Root-Retained Overdentures Enhance Stability and Patient Satisfaction confirms Systematic Review

Greece: A recent systematic review of randomized controlled trials has shed light on the clinical parameters affecting the performance and patient satisfaction of root-retained overdentures (RODs).

The research, published in Gerodontology, revealed that despite the limitations of this systematic review, root-retained overdentures continue to be a valid treatment option, providing enhanced denture stability, better bone preservation around abutment teeth, and high levels of patient satisfaction.

“Maintaining good oral hygiene and scheduling regular follow-ups are essential for success. Additionally, more well-designed randomized controlled trials are needed to draw more definitive conclusions,” the researchers wrote.

Root-supported overdentures provide enhanced support, horizontal stability, improved retention, and better maintenance of proprioception and sensory feedback from the periodontal tissues, contributing to high patient satisfaction. As a successful treatment option for partially edentulous patients, RODs remain a viable alternative; however, conclusive evidence regarding their clinical evaluation is still lacking.

Against the above background, Aspasia Pachiou, Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece, and colleagues assessed the clinical parameters influencing the performance of root-supported overdentures and identified potential factors that may impact their effectiveness.

For this purpose, the researchers developed a search strategy based on the PIO (Population, Intervention, Outcome) framework, conducting an electronic search across several databases, including PubMed, Cochrane Library, and Scopus. This systematic search was limited to randomized controlled trials (RCTs) published in English until January 2023 and was carried out by two independent reviewers. The quality of the included studies was evaluated using the Cochrane Risk of Bias tool.

Findings from the Study:

  • The final selection comprised 11 randomized controlled trials (RCTs).
  • Clinically relevant variables identified included:
    • Complications: Caries were the most frequently reported complication.
    • Periodontal aspects and bone changes around abutment teeth.
  • Assessment of methods and clinical recommendations for maintaining these restorations.
  • Evaluation of patient-related outcomes.
  • Risk of bias assessment revealed:
    • Nine studies were classified as high risk.
    • Two studies were classified as low risk.
  • A meta-analysis was not feasible due to the study’s characteristics.

In conclusion, using protective or preventive agents can significantly reduce the risk of root caries. For individuals with root-supported overdentures, maintaining meticulous oral hygiene and attending regular follow-up visits are essential. Additionally, addressing the maintenance needs of both RODs and abutment teeth is crucial for ensuring the long-term success of these dental devices.

Reference:

Pachiou, A., Karakostas, P., Roulias, P., & Naka, O. (2024). Clinical parameters that affect performance and patient satisfaction of root-retained overdentures: A systematic review of randomised controlled clinical trials. Gerodontology, 41(3), 328-334. https://doi.org/10.1111/ger.12739

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Climate shifts and urbanisation drive Nepal dengue surge

Nepal is fighting a surge in dengue cases, a potentially deadly disease once unheard of in the country’s high-altitude Himalayan regions, as climate change and urbanization nurture fever-bringing mosquitoes in new zones.

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Enzymes linked to high-fat diet’s impact on multiple sclerosis offer potential way to protect neurons

Research published in the journal Glia has identified crucial links between dietary choices and the progression of multiple sclerosis (MS).

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Halloween candy: Don’t get spooked by all that sugar

Sugar overload is a real danger on Halloween, as piles of candy prove a powerful temptation to both Trick-or-Treaters and the folks handing out the goodies.

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Medication decisions in pregnancy: Experts propose an ethics-based, evidence-backed approach

Most women use medication during pregnancy. Yet, selecting appropriate drugs and doses is challenging. In an article in The Lancet, physicians and researchers from the Radboud university medical center, Maastricht UMC+, Imperial College London, and the University of Liverpool introduce a shared decision-making approach combining ethical principles and a pregnant woman’s values with existing evidence.

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Examining apixaban vs aspirin in patients with cancer and cryptogenic stroke

Ochsner Health physicians Dr. Richard Zweifler and Dr. Joseph Tarsia are co-authors on a post hoc analysis carried out in the ARCADIA randomized clinical trial, comparing the effectiveness of apixaban versus aspirin in preventing adverse clinical outcomes in patients with a history of cancer and cryptogenic stroke. The research found no significant difference in the risk of major ischemic and hemorrhagic events between those taking apixaban and aspirin. The study was published in the JAMA Neurology journal.

