Objective. To assess the accuracy and precision in measurement of pairwise implant displacement across three methods of cranial base superimposition. Background. Cephalometric superimposition is the principal radiographic method used to evaluate changes within the craniofacial skeleton. Many studies have examined the accuracy of software intended to produce cephalometric superimposition. Such studies have utilized anatomic landmarks, selected by the respective software manufacturers, as registration points for constructing superimpositions and their analysis. As a result, these studies are only as accurate as the stability and validity of anatomic registration landmarks used. To our knowledge, no other study has utilized metallic implants to critically assess digital vs. analog cephalometric cranial base superimposition. Methods. Serial cephalograms from twenty-two patients across three time points containing metallic implants were obtained from the Mathews Acquisition Group. Each of the sixty-six cephalograms was traced by hand and digitally. Cranial base superimpositions were completed according to the analog structural method proposed by Björk and Skieller, and Johnston, and then by Dolphin version 11.5 and Quick Ceph Studio V3.2.8 digital software according to manufactures instructions. Total displacement measurements of selected implants across paired time points were recorded for both digital methods and analog method of superimposition with analog serving as the reference. Results: There were no statistically significant contrasts of mean total displacement of implants by superimposition method (p = 0.999). No significant differences are reported in mean implant displacement when comparing digital to analog superimposition methods for contrasts by time, structure, or implant location. Conclusions: The results show that there are no significant differences in accuracy and precision of digital and analog cranial base superimposition. The results of this study suggest that cranial base superimpositions on S-Na that are registered on S may be a good approximation of the structural method of cranial base superimposition. There are many methodological differences between digital and analog cranial base superimposition and future research examining such differences is recommended.

Background: At a primary care center in Brooklyn, New York, approximately 27% of diabetic patients with abnormal Hgb A1C fail to return for follow-up appointments, as recommended by the Centers for Disease Control and Prevention (CDC). According to electronic medical records (EMR), healthcare providers demonstrated inconsistency in ordering and monitoring Hgb A1C and clinic follow-up appointments for patients. Purpose: The purpose of this quality improvement project was to determine retrospectively the healthcare providers’ ordering, monitoring, and follow-up appointments for adult diabetic patients with abnormal Hgb A1Cs; to develop and implement astandardized process for healthcare providers to monitor and follow these patients, especially those with possible nonclinic follow-up compliance and abnormal Hgb A1C; to determine prospectively healthcare providers’ ordering, monitoring, and follow-up appointments; and to evaluate the prospective charts to determine if Hgb AIC results changed from abnormal to normal or elevation over time until the next follow-up appointment.

Background. Physical therapists (PTs) in the U.S. military practice direct access and can order limited prescription medications, imaging studies. Military PTs function as autonomous primary care managers (PCMs) for patients with musculoskeletal (MSK) disorders. Objective. The study compared cost of PT management of patients with MSK disorders to management by traditional PCMs; medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods. The researcher used a retrospective study of electronic medical records, using an exploratory, non-experimental, cross-sectional, and quantitative design method. Results. At an Air Force military medical clinic during an 18-month period from January 2016 through June 2017, 8,053 patients with MSK disorders were assessed. PT management of MSK patients resulted in a significantly lower rate of imaging studies, NSAIDS and cost of care when compared to MDs, DOs, PAs, or ARNPs. Patients with MSK disorders managed by PTs had no significant difference in return to work rate when compared to MDs, DOs, PAs, or ARNPs. Limitations. Data was collected at one Air Force medical clinic, with the majority of patients being active duty military. Conclusions. Findings suggest that PTs returned patients to work on par with care provided by traditional PCM’s. However, PTs used significantly fewer medications and imaging studies resulting in less overall cost of care. Longitudinal studies looking at recurrence rate of MSK conditions comparing non-PT PCMs to traditional PCMs manage would be of value when assessing cost over time. Keywords: Direct access physical therapy, primary care physical therapy.

