Robert M. Ricketts and Rudolf Slavicek: dentistry by the rules of nature.

The stomatognathic structures act as a complex and integrated system, thereby accomplishing several essential functions of the body. Aside from participating in food digestion, they are key for respiration and swallowing and play a central role in social interaction and stress management. The lifeworks of Robert M. Ricketts (1920-2003), an American orthodontist, and Rudolf Slavicek (1928-2022), an Austrian prosthodontist, were centered on this understanding. Both were educated in the time of gnathology, functional dentistry, and cephalometry and were ready to challenge conventional knowledge and traditions, leading toward innovation. As untiring clinicians, researchers, and mentors, they were fully invested in the study of the stomatognathic system, considering its morphology, dynamics, growth patterns, evolution, and interactions with the body and mind. Based on their extensive knowledge of the masticatory system, they advanced dentistry both with theoretical notions and by implementing new diagnostic and therapeutic concepts, thus reinforcing the idea of dentistry as a medical discipline requiring interdisciplinary effort. Their heritage is represented by numerous publications, discoveries, and inventions that inspire the dental community to follow their exemplary approach to the individualized care of patients. Their knowledge and passion are further passed on through their students. As part of their legacy, they prepared the ground for new research aimed at fostering advancements in occlusion medicine, hence supporting education in oral health.

Assessment of Handicapping Labio-Lingual Deviation index scoring methods and their effect on orthodontic treatment coverage by Medicaid.

BACKGROUND: The purpose of this study was to assess the validity and reliability of Handicapping Labio-Lingual Deviation index (HLDI) scoring methods as calculated by digital models (DM) and visual inspection (VI) and their agreement to either meet or fail to meet the Medicaid coverage threshold. An additional objective was to assess the agreement with Medicaid managed care organizations (MCO) coverage decisions. METHODS: The study included the orthodontic records of 401 patients who applied for Medicaid coverage. Two methods were used to calculate HLDI scores: (1) Measurements derived from DMs using OrthoCAD software; and (2) VI of intraoral photographs. The levels of agreement between the two methods and the Medicaid coverage decision by a MCO were evaluated. RESULTS: The study results show a high level of agreement between the two HLDI calculation methods, DM and VI evaluation methods(Cramer's V = 0.812). The agreement on coverage decisions (eligible/not eligible) between VI methods and the official MCO decision was Cramer's V = 0.318. The agreement on coverage decisions between the DM method and the official MCO decision was Cramer's V = 0.318. CONCLUSIONS: MCO assessment results of the patients using HLDI showed low agreement with the results obtained by DM and VI scoring methods used in this study. The Illinois Medicaid system is apparently using unknown factors other than the HLDI score when determining when approving or disapproving orthodontic coverage. PRACTICAL IMPLICATIONS: MCO decisions on eligibility for orthodontic treatment coverage were not consistent with patients' treatment needs.

Assessment of automatic cephalometric landmark identification using artificial intelligence.

OBJECTIVE: To compare the accuracy of cephalometric landmark identification between artificial intelligence (AI) deep learning convolutional neural networks (CNN) You Only Look Once, Version 3 (YOLOv3) algorithm and the manually traced (MT) group. SETTING AND SAMPLE POPULATION: The American Association of Orthodontists Federation (AAOF) Legacy Denver collection was used to obtain 110 cephalometric images for this study. MATERIALS AND METHODS: Lateral cephalograms were digitized and traced by a calibrated senior orthodontic resident using Dolphin Imaging. The same images were uploaded to AI software Ceppro DDH Inc The Cartesian system of coordinates with Sella as the reference landmark was used to extract x- and y-coordinates for 16 cephalometric points: Nasion (Na), A point, B point, Menton (Me), Gonion (Go), Upper incisor tip, Lower incisor tip, Upper incisor apex, Lower incisor apex, Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), Pogonion (Pg), Pterigomaxillary fissure point (Pt), Basion (Ba), Articulare (Art) and Orbitale (Or). The mean distances were assessed relative to the reference value of 2 mm. Student paired t-tests at significance level of P < .05 were used to compare the mean differences in each of the x- and y-components. SPSS (IBM-vs. 27.0) software was used for the data analysis. RESULTS: There was no statistical difference for 12 out of 16 points when analysing absolute differences between MT and AI groups. CONCLUSION: AI may increase efficiency without compromising accuracy with cephalometric tracings in routine clinical practice and in research settings.

Improving the accuracy of publicly available search engines in recognizing and classifying dental visual assets using convolutional neural networks.