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TearCare Significantly Improves QoL and Visual Function in Dry Eye Disease Patients: Study

Researchers have found out that the treatment of TearCare (TC) may improve clinical outcome measures as well as improve quality of life in patients experiencing dry eye disease (DED) and meibomian gland disease (MGD). A recent study was published in the journal Clinical Ophthalmology conducted by Feng Y. and colleagues.

This study included adults diagnosed with MGD and DED. 32 individuals, with an average age of 55.9 years, had a minimum visual acuity of 20/40 and hadn’t received any surgical or new DED treatment during the past 60 days. Baseline and after one month of receiving TC, the participants were studied on various parameters, that included MGSS, TBUT, and KFL. Self-reported symptoms were evaluated by the Ocular Surface Disease Index (OSDI) and the Visual Function Questionnaire-25 (VFQ-25), functional visual measures that included reading speed, measured with International Reading Speed Texts (IReST), Minnesota Low Vision Reading Test (MNREAD), and Wilkins Rate of Reading Test (WRRT).

  • 52% (16 participants) demonstrated a clinically significant improvement in reading speed, defined as an increase of at least 10 words per minute in IReST score. Both the IReST and MNREAD reading tests were statistically significant (p = 0.012 and p = 0.028, respectively).

  • Quality of life improved significantly, OSDI scores decreased significantly and VFQ-25 increased (both p < 0.001), indicating a decrease in self-reported symptoms and increased perception of visual function.

  • All the clinical parameters, including MGSS, TBUT, and KFL, were statistically improved after TC treatment at p < 0.001, which shows that TC is effective in restoring the meibomian gland function and stability of tear film.

In conclusion, TearCare has demonstrated clinical and functional benefits in patients suffering from DED who present with MGD. Its efficacy after one session of therapy makes it an ideal frequent therapy for the DED patient, particularly one who is significantly challenged by functional visual impediments.

Reference:

Feng, Y., Venkateswaran, N., Steele, A., Rosenberg, E., & Gupta, P. (2024). Impact of TearCare on reading speed in patients with dry eye disease. Clinical Ophthalmology (Auckland, N.Z.), 18, 2873–2878. https://doi.org/10.2147/opth.s469300

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112.5Iu r-hFSH starting dose enough for successful IVF in Amh ≥3 ng/ml: FertSert

Controlled ovarian hyperstimulation(COH) is needed in order
to improve the pregnancy rate in IVF cycles. Recently, there has been an
interest in using a much lower dosage of FSH for mild stimulation in IVF
protocols. The purpose of this study was to assess the mild stimulation with
starting dose of recombinant human FSH (r-hFSH) 112.5IU could be enough for
successful IVF outcomes in patients with AMH ≥3ng/ml in IVF cycles.

Authors retrospectively reviewed 657 consecutive cycles of
594 normo-ovulatroy women(AMH ≥3ng/ml) who underwent IVF treatment
over a 3-year period (2010 –2012) at their institution. Study population was
divided into two groups according to r-hFSH starting dose for COH-IVF cycles.

Group A: r-hFSH(Gonal-F) starting dose 112.5IU (n=257), Group
B: starting dose 150IU (n=400) in women with AMH ≥3ng/ml. Outcomes were compared
the number of oocytes retrieved, total dose of r-hFSH, total r-hFSH stimulation
days, clinical pregnancy and abortion rate between the two groups.

The total dose of r-hFSH administered was significantly
different between the group A and the group B (1055.1 IU and 1365.5 IU,
p<0.01). The total number of r-hFSH administration days (9.6days (5–17) and
9.1days (9–16), p=0.08) and embryo quality were comparable in both groups.

Although the number of retrieved oocytes (14.9 6.8 vs. 13.3
6.1, P>0.01) and fertilized oocytes(9.1 4.9 vs. 8.8 4.3, P=0.02) were
significantly higher in group A than group B.

However, the pregnancy rate (63.4% vs 58.3%, p¼0.139) and
abortion rate (12.9% vs13.3%) were not significantly different between both
groups.

In study results, a total mean r-hFSH dose of 1055.1IU with
the 112.5IU starting dose in COH cycle was sufficient for the number of
retrieved oocytes and the pregnancy rates in patients with AMH ≥3ng/ml.
Therefore, These seems clear that a subset of patients with AMH ≥ng/
ml undergoing ovarian stimulation can be adequately treated with a 112.5 IU
starting dose of r-hFSH.