This qualitative study describes how physical therapist experts in musculoskeletal disorders evaluate and interpret imaging studies and how they employ imaging in clinical decision-making. The informants are physical therapists who are certified orthopedic clinical specialists (OCS) and/or fellows of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). The study employed web conferencing to display patient cases, record screen-capture videos, and to conduct interviews. Informants were observed and their activity video-captured as they evaluated imaging studies and, afterwards, interviews were employed to explore the processes they utilized to evaluate and interpret the images and to discuss imaging-related clinical decision-making, including possible functional consequences of changes seen in the images, contraindications to treatment, and indications for referral. The interviews were transcribed and analyzed in the tradition of grounded theory. This study found that the informants’ evaluation of imaging studies was contextual and non-systematic, guided by the clinical presentation. The informants used imaging studies to provide a deeper understanding of clinical findings and widen perspectives, arriving at clinical decisions through the synthesis of imaging, clinical findings, and didactic knowledge. They tended to look for imaging evidence of interference with normal motion, rather than evidence of pathology. Overall, the informants expressed conservative views on the use of imaging, noting they would rather use clinical findings and treatment response than imaging findings as a basis for referral to other health care professionals. Using imaging studies to support clinical decision-making can provide physical therapists a wider perspective when planning treatment interventions. By showing physical therapists’ approach to interpreting imaging studies and how this relates to their clinical decision-making, the findings of this study could contribute to discussions of the place of imaging in physical therapist practice, as well as help set objectives for imaging curricula in professional-level and continuing education.

Background: Physical therapists regularly make decisions regarding intervention intensity based upon pathoanatomy and symptom irritability, but the reliability and validity of classifying patients by symptom irritability are unknown. Purpose: Examine the reliability and construct validity of the shoulder symptom irritability classification (SSIC) system for the purposes of determining an appropriate treatment intensity. Design: Prospective repeated-measures cross-sectional single-blinded design. Methods: 101 consecutive subjects with primary complaints of shoulder pain were assessed by a pair of blinded raters. Raters recorded the SSIC level and selected the appropriate intervention intensities for the subjects. Data Analysis: Prevalence-adjusted, bias-adjusted Kappa for ordinal scales (PABAK-OS) and observed agreement were the primary measures of reliability. Analysis of variance (ANOVA) was used to compare functional disability across different levels of irritability. Receiver operating characteristic (ROC) curve analysis was utilized to derive cut-off scores for the patient-reported outcome (PRO) measures. Ordinal regression was utilized to compare the strength of patient-reported pain and disability in the determination of shoulder symptom irritability. Results: Inter-rater reliability (PABAK-OS) was 0.69 (95% Confidence Interval [CI] = 0.59, 0.78). ANOVA demonstrated significant differences in functional limitation between SSIC groups for all PRO measures. ROC curve analysis found significant cut-off scores for all PRO measures. Lastly, rater agreement between SSIC and treatment strategy was found to have PABAK-OS of 0.82 (95% CI 0.75, 0.88) with 80% agreement. Discussion: The inter-rater reliability of the SSIC system good and is not contingent upon experience or expertise. Despite lack of predominance of the function in the components of SSIC, functional limitation significantly influences SSIC along with aspects of pain that influence function. While the cut-off scores show promising results, further work is needed to validate the results. Ultimately, there appears to an excellent relationship between rater selected SSIC and treatment strategy demonstrating a foundation for construct validity of the SSIC. Therefore, the results of this study should serve as a foundation for future work for refinement of the SSIC as a component of the STAR-Shoulder diagnostic classification system. Clinical Significance: The shoulder symptom irritability classification scale is reliable and clinically useful for improvement of communication between medical providers.

Introduction: Lateral cephalometric superimpositions (LCS) are used to measure dental and skeletal changes that occur in the craniofacial complex over time. Orthodontists use LCSs to assess treatment outcomes. The purpose of this study was to conduct an assessment of the measured displacement of defined dental landmarks across digital and analog methods of mandibular regional serial superimposition as compared to an implant-registered superimposition reference. The data used in this study was derived from the Mathew's Acquisition Group implant sample; the first United States longitudinal study of growing children with maxillary and mandibular Björk type metallic implants. Methods: Sixty-six lateral cephalometric radiographs were selected from twenty-two children. Three cephalometric tracings were completed for each subject that were then superimposed pairwise (T1 vs. T2, T2 vs. T3) across four separate methods of superimposition, two analog: Implant, Structural; and two digital: Dolphin, Quick Ceph. Each superimposition was then imported into Adobe Photoshop where the images were scaled and the displacement of defined dental structures was measured. Defined dental structures included: (1) first molar mesial contact point, (2) first molar apical root bisection, (3) central incisor root apex, and (4) central incisor crown incisal edge. A random-effects, generalized linear model was used to contrast dental landmark displacement measurements. Results: There was no difference between the mean displacement of defined dental structures between different methods (p=0.145). There was no difference between the different methods by defined dental structure (p=0.150). Conclusions: Our study demonstrated that there are no statistically significant differences among three methods of mandibular regional superimposition in comparison to an implant-registered (reference) method (analog: Structural, Implant; digital: Dolphin, and Quick Ceph). The historical data set utilized in our study, limited by the small sample size, resulted in a relatively low power (0.15). A low power increases the likelihood of incorrectly failing to reject a null hypothesis that is actually false. which must be considered in our study.

