qualitative synthesis. The reviewed studies revealed that SLE patients are more at risk of compromised oral and dental health exhibiting increased risk of periodontal diseases and temporomandibular joint disorders. The use of systemic drugs especially immunosuppressive and anticoagulants in SLE patients may also influence their oral management. Results emphasize the need to carry out, at an early stage of the disease, an appropriate oral management of these patients to improve oral health-related quality of life and to prevent the need of more invasive therapeutics. A multidisciplinary approach is needed for dental and medical management of such patients.