Comparison of Occlusal Parameters between Open Bite and Nonopen Bite Patients Using the T-Scan III System: A Pilot Study

Objective To evaluate and compare the first tooth contact region, occlusion time, time to generate total force, and force distribution between open bite (OB) and non-OB (NOB) patients at the maximum intercuspation position using the T-Scan III system. Materials and Methods Sixteen patients were divided into the OB and NOB groups (n = 8 for each group). The T-Scan III system was used to evaluate the first tooth contact region, occlusion time, time to generate total force, and force distribution. Statistical Analysis The mean patient age, overjet, overbite, occlusion time, and time to generate total force were compared between the groups by independent samples t-test. Relative force distributions between groups and among regions were compared by the Mann–Whitney U- and Kruskal–Wallis H-tests, respectively. A probability value of less than 5% (p < 0.05) was considered significant. Results Differences in the first tooth contact region between groups were observed. The molar region was the first tooth contact region in the OB group, while first tooth contact was observed in all regions in the NOB group. Neither the occlusion time nor the time to generate total force was significantly different between the groups (p > 0.05). The highest force distributions were observed in the molar regions in both groups. Significant intragroup differences were found among all regions (p < 0.05), except between the anterior and premolar regions in the NOB group (p = 0.317). Intergroup differences in the force distributions in the anterior (p = 0.000), premolar (p = 0.038), and molar (p = 0.007) regions were significant. Conclusion Unlike in the NOB group, in which first tooth contact occurred in every region, in the OB group, first tooth contact occurred only in the molar region. Compared with those in the NOB group, the force distributions in the OB group were approximately 1.5 times higher in the molar region but were significantly lower in the anterior and premolar regions.

Combined, Converted, and Prophylactic Use of Resuscitative Endovascular Balloon Occlusion of the Aorta for Severe Torso Trauma: A Retrospective Study

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used as an intra-aortic balloon occlusion method in Japan; however, the protocols for its effective use in different pathological conditions remain unclear. This study aimed to summarise the strategies of REBOA use in severe torso trauma.Methods: Twenty-nine cases of REBOA for torso trauma treated at our hospital over 5 years were divided into the shock (n=12), cardiopulmonary arrest (CPA) (n=13), and non-shock (n=4) groups. We retrospectively examined patient characteristics, trauma mechanism, injury site, severity score, intervention, survival rates at 24 hours, and intervention details in each group.Results: In the shock group, 9 and 3 patients survived and died within 24 hours, respectively; time to intervention (56.6 vs 130.7 min, p=0.346) and total occlusion time (40.2 vs 337.7 min, p=0.009) were both shorter in surviving patients than in the casualties. In the CPA group, 10 patients were converted from resuscitative thoracotomy with aortic cross-clamp (RTACC); a single patient survived. Four patients in the non-shock group survived, having received prophylactic REBOA.Conclusions: The efficacy of REBOA for severe torso trauma depends on patient condition. In the shock group, time to intervention and total occlusion time correlated with survival. The use of REBOA with definitive haemostasis and minimum delays to intervention may improve outcomes. Patients with CPA are at a high risk of mortality; however, conversion from RTACC may be effective in some cases. Prophylactic intervention in the non-shock group may help achieve immediate definitive haemostasis.

The Relationship between Dentofacial Vertical Pattern and Bite Force Distribution among Children in Late Mixed Dentition

Background: Digital bite measurement systems such as the T-Scan III allow for the computerized measurement of occlusal force distribution. This study aimed to establish the relationship between dentofacial vertical pattern and bite force distribution among children in late mixed dentition. Materials and Methods: In total, 86 children (45 male, 41 female) aged between 9 and 11 years with short (n = 28), medium (n = 28), and long (n = 30) facial heights were included in this study. The height, weight, age, and gender were recorded. Occlusal bite force distribution and time of occlusal cycle were recorded using a T-Scan III device (Tekscan Corp. Boston, MA, USA). The bite force distribution was compared among facial types using a One-Way ANOVA and post hoc test, a linear regression model with time of occlusion as dependent variable was developed. Results: No significant differences were observed in occlusion time between genders. Children with long facial height had a significantly lower anterior bite force distribution (p < 0.05) and significantly higher posterior bite force distribution (p < 0.05) than those with average or short facial height. Age, gender, height, and weight had no significant association with time of the occlusal cycle. Conclusion: Children with an increased vertical facial height have a more posterior distribution of force than children with average or short facial heights in the late mixed dentition.