Objective: This study was conducted to determine the effectiveness of physical and mechanical disinfection of P. gingivalis from implant disks and to evaluate bone cells growth and attachment to the disks. Background. Each year, over three million of Americans replacing missing teeth with dental implants. An inflammatory process around an implant that causes bone loss, characterizes peri-implantitis, first diagnosed in the 1980s. The prevalence is approximately 22%. To date, no treatment protocol of peri-implantitis has been proposed. Methods. 207 implants disks. Four different implant surfaces utilized. Disks were contaminated by p. gingivalis and consequentially disinfected by physical means (spraying prophy jet, titanium brush, and ultrasonic activation) and chemically by Hydrogen Peroxide 3%, 0.12% Chlorhexidine Gluconate, and Sodium Bicarbonate. Osteoblasts were added to the disks. Growth factors (Emdogain and Gem21S) were used in two groups. Osteoblast vitality, attachment and morphology were evaluated. Results. On 3iT3 the all disinfection methods had similar results. On Osseotite and Nanotite surfaces, the citric acid combined with ultrasonic activation granted the worse results. Hence, disks that did not have the surface altered by physical decontamination had most cells attached. Hydrogen Peroxide 3% showed to be the most biocompatible and 0.12% Chlorhexidine gluconate showed most cellular toxicity. Implant coating did not influence osteoblast attachment. Growth factors did not promote osteoblast attachment. Conclusion: Further investigations are necessary.

Background . Little is known about the long-term clinical bonding effectiveness of the Fiber-reinforced composite (FRC) posts cemented with self-etch adhesive systems. Bond stability and longevity of the cemented post are adversely affected by physical and chemical factors over time, such as expansion and contraction stresses caused by thermal changes and occlusal load. This clinical condition can be simulated in vitro by thermocyclic loading; and bonding effectiveness can be evaluated by applying the micropush out test. Therefore, more in vitro studies are needed to evaluate the bond strength of the fiber posts cemented with different resin cement systems after simulating the artificial aging induced by thermocycling. The aim of this study was to compare the microtensile bond strength of two different resin cement systems (total etch, and self-etch resin cement system) used for cementation of fiber reinforced composite posts in three different aging periods using thermocycling. Methods . Following IRB approval, sixty freshly extracted bicuspid single rooted natural teeth were endodontically treated, and the post-spaces were prepared to receive a fiber-post cemented with either a total etch resin cement (Rely-X Ultimate) or with a self-etch resin cement (Rely-X Unicem). No thermocycling, 20,000 and 40,000 cycles was used to age the specimens. Teeth were randomly allocated into six different groups: G1 - Control: Rely-X Ultimate cement with no thermocycling. G2: Rely-X Ultimate cement with 20,000 thermocycling. G3: Rely-X Ultimate cement with 40,000 thermocycling. G4: Rely-X Unicem cement. G5: Rely-X Unicem cement. G6: Rely-X Unicem cement. Microtensile bond strength determined using a micropush out test on a universal testing machine (MTS). Additionally, the failure mode of each specimen was observed under a stereomicroscope (Olympus) at 40x magnification. Finally, one representative sample was randomly selected from each of the five failure modes for scanning electron microscope (SEM) examination of the surface morphology in order to obtain SEM images of the failure patterns at 29-70x magnifications. Statistical analysis: Nested general linear and generalized linear model was created to look for statistical significance. Level of significance was set at P < 0.05. Results . No significant differences were found on the bond strength between the two types of resin cement systems (total etch and self-etch). Regarding the thermocycling effect, the bond strengths of the group of 40,000 cycles was significantly lower than the 20,000 cycle group. In addition, the bond strengths of the specimens collected from the coronal third of the root were significantly lower than the specimens from the apical third. A Fisher's Exact test was applied to evaluate the failure mode differences, and showed statistically significant differences between the groups. Conclusions . The bond strength to the root canal dentin did not vary with the type of resin cement systems (total-etch vs self-etch). The microtensile bond strength values of FRC posts were significantly affected by increasing the thermocycling, and were significantly different among the different longitudinal levels of the root canal.

