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JACC. Advances Apr 2024Cost-effectiveness of testing for coronary artery calcium (CAC) relative to other treatment strategies is not established in Canada.
BACKGROUND
Cost-effectiveness of testing for coronary artery calcium (CAC) relative to other treatment strategies is not established in Canada.
OBJECTIVES
The purpose of this study was to evaluate the cost-effectiveness of using CAC score-guided statin treatment compared with universal statin therapy among intermediate-risk, primary prevention patients eligible for statins.
METHODS
A state transition, microsimulation model used data from Canadian sources and the Multi-Ethnic Study of Atherosclerosis to simulate clinical and economic consequences of cardiovascular disease from a Canadian publicly funded health care system perspective. In the CAC score-guided treatment arm, statins were started when CAC ≥1. Outcome of interest was the incremental cost-effectiveness ratio at 5 and 10 years; an incremental cost-effectiveness ratio <$50,000 per quality-adjusted life year (QALY) gained was considered cost-effective. Sensitivity analyses examined uncertainty in model parameters.
RESULTS
Compared with universal statin treatment at 5 and 10 years, CAC score-guided statin treatment was projected to increase mean costs by $326 (95% CI: $325-$326) and $172 (95% CI: $169-$175), increase mean QALYs by 0.01 (95% CI: 0.01-0.01) and 0.02 (95% CI: 0.02-0.02), and cost $54,492 (95% CI: $52,342-$56,816) and $8,118 (95% CI: $7,968-$8,279) per QALY gained, respectively. The model was most sensitive to statin cost, CAC testing cost, adherence to statin monitoring, and disutility associated with daily statin use. At 5 years, CAC score-guided statin treatment was cost-effective when CAC test costs ranged from $80 to $160 in different scenarios.
CONCLUSIONS
CAC score-guided statin initiation in comparison to universal statin treatment was borderline cost-neutral at 5 years and cost-effective at 10 years in statin-eligible Canadian patients at intermediate cardiovascular disease risk.
PubMed: 38939688
DOI: 10.1016/j.jacadv.2024.100886 -
JACC. Advances Apr 2024A treatment strategy for congenital heart defects with moderate to severe pulmonary arterial hypertension (PAH) has not been established.
BACKGROUND
A treatment strategy for congenital heart defects with moderate to severe pulmonary arterial hypertension (PAH) has not been established.
OBJECTIVES
The purpose of this study was to identify patients in whom a treat and repair strategy was considered and to examine pretreatment variables associated with successful defect repair.
METHODS
Patients with atrial or ventricular septal defect and PAH (pulmonary vascular resistance [PVR] ≥ 5 Wood units) eligible for the treat and repair strategy were included. Hemodynamics among pretreatment, pre-repair, and post-defect repair were compared. Clinical outcomes in patients with or without defect repair were also compared. Clinical outcomes included all-cause death, hospitalization for worsening pulmonary hypertension, and lung transplantation.
RESULTS
Among 25 eligible for the treat and repair strategy, 20 underwent successful repair (repaired group) and 5 did not have a repair (unrepaired group). In the repaired group, PVR significantly decreased from 9.6 ± 2.6 WU at pretreatment to 5.0 ± 3.4 pre-repair (ß coefficient -4.6 [95% CI: -5.9 to -3.3]). The pulmonary to systemic blood flow ratio (Qp/Qs) increased from 1.5 ± 0.6 at pretreatment to 2.4 ± 1.3 pre-repair (ß coefficient 0.9 [95% CI: 0.4-1.38]). In the unrepaired group, pretreatment PVR decreased with treatment; however, PVR remained elevated. Qp/Qs did not change between pretreatment and post-treatment. The repaired group had a better prognosis than the unrepaired group (HR 0.092 [95% CI: 0.009-0.905]). Pretreatment mean pulmonary artery pressure, PVR, Qp/Qs, and arterial oxygen saturations were associated with undergoing defect repair.
CONCLUSIONS
In this small cohort, a treat and repair strategy was successfully used in a significant proportion of the patients with congenital heart defects with moderate to severe PAH.
