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Journal of the American College of... Sep 2020Bicuspid aortic stenosis accounts for almost 50% of patients undergoing surgical aortic valve replacement in the younger patients. Expanding the indication of... (Observational Study)
Observational Study
BACKGROUND
Bicuspid aortic stenosis accounts for almost 50% of patients undergoing surgical aortic valve replacement in the younger patients. Expanding the indication of transcatheter aortic valve replacement (TAVR) toward lower-risk and younger populations will lead to increased use of TAVR for patients with bicuspid aortic valve (BAV) stenosis despite the exclusion of bicuspid anatomy in all pivotal clinical trials.
OBJECTIVES
This study sought to evaluate the association of BAV morphology and outcomes of TAVR with the new-generation devices.
METHODS
Patients with BAV confirmed by central core laboratory computed tomography (CT) analysis were included from the international multicenter BAV TAVR registry. BAV morphology including the number of raphe, calcification grade in raphe, and leaflet calcium volume were assessed with CT analysis in a masked fashion. Primary outcomes were all-cause mortality at 1 and 2 years, and secondary outcomes included 30-day major endpoints and procedural complications.
RESULTS
A total of 1,034 CT-confirmed BAV patients with a mean age of 74.7 years and Society of Thoracic Surgeons score of 3.7% underwent TAVR with contemporary devices (n = 740 with Sapien 3; n = 188 with Evolut R/Pro; n = 106 with others). All-cause 30-day, 1-year, and 2-year mortality was 2.0%, 6.7%, and 12.5%, respectively. Multivariable analysis identified calcified raphe and excess leaflet calcification (defined as more than median calcium volume) as independent predictors of 2-year all-cause mortality. Both calcified raphe plus excess leaflet calcification were found in 269 patients (26.0%), and they had significantly higher 2-year all-cause mortality than those with 1 or none of these morphological features (25.7% vs. 9.5% vs. 5.9%; log-rank p < 0.001). Patients with both morphological features had higher rates of aortic root injury (p < 0.001), moderate-to-severe paravalvular regurgitation (p = 0.002), and 30-day mortality (p = 0.016).
CONCLUSIONS
Outcomes of TAVR in bicuspid aortic stenosis depend on valve morphology. Calcified raphe and excess leaflet calcification were associated with increased risk of procedural complications and midterm mortality. (Bicuspid Aortic Valve Stenosis Transcatheter Aortic Valve Replacement Registry; NCT03836521).
Topics: Aged; Aged, 80 and over; Bicuspid Aortic Valve Disease; Female; Follow-Up Studies; Humans; Internationality; Male; Mortality; Prospective Studies; Registries; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 32854836
DOI: 10.1016/j.jacc.2020.07.005 -
Annual Review of Medicine Jan 2023This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development... (Review)
Review
This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development and assessment of valvular disease, strategies for global prevention of rheumatic heart disease, understanding and management of secondary mitral regurgitation, the updated classification of bicuspid aortic valve disease, recognition of heightened cardiovascular risk associated with moderate aortic stenosis, and a growing armamentarium of transcatheter therapies.
Topics: Humans; Heart Valve Diseases; Mitral Valve Insufficiency; Aortic Valve Stenosis; Atrial Fibrillation; Bicuspid Aortic Valve Disease
PubMed: 36400067
DOI: 10.1146/annurev-med-042921-122533 -
Progress in Orthodontics Jan 2023The present study was designed to define: (1) which are the less predictable OTM with Invisalign aligners when the treatment plan is designed by expert operators, (2) if...
BACKGROUNDS
The present study was designed to define: (1) which are the less predictable OTM with Invisalign aligners when the treatment plan is designed by expert operators, (2) if the presence and shape of attachments influence the predictability of OTM and (3) if patients' demographics influence OTM predictability. The sample comprises 79 prospectively recruited patients (mean age 30.8 years; SD 12.0; 23 M, 56 F), treated by expert operators with an average of 27 aligners (SD 15) in the maxillary arch and 25 aligners (SD 11) in the mandibular arch. Post-treatment digital models and final virtual treatment plan models were exported from ClinCheck software as STL files and subsequently imported into Geomagic Qualify software, to compare final teeth positions. The differences were calculated and tested for statistical significance for each tooth in the mesial-distal, vestibular-lingual and occlusal-gingival directions, as well as for angulation, inclination and rotation. In addition, the statistical significance of categorical variables was tested.