Source: S. G. Kim, J. H. Lee, I. H. Park;FertilitySterility

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Hearing loss may increase risk of Parkinson’s disease in veterans: JAMA

A new study published in the Journal of American Medical Association showed that hearing loss may indicate early extrastriatal pathology and increase the likelihood of Parkinson’s disease. It is uncertain if objective hearing loss increases the incidence of Parkinson disease (PD). Self-reported hearing loss is used insensitively in PD investigations, and there is a dearth of objective data. Thus, Lee Neilson and colleagues carried out this study to investigate the relationship between incident PD and hearing loss in US veterans, as well as how well-known prodromal disorders and hearing aids may alter this relationship.

The US Department of Veterans Affairs’ electronic health record data for veterans who had an audiogram between January 1, 1999 and December 30, 2022, was examined in this cohort research. The individuals with incomplete data or a history of Parkinson’s disease were not included. The primary exposure of this study was hearing loss verified by audiogram. The main goal was to assess the cumulative incidence of Parkinson’s disease while controlling for competing risk of mortality.

A total of 3,596,365 veterans were among the 7,296,051 who had an audiogram. Their mean (SD) age was 67 (10.3) years, and they were primarily male. Of the ones with hearing loss, 1,080,651 (30.0%), 1,039,785 (28.9%), 568,296 (15.8%), and 157,623 (4.3%) had mild (20-<35 dB), moderate, moderate to serious (50-<65 dB), and serious to significant (65-120 dB) hearing loss, respectively.

  • A total of 750,010 people (20.8%) had normal hearing at the time of the audiometry examination. All exposed and unexposed groups were matched for age, gender, and smoking history, and race, ethnicity, and frailty were further adjusted.
  • Veterans with light, moderate, moderate to severe, and severe to profound hearing loss had 6.1, 16.2, and 12.1 more occurrences of PD at 10 years following the baseline audiogram, respectively, in comparison to those with normal hearing.
  • At ten years, hearing loss was linked to 5.7 more incidences of Parkinson’s disease than each condition alone when paired with known prodromal symptoms. At 10 years, incident instances of PD dropped by 21.6 cases when hearing aids were promptly dispensed.

Overall, this study suggested that hearing loss is a separate risk factor for Parkinson’s disease progression. Widespread screening for hearing loss and proper use of hearing aids may lower the incidence of Parkinson’s disease because this could reduce this risk.

Source:

Neilson, L. E., Reavis, K. M., Wiedrick, J., & Scott, G. D. (2024). Hearing Loss, Incident Parkinson Disease, and Treatment With Hearing Aids. In JAMA Neurology. American Medical Association (AMA). https://doi.org/10.1001/jamaneurol.2024.3568

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Antimullerian hormone levels alone are insufficient and nonspecific for PCOM diagnosis: Study

Polycystic ovary syndrome (PCOS) is a prevalent endocrine
disorder that affects women of reproductive age. Women with PCOS may exhibit
various features related to reproduction, endocrinology, metabolism,
dermatology, and psychosocial well-being. Polycystic ovary syndrome is a
heterogeneous syndrome, resulting in various phenotypes that are exacerbated by
obesity, ethnic differences, and changes in clinical features over time. The
diversity makes identifying and managing PCOS challenging, leading to
dissatisfaction among patients worldwide.

In the 2003 Rotterdam criteria, polycystic ovarian
morphology (PCOM) was included as a criterion for the diagnosis of PCOS. In
2018, the Rotterdam criteria evolved into the universally accepted
international guideline diagnostic criteria for PCOS. These criteria consist of
any two of three key features: oligo- or anovulation, clinical and/or
biochemical hyperandrogenism, and/or PCOM on ultrasound in adults, although
other relevant disorders are excluded. The definition of PCOM, including
ovarian volume and/or the number of follicles per ovary (FNPO), using
ultrasound examination is challenging.

In addition the guideline acknowledged the controversy and
challenges associated with this diagnostic criterion, particularly in the
adolescent population, where ultrasound is no longer recommended for diagnosis.
The accuracy and reproducibility of FNPO measurements depend on the skills of
the ultrasound operator as well as the instrument used.