PubMed: 38939653
DOI: 10.1016/j.jacadv.2024.100887 -
Journal of Conservative Dentistry and... May 2024To evaluate and compare the microhardness of Filtek Z250XT, Beautifil II, and Neo Spectra ST HV after immersion in chlorhexidine mouthwash.
AIM
To evaluate and compare the microhardness of Filtek Z250XT, Beautifil II, and Neo Spectra ST HV after immersion in chlorhexidine mouthwash.
MATERIALS AND METHODS
Thirty disc specimens (10 for each group) made of three different restorative materials, Group 1 - Filtek (3M ESPE), Group 2 - Beautifil II (Shofu), and Group 3 - Neo Spectra ST HV (Dentsply). To simulate 1 year of daily mouthwash use, 10 specimens from each group were immersed in chlorhexidine, kept in an incubator at 37°C for 12 h, and later subjected to microhardness measurement using Vicker's hardness test. Finally, analysis of variance and post hoc tests were used to analyze the results statistically.
RESULTS
A significant reduction in microhardness was observed after immersion in chlorhexidine in Groups 1 and 3 compared to Group 2.
CONCLUSIONS
Filtek Z250XT exhibits the highest microhardness compared to the other two materials. However, Beautifil II is more resistant to chlorhexidine mouthwash and does not show a significant reduction compared to the other two restorative materials.
PubMed: 38939552
DOI: 10.4103/JCDE.JCDE_87_24 -
Journal of Conservative Dentistry and... May 2024Evaluation of the antibacterial and cytotoxic properties of TotalFill and NeoSEALER Flo bioceramic sealers compared to AH Plus resin sealer.
AIM
Evaluation of the antibacterial and cytotoxic properties of TotalFill and NeoSEALER Flo bioceramic sealers compared to AH Plus resin sealer.
MATERIALS AND METHODS
Modified direct contact test was used on three sets of sealers: Freshly mixed sealers, sealers that were 1-day old, and sealers that were 7-day old. After 24 h of incubation, the colony-forming units were digitally counted using Promega Colony Counter after 30 and 60 min of exposure to . For cytotoxic effect evaluation, 3-(4,5-dimethylthiazol-2-yl)-2-5-diphenyltetrazolium bromide assay was performed at three different time points: 24 h, 48 h, and 120 h after adding the sealer eluates to human gingival fibroblasts, to assess cell viability. Data were analyzed using mixed model analysis of variance followed by test.
RESULTS
TotalFill bioceramic sealer showed the highest bacterial reduction against throughout all intervals. AH Plus showed great antibacterial activity initially which reduced drastically after 7 days. All the sealers showed a reduction in their antibacterial activity with time. TotalFill and NeoSEALER Flo showed very high cell viability in contrast to AH Plus.
CONCLUSION
TotalFill and NeoSEALER Flo demonstrate superior antimicrobial properties against which reduces with time. TotalFill and NeoSEALER Flo demonstrate acceptable biocompatibility against human gingival fibroblasts, which decreased over time.
PubMed: 38939551
DOI: 10.4103/JCDE.JCDE_103_24 -
Journal of Conservative Dentistry and... May 2024Variations in the root canal anatomy of a maxillary first molar are often challenging to diagnose and treat; thus, clinicians must have a thorough knowledge of the same....
Variations in the root canal anatomy of a maxillary first molar are often challenging to diagnose and treat; thus, clinicians must have a thorough knowledge of the same. This case report highlights the successful nonsurgical endodontic management of a maxillary first molar with an unusual morphology of three roots and six root canals. A total of six root canals (mesiobuccal [MB] 1, MB2, MB3, distobuccal [DB] 1, DB2, and palatal) were detected after initiating root canal therapy and access cavity preparation. Conventional root canal treatment was completed, and postoperative cone-beam computed tomography scanning was done to verify the total number of canals and ensure the adequacy of root canal fillings. Managing such cases with rare variations in the root canal systems could be arduous and thus, clinicians should be well-versed in the methods to identify and manage such complexities to facilitate the successful outcomes of endodontic treatment.