Comparing occlusal contact quality after aligner and fixed appliance treatment using computerized occlusal analysis during 6 months of retention

Objective Less than ideal contacts have been reported following aligner therapy, which is believed will resolve with settling, despite settling improving occlusal balance has not been scientifically confirmed. The aim of this study was to compare the outcome quality of occlusal contacts in patients treated with fixed appliances or clear aligners. Methods 39 orthodontic patients (14 treated with aligners; 25 with fixed appliances) were evaluated with a digital occlusal analysis system (T-scan10 ™), assessing Maximum Intercuspation contact simultaneity, symmetry, and relative force distribution. The Occlusion Time, the Right/Left force percentage (%R/L), the Anterior/Posterior contact ratio (RAP), and the anteroposterior Center of Force (COF) locations were recorded at treatment completion, and 3 and 6 months after. Results No significant differences in measured occlusal contact quality parameter were found between groups at treatment completion or follow-up (OT, %R, RAP nor COF position). The COF moved posteriorly and remained stable after 3 months, near to the first molar, but was located more anterior in females (p= 0.01). 10 patients finished treatment with marked asymmetry, (%R/L > 50±10%), especially in the fixed appliance group (9/25 =3 6%) versus the aligner group (1/14 = 7%). 1/3 of all patients (both groups combined) after 6 months retention had %R/L imbalances > 50±10%. Conclusions Occlusal contacts were comparable at completion of treatment with aligners or brackets and after 3-6 months of retention. Contacts increased in the posterior region with time, but settling did not improve marked asymmetry in all patients.

Aortocoronary Bypass Surgery in Patients with Recurrent Post-Coronary Stenting Angina

Background. A wide adoption of percutaneous coronary operations has led to an average one-third reduction in the aortocoronary bypass surgery (ACB) rate and altering of the ACB patient profile to mainly represent advanced occlusive coronary atherosclerosis.Materials and methods. The study analyses treatment outcomes in coronary heart disease patients with recurrent angina after a previous endovascular intervention. Over years 2009–2015, 1,023 ACB operations were performed at the Almetyevsk — OAO Tatneft Medical Unit cardiac surgery rooms. Pre-surgery coronary artery stenting (CAS) was rendered at various terms in 96 patients (23 % women, 76 % men; cohort 1). The main cohort (n = 96) was divided into 2 subgroups: IA (n = 64), single CAS; IB (n = 32), multiple CAS patients. For statistical significance, cohort 2 (control) comprised 185 patients (21 % women, 79 % men) to include every 5th history of the remaining 927 patients operated within same period.Results and discussion. The mean aortic occlusion time was shorter in multiple CAS patients vs. other cohorts (61.3 ± 31.2 vs. 72.5 ± 27.8 and 70.7 ± 41.2 min). Cohort 1 had an overall higher emergency resternotomy rate due to ongoing bleeding (7.4 and 8.3 vs. 2.0 %). Furthermore, pre-surgery multiple CAS patients more likely faced the complications of perioperative MI (8.5 vs. 3.1 and 1.4 %) and acute postoperative heart failure (7.2 vs. 2.3 and 1.4 %, p < 0.01). This cohort often required inotropic support (9.3 vs. 3.8 and 2.1 %).Conclusion. Statistical analysis revealed a significantly higher complication and mortality rate in patients with previous coronary stenting compared to ACB patients. Adverse ACB outcomes were observed with multiple-coronary stenting cases, in contrast to the cohort with no pre-surgery interventions.

The Zone II Aorta is not a Forbidden Zone for Occlusion in Women with Morbidly Adherent Placenta

Aim: To evaluate the safety and efficacy of balloon occlusion at the Zone II aorta for the management of morbidly adherent placenta.Methods: From September 2015 to October 2018, a total of 80 consecutive patients who were prenatally diagnosed with morbidly adherent placenta were assigned into two groups: the balloon occlusion group (n=40) and the non-balloon occlusion group (n=40). The intraoperative estimated blood loss, blood transfusion, urine output, serum creatinine (Scr), blood urea nitrogen (BUN) and hysterectomy rate were recorded and compared between the two groups.Results: The estimated blood loss in the balloon occlusion group was significantly lower than that in the non-balloon occlusion group (811.75±299.93 ml vs 1529.75±808.01 ml, P<0.001). The median amount of packed RBCs transfused in the balloon occlusion group and non-balloon occlusion group was 0 U and 2 U, respectively (P=0.001). The women in the former group had a lower blood transfusion rate than those in the latter group (30% vs 57.5%, P=0.013). Hysterectomy occurred in none in the balloon occlusion group but in 6 patients in the non-balloon occlusion group (P=0.011).Conclusion: The middle abdominal aorta (Zone II) is not a forbidden zone for occlusion as long as the single occlusion time is limited to 15 mins. Balloon occlusion at the Zone II aorta can effectively reduce blood loss, transfusion requirements and hysterectomy rates in patients with morbidly adherent placenta.