Objectives: The purpose of this in-vitro study was to evaluate the effects of three different surface preparation methods on the shear bond strength of orthodontic brackets bonded to zirconia and determine the most appropriate method. Methods: 45 zirconia and 30 leucite-reinforced porcelain mandibular premolar crowns were divided into 5 groups and received the following surface preparations: 37% phosphoric acid and non-hydrolyzed silane, 4% hydrofluoric acid and hydrolyzed silane, microetch with 50μ Al 2 O3 particles. A universal adhesive primer containing MDP was applied and the brackets were bonded with a bis-GMA composite resin. Shear bond strength (SBS) at bond failure and ARI score were recorded. Results: There was a statistically significant difference among the studied groups for the SBS. The highest mean SBS (11.03 MPA) was recorded for the zirconia/microetch group, and the lowest SBS (3.49 MPa) for the zirconia/phosphoric acid group. The leucite-reinforced porcelain/ hydrofluoric acid group had significantly more fractures than any other debond pattern. The zirconia/hydrofluoric acid group was the only one with a SBS (8.08 MPa) that fell within the recommended range of 6-8 MPa. This group also had a favorable debond pattern with most composite remaining on the bracket. Conclusions: Important consideration should be given to the surface preparation of porcelain and zirconia prior to bonding orthodontic attachments. Phosphoric acid etch is not an adequate surface preparation when bonding to zirconia. Hydrofluoric acid is not suitable when bonding to leucite-reinforced porcelain, as it is associated with a higher rate of surface fracture. Microetch with 50μ Al 2 O3 particles in combination with an MDP containing universal adhesive primer provided optimal mean shear bond strength, along with favorable debond patterns when bonding to zirconia. Hydrofluoric acid etch in combination with a silane and a universal primer containing MDP provided acceptable shear bond strength to zirconia. This protocol was not significantly different from zirconia prepared with microetch and either method can be successfully employed.

December 2011. A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Introduction: The purpose of this study is to compare the shear bond strengths (SBSs) of two new commercial adhesive systems to a conventional multistep bonding system incorporating a 35% phosphoric acid gel. In addition, the amount of adhesive remaining on each tooth following debonding will be analyzed and compared using the adhesive remnant index (ARI). Methods: 88 human premolar teeth chosen from the Nova Southeastern tooth databank were randomly divided into four groups. Group I (control group): Transbond XT primer and adhesive (35% phosphoric acid), Group II: iBond Total Etch system with iBond 35 gel (35% phosphoric acid), Group III: iBond Total Etch system with iBond 20 gel (20% phosphoric acid). Group IV: iBond Self Etch. A scanning electron microscope (SEM) was utilized to qualitatively examine the enamel surface of one randomly selected tooth per group immediately after etching, leaving 21 teeth per group available for the debonding procedure (n=21). Following bonding of the stainless steel brackets (3M Unitek, Monrovia, CA), the teeth were stored in water at 37°C ± 2°C for forty-eight hours. A universal testing machine (Instron, Canton, MA) was then used to determine the shear bond strength of each bracket. Additionally, the amount of adhesive remaining on each tooth following debonding was recorded using 10x light microscopy. Results: A 1-way ANOVA revealed that no statistical differences in bond strength were found between the four groups. SBS values of groups I (11.7 ± 3.9), II (11.6 ± 4.6), III (10.3 ± 4.1), and IV (10.8 ± 3.9) demonstrated mean SBSs considered adequate. The iBond Total Etch (20%) and iBond Total Etch (35%) groups were more likely to have an ARI score of 2-3 than the control group (Transbond XT). No significant differences were found between iBond Self Etch and the control group. Conclusion: The SBS's of all three groups, as compared to the control group, were adequate. The iBond Total Etch system, whether used with iBond 20 gel or iBond 35 gel, had more adhesive remaining on the tooth surface after debonding. Standardization amongst shear bond strength studies is significantly needed in the near future in order to accurately compare findings.