PubMed: 38939550
DOI: 10.4103/JCDE.JCDE_123_24 -
Journal of Conservative Dentistry and... May 2024Seal the dentin of the pulp chamber during endodontic treatment to avoid interfering with the restorative treatment performed afterward.
CONTEXT
Seal the dentin of the pulp chamber during endodontic treatment to avoid interfering with the restorative treatment performed afterward.
AIMS
The aim was to evaluate the effect of three adhesive systems applied in different bonding strategies (etch-and-rinse, self-etch, and universal adhesive) and time-point application (immediately after the cavity access preparation or after endodontic obturation) on the hybrid layer formation and dentinal penetrability.
MATERIALS AND METHODS
Forty-eight sound molars were randomly distributed into six groups ( = 10) according to the adhesive system used: Forty-eight sound molars were randomly distributed into six groups ( = 10) according to the adhesive system used and the time-point application: Adper Scotchbond Multi-purpose (AS), Clearfil SE (CF) and Scotchbond Universal (SU) in strategy of immediate endodontic sealing (IES) or delayed endodontic sealing (DES). In IES-AS, IES-CF, and IES-SU groups, dentin sealing was performed immediately after the cavity access, while in DES-AS, DES-CF, and DES-SU, after root canal obturation. The specimens were sectioned in the long axis, in a buccal-lingual direction, and the dentinal penetrability of the adhesive systems was evaluated using confocal microscopy images. Hybrid layer formation was analyzed by scanning electron microscopy images.
STATISTICAL ANALYSIS USED
Dentinal penetrability data were analyzed with the ANOVA test and the Kruskal-Wallis test was performed for hybrid layer data (α = 0.05).
RESULTS
IES-CF showed the lowest dentinal penetrability ( < 0.05), while the other protocols were similar to each other ( > 0.05). No significant differences were found between groups regarding the hybrid layer formation ( > 0.05). Immediate and DES protocols do not influence the hybrid layer formation, regardless of the bond strategy used.
CONCLUSIONS
Sealing the pulp chamber dentin before endodontic treatment can improve the bond strength of the final restoration but the formation of the hybrid layer was not influenced by the bond strategy.
PubMed: 38939549
DOI: 10.4103/JCDE.JCDE_80_24 -
Journal of Conservative Dentistry and... May 2024
PubMed: 38939548
DOI: 10.4103/JCDE.JCDE_171_24 -
Journal of Conservative Dentistry and... May 2024Biodentine is widely used for endodontic applications; recently, it has been incorporated with triple antibiotic paste (TAP). The effect of endodontic irrigants on the...
BACKGROUND
Biodentine is widely used for endodontic applications; recently, it has been incorporated with triple antibiotic paste (TAP). The effect of endodontic irrigants on the physical characteristics of this new combination needs to be studied.
AIMS
The aim of the study was to evaluate the surface roughness and microhardness of Biodentine incorporated with TAP subjected to various endodontic irrigants.
MATERIALS AND METHODS
Hundred cylindrical discs (6 mm × 3 mm) were prepared by mixing the Biodentine with TAP (3:1). The specimens were subjected to different irrigating solutions for 5 min in 5 groups ( = 20): Group 1: distilled water (control), Group 2: 2.5% sodium hypochlorite, Group 3: 17% ethylenediaminetetraacetic acid, Group 4: 2% chlorhexidine (CHX), and Group 5: 2% chitosan nanoparticles (CSNs). Half of the specimens in each group were subjected to surface roughness ( = 10) and another half to microhardness ( = 10). Surface roughness was measured using a surface roughness tester, and digital Vickers microhardness testing was performed on each specimen.
STATISTICAL ANALYSIS
One-way ANOVA and Tukey's tests ( ≤ 0.05) were used.
RESULTS
The highest microhardness was found with 2% CSN, whereas 2% CSN and 2% CHX had a minimal effect on the surface roughness of Biodentine incorporated with TAP ( ≤ 0.05).
CONCLUSION
The root canal irrigant 2% CSN exhibited the highest microhardness and least surface roughness of modified Biodentine with TAP.