Given these ultrasound challenges, antimullerian hormone
(AMH) levels have been proposed as an alternative marker for PCOM as well as
for diagnosing PCOS. Antimullerian hormone is a dimeric glycoprotein and
predominantly secreted by granulosa cells of the preantral and small antral
ovarian follicles. AMH inhibits the recruitment of follicles from the
primordial follicle pool. It also seems to inhibit aromatase activity, which is
responsible for the conversion of androgens into estrogens. Finally, it has an
inhibitory effect on follicle-stimulating hormone-dependent follicle growth.
Therefore, increased AMH levels can contribute to ovulatory dysfunction because
of the accumulation of antral follicles and to hyperandrogenism because of
aromatase inhibition, which are both often observed in women with PCOS.
Convincingly, it has been shown that women with PCOS have higher levels of AMH
compared with ovulatory women without PCOS. In addition, strong correlations
have been observed between follicle number on ultrasound and circulating AMH
levels in PCOS. However, significant heterogeneity exists between studies
addressing the role of AMH levels as a diagnostic marker in PCOS, leaving the
diagnostic role of this hormone unclear. The aim of this study by Kim van der
Ham et al was to assess the diagnostic accuracy of AMH for PCOS as well as the
accuracy for the detection of PCOM. This work was used to update the
international evidence-based PCOS guideline.

Eligible studies were those conducted in humans, published
in English, and reporting sensitivity, specificity, and/or area under the curve
values. Extracted data included study population, age, body mass index, AMH
assay, cut-off value of AMH levels, sensitivity, specificity, and area under
the curve values. The risk of bias was assessed using the quality assessment of
diagnostic accuracy studies tool. A random effects model was used to test
diagnostic accuracy.

Eighty-two studies were included. The adult AMH-PCOS
meta-analyses (n = 68) showed a pooled sensitivity and specificity of 0.79 (95%
confidence interval [CI], 0.76–0.82; I2 = 86%) and 0.87 (95% CI, 0.84–0.89; I2
= 91%). The adolescent AMH-PCOS metaanalysis (n = 11) showed a pooled
sensitivity and specificity of 0.66 (95% CI, 0.58–0.73; I2 = 74%) and 0.78 (95%
CI, 0.71–0.83; I2 = 45%). The adult AMH-PCOM meta-analysis (n = 7) showed a
pooled sensitivity and specificity of 0.79 (95% CI, 0.72–0.85; I2 = 94%) and
0.87 (95% CI, 0.78–0.93; I2 = 94%).

Authors found a significant heterogeneity among the studies.
Multiple factors contributed to this high heterogeneity. Two of these factors
include differences in age and BMI. It is well known that AMH levels decrease
with increasing age. Even in women with PCOS, who seem to have a prolonged
reproductive lifespan and a delayed menopause, AMH levels still decline over
time. Similarly, women with a higher BMI appear to have lower AMH levels in the
general population as well as in PCOS. There were differences in BMI and age
among the included study populations, and not all studies matched their cases
and controls for these variables. The use of hormonal contraceptives may also
influence AMH levels, just as it does with other sex steroid levels.

In conclusion, this meta-analysis demonstrated that AMH
level is a reasonably sensitive and specific marker for detecting PCOM in
adults, although it lacks accuracy for PCOM in adolescents. Moreover, the AMH
level is unsuitable as a single diagnostic test for a heterogeneous and
multicomponent diagnosis, such as PCOS. Heterogeneity among the studies was
observed, mainly because of different AMH threshold levels, assay types, and
variations in age, BMI, and control group characteristics, with the need for
further research to strengthen the current evidence. On the basis of these
results, AMH levels alone are not recommended for the diagnosis of PCOS in the
2023 international evidence-based guidelines for the assessment and management of
PCOS. However, it could be considered an endocrine substitute for the
ultrasound assessment of PCOM. Therefore, AMH is incorporated into the guideline
diagnostic algorithm, where it is indicated in those with either (but not both)
irregular cycles or hyperandrogenism. This substantive change in diagnostic
criteria for such a common condition is expected to reduce inconvenience and
the cost of diagnosis. This work has also identified research priority areas
moving forward.

Source: Kim van der Ham, M.D.,a Joop S. E. Laven, Ph.D.,a
Chau Thien Tay, Fertil Steril® Vol. 122, No. 4, October 2024

https://doi.org/10.1016/j.fertnstert.2024.05.163

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