Global Thrombosis Test: Occlusion by Coagulation or SIPA?

The global thrombosis test (GTT) is a point of care device that tests thrombotic and thrombolytic status. The device exposes whole blood flow to a combination of both high and low shear stress past and between ball bearings potentially causing thrombin and fibrin formation. The question arises as to whether thrombosis in the GTT is dominated by coagulation-triggered red clot or high shear-induced white clot. We investigated the nature of the thrombus formed in the GTT, the device efficacy, human factors use, and limitations. The GTT formed clots that were histologically fibrin-rich with trapped red blood cells. The occlusion time (OT) was more consistent with coagulation than high shear white clot and was strongly lengthened by heparin and citrate, two common anticoagulants. The clot was lysed by tissue plasminogen activator (tPA), also consistent with a fibrin-rich red clot. Changing the bead to a collagen-coated surface and eliminating the low shear zone between the beads induced a rapid OT consistent with a platelet-rich thrombus that was relatively resistant to heparin or tPA. The evidence points to the GTT as occluding primarily due to fibrin-rich red clot from coagulation rather than high shear platelet aggregation and occlusion associated with arterial thrombosis.

Comparative Evaluation of Occlusion before and after Soft Tissue Mobilization in Patients with Temporomandibular Disorder—Myofascial Pain with Referral

The aim of the study was to evaluate occlusal parameters in patients with myofascial pain with referral before and after soft tissue mobilization. The study group consisted of 50 people (37 females and 13 males, average age 23.36 ± 2.14 years) diagnosed with myofascial pain with referral. All patients underwent triplicate soft tissue mobilization. Occlusal parameters were evaluated six times, before and after each treatment, using T-scan III. A decreasing tendency of the occlusion time was observed after the first, second, and third therapy. After the third treatment, the mean occlusion time in the entire study group was 0.119 s. The 1st soft tissue mobilization shortened both right and left disclusion times to 0.181 s and 0.185 s, respectively. After the third treatment, these parameters amounted to 0.159 s and 0.165 s, respectively. The Friedman test for the entire study group indicated that soft tissue mobilization altered the occlusion time and both disclusion times (p < 0.05). In conclusion, soft tissue mobilization affects biotensegrity of the masticatory system, thus modifying occlusal parameters. The occlusion time and both disclusion times cannot be considered as cofactors of the existing temporomandibular disorders—myofascial pain with referral.

A Combined Microsurgical and Endovascular Approach to Giant Paraclinoid Aneurysm: 2-Dimensional Operative Video

Giant paraclinoid aneurysm remains a treatment challenge because of their complex anatomy and surgical difficulties stems frequently from a calcified or atherosclerotic aneurysmal neck and compression of the optic pathways.1-9 To improve exposure, facilitate the dissection of the aneurysm, assure vascular control, reduce brain retraction and temporary occlusion time, and enable simultaneous treatment of possible associated aneurysms, we combined the cranio-orbital zygomatic (COZ) approach9 with endovascular balloon occlusion of the internal carotid artery (ICA) and suction decompression of the aneurysm.4 The patient is a 50-yr-old female who presented with headache and hemianopsia. MRI, CT, and 4-vessel angiography revealed a giant right ophthalmic paraclinoid partially thrombosed aneurysm. Surgery was performed via right COZ approach with removal of the anterior clinoid. Unroofing the optic canal and opening the falciform ligament and the optic sheath, allowing the dissection and mobilization of the optic nerve from the aneurysm and the origin of ophthalmic artery. The endovascular team placed a deflated, double lumen balloon catheter in the ICA 2 cm above the common carotid bifurcation. Proximal control is achieved by inflating the balloon. Distal control is then gained by temporary clipping just proximal of the origin of PcomA.4 Retrograde suction decompression through the catheter partially collapses and softens the aneurysm.1,4,6-8 Carotid occlusion was applied twice, 2:47 and 2:57 min. Intraoperative angiogram revealed the obliteration of the aneurysm and the patency of the carotid and ophthalmic artery. The patient recovered well, and visual deficit resolved and was neurologically intact. Patient consented for surgery. Illustrations in video reprinted with minimal modification from Surgical Neurology, vol 50, issue 6, Arnautović KI, Al-Mefty O, Angtuaco E, A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneuroysms, 504–518,4 Copyright 1998, with permission from Elsevier Science Inc.