AIM: To assess the accuracy of DigiBrain4, Inc (DB4) Dental Classifier and DB4 Smart Search Engine* in recognizing, categorizing, and classifying dental visual assets as compared with Google Search Engine, one of the largest publicly available search engines and the largest data repository. MATERIALS AND METHODS: Dental visual assets were collected and labeled according to type, category, class, and modifiers. These dental visual assets contained radiographs and clinical images of patients' teeth and occlusion from different angles of view. A modified SqueezeNet architecture was implemented using the TensorFlow r1.10 framework. The model was trained using two NVIDIA Volta graphics processing units (GPUs). A program was built to search Google Images, using Chrome driver (Google web driver) and submit the returned images to the DB4 Dental Classifier and DB4 Smart Search Engine. The categorical accuracy of the DB4 Dental Classifier and DB4 Smart Search Engine in recognizing, categorizing, and classifying dental visual assets was then compared with that of Google Search Engine. RESULTS: The categorical accuracy achieved using the DB4 Smart Search Engine for searching dental visual assets was 0.93, whereas that achieved using Google Search Engine was 0.32. CONCLUSION: The current DB4 Dental Classifier and DB4 Smart Search Engine application and add-on have proved to be accurate in recognizing, categorizing, and classifying dental visual assets. The search engine was able to label images and reject non-relevant results.

Orthodontic treatment in a patient with cherubism: Benefits and limitations.

AIM: Cherubism is an uncommon hereditary disease that leads to the development of giant cell lesions in the jaws, alterations in the dentition, and malocclusion. The biological behavior of bones to orthodontic forces in these patients is not described in the literature, leading dentists to avoid this management. The aim of this article was to describe a case report of management with orthodontics. We present details regarding clinicoradiographic features, diagnosis, treatment, and follow-up. CASE REPORT: A 12-year-old male patient diagnosed with cherubism presented to our service with complaints about his esthetic facial and dental appearance. Management was interdisciplinary, including careful and controlled orthodontic treatment. The results were satisfactory; alignment, dental leveling, and correction of the malocclusion were achieved. CONCLUSION: Patients with cherubism may benefit from orthodontics, improving oral function, and esthetic and psychosocial well-being. The orthodontic treatment might be performed according to the severity of clinical manifestation, expectations of the patients, and limitations of each case.

Fatal case of donor-derived colistin-resistant carbapenemase-producing Klebsiella pneumoniae transmission in cardiac transplantation

ABSTRACT Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.

Fatal case of donor-derived colistin-resistant carbapenemase-producing Klebsiella pneumoniae transmission in cardiac transplantation.

Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.

Change in the vertical dimension of Class II Division 1 patients after use of cervical or high-pull headgear.

INTRODUCTION: The goals of this study were to compare the effects that cervical and high-pull headgear have on the vertical dimensions in Class II Division 1 patients during phase 1 treatment and to compare these effects with untreated predicted growth for the sample population. METHODS: Pretreatment and posttreatment cephalometric radiographs of children who had undergone Class II Division 1 correction with cervical (n = 22) or high-pull headgear (n = 19) were analyzed for the measurements that describe the changes in the vertical component of growth and mandibular position. The groups were matched for age (mean, 9 ± 2.5 years), treatment time (mean, 14 months), malocclusion, and similar skeletal features. The groups were compared with each other and also with an untreated growth model. RESULTS: Treatment with cervical headgear resulted in smaller increases in measurements that describe the vertical dimension than with high-pull headgear. Cervical headgear showed more favorable changes in mandibular growth that were statistically significant when compared with the untreated growth models. CONCLUSIONS: In this study, the cervical headgear showed more control over the vertical dimension and produced more favorable changes in mandibular position by normalizing the occlusal plane. Compared with the untreated growth model, cervical headgear worked synergistically with growth to produce more optimal changes in mandibular position.

Assessment of vertical changes during maxillary expansion using quad helix or bonded rapid maxillary expander.

OBJECTIVE: To determine if there is a significantly different effect on vertical changes during phase I palatal expansion treatment using a quad helix and a bonded rapid maxillary expander in growing skeletal Class I and Class II patients. MATERIALS AND METHODS: This retrospective study looked at 2 treatment groups, a quad helix group and a bonded rapid maxillary expander group, before treatment (T1) and at the completion of phase I treatment (T2). Each treatment group was compared to an untreated predicted growth model. Lateral cephalograms at T1 and T2 were traced and analyzed for changes in vertical dimension. RESULTS: No differences were found between the treatment groups at T1, but significant differences at T2 were found for convexity, lower facial height, total facial height, facial axis, and Frankfort Mandibular Plane Angle (FMA) variables. A comparison of treatment groups at T2 to their respective untreated predicted growth models found a significant difference for the lower facial height variable in the quad helix group and for the upper first molar to palatal plane (U6-PP) variable in the bonded expander group. CONCLUSION: Overall, both the quad helix expander and the bonded rapid maxillary expander showed minimal vertical changes during palatal expansion treatment. The differences at T2 suggested that the quad helix expander had more control over skeletal vertical measurements. When comparing treatment results to untreated predicted growth values, the quad helix expander appeared to better maintain lower facial height and the bonded rapid maxillary expander appeared to better maintain the maxillary first molar vertical height.