RESULTS
The lack of correction was significant for all movements and in all group of teeth (P < 0.01) except for the rotation of maxillary first molar. The prescribed OTM, the group of teeth and movement, the frequency of aligner change and the use of attachment influence the outcome. The greatest discrepancies in predicted and achieved tooth position were found for angular movements and rotation of teeth characterized by round-shaped crowns, for a ratio of approximately 0.4° per 1° prescribed. Optimized attachments for upper canines and lower premolar rotation seem not working properly. Second molar movements are mostly unexpressed. Furthermore, changing the aligner every 14 days will reduce the lack of correction of the 12% with respect to 7 days aligner change.
CONCLUSIONS
Predictability of orthodontic movement with aligners still has limitations related to the biomechanics of the system: the shape of some attachments and the characteristics of aligner material need to be redefined. However, the results of this study allow to properly design the virtual treatment plan, revealing how much overcorrection is needed and which attachments are most effective.
Topics: Tooth Movement Techniques; Software; Orthodontic Appliances, Removable; Molar; Bicuspid
PubMed: 36642743
DOI: 10.1186/s40510-022-00453-0 -
BMC Oral Health Jun 2021The present study aimed to investigate the effects of low-level laser therapy (LLLT) on orthodontic tooth movement and its correlation with the levels of interleukin-1β... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The present study aimed to investigate the effects of low-level laser therapy (LLLT) on orthodontic tooth movement and its correlation with the levels of interleukin-1β (IL-1β), receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) in gingival crevicular fluid (GCF).
METHODS
This split-mouth design study included 12 patients scheduled for the extraction of both upper first premolars. Patients were randomly selected for experimental group that received left- or right-side radiation with a diode laser (810 nm wavelength, 100 mW power output, 6.29 J/cm energy density). Laser treatment was applied on days 0, 7, 14, and 21, after loading the canine retraction forces. GCF concentrations of IL-1β, RANKL, and OPG were analyzed. The upper arch of each patient was scanned with an intraoral scanner to assess tooth movement.
RESULTS
The cumulative tooth movement over 28 days was significantly higher in the laser group than in the control group. We observed significant reductions in OPG levels and increases in IL-1β and RANKL levels in GCF samples on the experimental sides.
CONCLUSION
With the parameter settings used in this study, LLLT could, to some extent, lead to changes in bone metabolism, which could accelerate orthodontic tooth movement.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR2000039594. Registered 2 November 2020-Retrospectively registered, www.chictr.org.cn/edit.aspx?pid=62465&htm=4 .
Topics: Bicuspid; Gingival Crevicular Fluid; Humans; Lasers, Semiconductor; Low-Level Light Therapy; Tooth Movement Techniques
PubMed: 34182967
DOI: 10.1186/s12903-021-01684-z -
Dental Press Journal of Orthodontics Aug 2019Tooth crowding and protrusions demand rigorous attention during orthodontic planning that includes the extraction of first and second premolars. Some characteristics,...
Tooth crowding and protrusions demand rigorous attention during orthodontic planning that includes the extraction of first and second premolars. Some characteristics, such as dentoalveolar bone discrepancies, maxillomandibular relations, facial profile, skeletal maturation, dental asymmetries and patient cooperation, are important elements of an orthodontic diagnosis. This study discusses the options of treatments with extractions and describes the correction of a Class I malocclusion, bimaxillary protrusion, severe anterior crowding in both dental arches and tooth-size discrepancy, using first premolar extractions.
Topics: Bicuspid; Cephalometry; Humans; Malocclusion, Angle Class I; Orthodontics; Orthodontics, Corrective; Tooth Extraction
PubMed: 31390455
DOI: 10.1590/2177-6709.24.3.088-098.bbo -
Scientific Reports Jun 2020To evaluate tooth behaviours under various maxillary incisor retraction protocols for clear aligner therapy. A three-dimensional finite element model of maxillary...
To evaluate tooth behaviours under various maxillary incisor retraction protocols for clear aligner therapy. A three-dimensional finite element model of maxillary dentition was constructed for first premolar extraction. A loading method was developed to mimic the mode of action of clear aligners for incisor en masse retraction. Three protocols with different amounts of retraction and intrusion on incisors were designed. Initial tooth displacements and stresses on periodontal ligaments were analysed with ANSYS software. The central (U) and lateral (U) incisors exhibited uncontrolled lingual tipping and extrusion upon 0.25 mm retraction. U1 exhibited translation movement, while U underwent less tipping during 0.2 mm retraction and 0.15 mm intrusion. Labial tipping and intrusion of U and bodily intrusion of U were observed during 0.1 mm of retraction and 0.23 mm of intrusion. With the additional intrusion on incisors, canine showed extrusion movement, and higher stresses on periodontal ligaments were shifted from U to canines. Incisors also exhibited different mesial-distal angulation in the three simulations, while posterior teeth all suffered mesial inclination. Incorporating intrusion displacement in clear aligners led to a tendency of lingual root movement during incisor retraction. The complexity of tooth movement should be recognized regarding clear aligner therapy.