PubMed: 38939547
DOI: 10.4103/JCDE.JCDE_58_24 -
Journal of Conservative Dentistry and... May 2024The aim of this study was to compare the accuracy of two different electronic apex locators (EALs) in detecting simulated incomplete vertical root fractures (VRFs).
AIM
The aim of this study was to compare the accuracy of two different electronic apex locators (EALs) in detecting simulated incomplete vertical root fractures (VRFs).
MATERIALS AND METHODS
Thirty freshly extracted single-rooted teeth were randomly divided into three groups of 10 teeth each labeled as Groups A, B, and C. Incomplete VRFs were simulated in the coronal, middle, and apical one-third of the roots for Groups A, B, and C, respectively. The teeth were embedded in alginate mold and fracture location was determined with Root ZX and Propex EALs for each sample and each group. To calculate the actual length (AL), each sample was sectioned at the upper level of the vertical fracture, and the length was measured by setting the stopper of the #10 K file under a stereomicroscope at ×30 magnification. The electronic lengths and ALs were compared using computer software, and the results were analyzed using SPSS 28.0 at a 95% confidence level.
RESULTS
No significant differences were seen in the accuracy of the two EALs when compared with ALs. Root ZX showed significantly longer measurements than ALs in groups B and C.
CONCLUSION
The tested EALs showed low accuracy (20%) in detecting simulated incomplete VRFs with a tendency for longer measurements compared to ALs.
PubMed: 38939546
DOI: 10.4103/JCDE.JCDE_132_24 -
Journal of Conservative Dentistry and... May 2024The escalating prevalence of noncarious tooth wear stands as a critical concern in the backdrop of evolving lifestyles and dietary patterns. Dental erosion, a...
OBJECTIVE
The escalating prevalence of noncarious tooth wear stands as a critical concern in the backdrop of evolving lifestyles and dietary patterns. Dental erosion, a progressive condition induced by both endogenous and exogenous acidic influences, directly impacts enamel integrity, resulting in surface loss. The contemporary surge in carbonated beverage consumption further exacerbates this erosive milieu, underscoring the urgency for dental practitioners to adopt meticulous treatment strategies. Existing literature underscores a noteworthy 94% reduction in tooth erosion risk for individuals abstaining from sweetened soft beverages, emphasizing the imperative for a well-devised remineralization protocol to counter demineralized surfaces.
METHODOLOGY
Seventy-three enamel specimens were taken. Forty samples were subjected to pre-operative hardness testing, and five samples were subjected to baseline EDX evaluation followed by grouping of samples (Group 1 = control Group; Group 2 = casein phosphopeptide-amorphous calcium phosphate fluoride [CPP-ACPF] Group; Group 3 = Biomin F Group; and Group 4 = self-assembling peptide [SAP] P-114 Group). A demineralization-remineralization cycle was carried out for 5 days followed by testing through Vickers Microhardness Tester, EDX Evaluation, and Scanning Electron Microscopy (SEM) Imaging. Statistical analysis was performed using one-way analysis of variance followed by intergroup analysis using Tukey's test with SPSS software 25.0 version.
RESULTS
The mean percentage change in microhardness values was 30.05% in Group 1, 24.21% in Group 2, 18.85% in Group 3, and 12.08% in Group 4. The mean Ca/P ratio of samples tested through EDAX was 2.20 at baseline, 1.40 in Group 1 (Control Group), 1.62 in Group 2 (CPP-ACPF), 1.82 in Group 3 (Biomin F), and 2.01 in Group 4 (SAP-P114). Postintervention values were statistically significant from baseline values in both parameters.
CONCLUSION
Curodont Protect exhibits superior efficacy, offering valuable insights for future studies and clinical applications. The multifaceted evaluation, encompassing microhardness testing, SEM analysis, and EDXS assessment, contributes to a nuanced interpretation of the agents' impact, paving the way for informed decisions in clinical practice and future research endeavors.
PubMed: 38939544
DOI: 10.4103/JCDE.JCDE_62_24