La sociedad como enfermedad / Society as a disease

Para muchos, la sociedad puede entenderse como un organismo, cuyos fenómenos y acontecimientos pueden abordarse de la misma manera que un médico examina y estudia un cuerpo. La lógica del organismo establece que una sociedad está formada por un conjunto de unidades individuales dotadas de vida propia. La sociedad, tal como sucede con todo organismo vivo, puede enfermar o verse seriamente amenazado por elementos nocivos que pueden afectarlo estructural y funcionalmente, poner en riesgos u integridad o incluso su vida. Aunque no todas las sociedades son iguales, ni todos sus componentes comparten las mismas características, existen elementos que afectan a todas sus capas, aunque sus efectos son más evidentes en unas comunidades que en otras

En busca de la paz / In search of peace

La masacre en el local gay de Orlando dejó como saldo 50 muertos y 53 heridos y abre nuevamente el debate sobre varios temas polémicos en la sociedad. La homofobia, la intolerancia, el extremismo religioso,la violencia y un sin fin de otras cuestiones no menos preocupantes.

Sphenoid wing meningioma behavior on 11C-PiB and 18F-FDG PET.

Two patients with mild cognitive impairment underwent C-PiB and F-FDG brain PET. Both patients had previously gone through a contrast-enhanced MRI scan that revealed extra-axial tumors next to the sphenoid wing, suggestive of meningiomas. C-PiB PET images showed a highly increased uptake by the extra-axial masses. These 2 cases represent 1.2% of our C-PiB population (n = 163). No meningioma was found with negative C-PiB uptake. The F-FDG concentration was not increased within the lesions. C-PiB could be used as a meningioma marker.

En busca de la justicia perdida / In search of lost justice

Hablar de justicia y equidad exige más que un análisis semántico. Se trata de problemas reales y complejos, enraizados en el seno mismo de la sociedad y donde actúan como causas y consecuencias un sinfín de situaciones que ponen a prueba las bases jurídicas, morales y humanas del mundo y del tiempo en el que vivimos.La justicia, conmutativa cuando trata de igualdad y distributiva cuando asigna proporciones, está supeditada a quienes se encargan de administrarla, de ejercerla o de otorgarla. Por tanto, la justicia no es una virtud ni es un atributo infalible, sino una cuestión humana, por tanto falible, imperfecta y con frecuencia injusta y desigual. Justicia y equidad son cuestiones de carácter humano cuya mejoría debe apoyar en mayor conciencia social, más empatía, más bondad, y más amor. Necesitamos más corazón y más humanidad, con ello, la justicia y la equidad vendrán solas

Aborto no punible: cuestiones filosóficas de un debate que nos trasciende / Non-punishable abortion: philosophical questions of a debate that transcends us

El avance de las sociedades postula desafíos y problemas que complejizan la vida comunitaria. Los cambios son vertiginosos. A veces, las acciones avanzan más rápido que las ideas o las propuestas destinadas a resolver los problemas que suscitan. El aborto ocupa un lugar destacado dentro del debate público. Implica aspectos fundamentales entre los que se cuentan: la vida, la muerte, la salud, la religión, la ética, la moral y sus límites, la capacidad de decidir por uno mismo y la potestad para decidir por alguien más. El aborto es una problemática socio-sanitaria que trasciende a sí misma y nos arrolla con su complejidad.

[Pulmonary infiltrates in cancer patients]. / Infiltrados pulmonares en pacientes con cáncer.

Pulmonary infiltrates remain as a diagnostic and therapeutic challenge in cancer patients. In order to evaluate the etiology, diagnostic methods used, Intensive Care Unit admission and in-hospital mortality, we conducted an observational, prospective study which included all patients with cancer and recent pulmonary infiltrates admitted to the Instituto Alexander Fleming between August 2003 and March 2006. Diagnostic methods were categorized in sequential steps of complexity: 1st step: radiological pattern of the pulmonary infiltrates, blood and sputum cultures, serological tests and empirical treatment response; 2nd step: bronchoalveolar lavage (BAL), non bronchoscopic tracheal aspirate and mini-BAL; 3rd step: pulmonary or extrapulmonary biopsies. Pulmonary infiltrate etiology was classified as: infection, treatment complication, disease progression, cardiovascular or mixed. Diagnosis was classified as proved or probable. A total of 106 samples from 103 patients were included. The etiologies were infection in 61 cases, disease progression in 4, treatment complication in 6, cardiovascular in 6 and mixed in 7. Proved diagnosis was obtained in 33 cases and probable diagnosis in 51 while 22 cases could not be diagnosed. Nine of the 10 diagnoses of mycoses were in oncohematologic cases. Seventy cases did not go further than procedures included in the 1st step. Thirty two cases stopped after diagnostic procedures of the 2nd step and 4 required biopsies. Forty four cases required Intensive Care Unit admission. In-hospital mortality was 30.2%. In our study, infection was the most frequent etiology. Mycoses were more frequent in oncohematologic cases. A proved or probable diagnosis was obtained in 84 (79.2%) cases. In 53.7% of the cases only non-invasive diagnostic methods were required.