Topics: Bicuspid; Biomechanical Phenomena; Dentition; Finite Element Analysis; Humans; Incisor; Maxilla; Orthodontic Appliances, Removable; Periodontal Ligament; Printing, Three-Dimensional; Software; Stress, Mechanical; Tooth Mobility; Tooth Movement Techniques
PubMed: 32576935
DOI: 10.1038/s41598-020-67273-2 -
Australian Dental Journal Dec 2019The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of... (Review)
Review
The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extraction and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first, second and the third molar teeth extraction and their subsequent dentofacial complex changes.
Topics: Bicuspid; Humans; Molar; Molar, Third; Tooth Eruption; Tooth Extraction
PubMed: 31465537
DOI: 10.1111/adj.12716 -
Progress in Orthodontics Dec 2022The purpose was to determine the predictability of tooth movements through clear aligner among premolar extraction patients and to explore the effects of various factors...
BACKGROUND
The purpose was to determine the predictability of tooth movements through clear aligner among premolar extraction patients and to explore the effects of various factors on tooth movements.
METHODS
A total of 31 extraction patients (10 males and 20 females; age 14-44) receiving clear aligner treatment (Invisalign) were enrolled in this study. The actual post-treatment models and pre-treatment models were superimposed using the palatal area as a reference and registered with virtual post-treatment models. A paired t test was used to compare the differences between actual and designed tooth movements of maxillary first molars, canines, and central incisors. A multivariate linear mixed model was performed to examine the influence of variables on actual tooth movements.
RESULTS
Compared to the designed tooth movements, the following undesirable tooth movements occurred: mesial movement (2.2 mm), mesial tipping (5.4°), and intrusion (0.45 mm) of first molars; distal tipping (11.0°), lingual tipping (4.4°), and distal rotation of canines (4.9°); lingual tipping (10.6°) and extrusion (1.5 mm) of incisors. Age, crowding, mini-implant, overbite, and attachments have differential effects on actual tooth movements. Moreover, vertical rectangular attachments on canines are beneficial in achieving more predictable canine and incisor tooth movements over optimized attachments. Lingual tipping and extrusion of incisors were significantly influenced by the interaction effects between incisor power ridge and different canine attachments (p < 0.05).
CONCLUSIONS
Incisors, canines, and first molars are subject to unwanted tooth movements with clear aligners among premolar extraction patients. Age, crowding, mini-implant, overbite, and attachments influence actual tooth movements. Moreover, vertical rectangular attachments on canines are beneficial in achieving more predictable incisor tooth movements over optimized canine attachments.
Topics: Male; Female; Humans; Bicuspid; Overbite; Tooth Movement Techniques; Malocclusion; Orthodontic Appliances, Removable; Malocclusion, Angle Class II; Multivariate Analysis
PubMed: 36581703
DOI: 10.1186/s40510-022-00447-y -
Maedica Mar 2023In the last few years, transcatheter aortic valve replacement (TAVR) has rapidly become the standard of care for severe symptomatic aortic stenosis (AS). If initially it...
In the last few years, transcatheter aortic valve replacement (TAVR) has rapidly become the standard of care for severe symptomatic aortic stenosis (AS). If initially it was preferred only for high-risk surgical patients, now even low-risk patients are eligible candidates. There were several factors to consider why patients with bicuspid aortic valves (BAVs) were omitted from these trials. However, it should be noted that bicuspid AS is not unusual among patients who experience transcatheter valve implantation. The TAVR procedure in BAV is a reliable and safe treatment option for surgical aortic valve replacement (SAVR) but it is associated with an elevated incidence of paravalvular regurgitation (PVR) and the likelihood of implanting a permanent pacemaker. Bicuspid valves do not appear to be a contraindication to TAVI according to current data, but further specific clinical trials will be required to confirm this conclusion.
PubMed: 37266466
DOI: 10.26574/maedica.2023.18.1.117 -
The Journal of Thoracic and... Jul 2019
Topics: Aorta; Aortic Valve; Bicuspid; Humans; Replantation; Tricuspid Valve
PubMed: 31248515
DOI: 10.1016/j.jtcvs.2018.10.158