Infiltrados pulmonares en pacientes con cáncer / Pulmonary infiltrates in cancer patients

La aparición de infiltrados pulmonares en los pacientes con cáncer representa un desafío diagnóstico y terapéutico. Con el objeto de evaluar la etiología, utilización de métodos diagnósticos, admisión en Terapia Intensiva (UTI) y letalidad intrahospitalaria de estos pacientes, realizamos un estudio prospectivo observacional donde se incluyeron todos los pacientes con cáncer y nuevos infiltrados pulmonares internados en el Instituto Alexander Fleming entre marzo 2003 y agosto 2006. Los métodos diagnósticos fueron categorizados en 3 etapas (1ª etapa: patrón radiológico de los infiltrados pulmonares, hemocultivos, cultivo de esputo, pruebas serológicas y respuesta al tratamiento empírico inicial; 2ª etapa: lavado broncoalveolar (LBA), aspirado traqueal y mini-LBA; 3ª etapa: biopsias pulmonares o extrapulmonares). La etiología de los infiltrados pulmonares se clasificó como infección, complicación del tratamiento, progresión de enfermedad, cardiovascular o mixta. Los diagnósticos fueron clasificados en diagnóstico de certeza o diagnóstico probable. Se incluyeron 106 casos en 103 pacientes. La etiología fue: infección en 61 casos, progresión de enfermedad en 4, complicación del tratamiento en 6, cardiovascular en 6 y mixta en 7. Se obtuvo diagnóstico de certeza en 33 casos y diagnóstico probable en 51. Se clasificaron como sin diagnóstico 22 casos. Nueve de las 10 micosis diagnosticadas fueron en pacientes oncohematológicos. Setenta casos se detuvieron en la 1ª etapa diagnóstica, 32 en la 2ª etapa y 4 necesitaron biopsias. Requirieron internación en UTI 44 casos. La letalidad intrahospitalaria fue 30.2%. En nuestro estudio, la infección fue la etiología más frecuente y las micosis fueron predominantes en los pacientes oncohematológicos. Se obtuvo diagnóstico de certeza o diagnóstico probable en 84 (79.2%) casos. En 53.7% de los casos no se requirieron métodos diagnósticos invasivos.

Pulmonary infiltrates remain as a diagnostic and therapeutic challenge in cancer patients. In order to evaluate the etiology, diagnostic methods used, Intensive Care Unit admission and in-hospital mortality, we conduced an observational, prospective study which included all patients with cancer and recent pulmonary infiltrates admitted to the Instituto Alexander Fleming between August 2003 and March 2006. Diagnostic methods were categorized in sequential steps of complexity: 1st step: radiological pattern of the pulmonary infiltrates, blood and sputum cultures, serological tests and empirical treatment response; 2nd step: bronchoalveolar lavage (BAL), non bronchoscopic tracheal aspirate and mini-BAL; 3rd step: pulmonary or extrapulmonary biopsies. Pulmonary infiltrate etiology was classified as: infection, treatment complication, disease progression, cardiovascular or mixed. Diagnosis was classified as proved or probable. A total of 106 samples from 103 patients were included. The etiologies were infection in 61 cases, disease progression in 4, treatment complication in 6, cardiovascular in 6 and mixed in 7. Proved diagnosis was obtained in 33 cases and probable diagnosis in 51 while 22 cases could not be diagnosed. Nine of the 10 diagnoses of mycoses were in oncohematologic cases. Seventy cases did not go further than procedures included in the 1st step. Thirty two cases stopped after diagnostic procedures of the 2nd step and 4 required biopsies. Forty four cases required Intensive Care Unit admission. In-hospital mortality was 30.2%. In our study, infection was the most frequent etiology. Mycoses were more frequent in oncohematologic cases. A proved or probable diagnosis was obtained in 84 (79.2%) cases. In 53.7% of the cases only non-invasive diagnostic methods were required.