Nevin Manimala

JAMA Netw Open. 2025 Mar 3;8(3):e250778. doi: 10.1001/jamanetworkopen.2025.0778.

ABSTRACT

IMPORTANCE: Contact days-days with health care contact outside the home-are a measure of how much of a patient’s life is consumed by health care. Clinical trials, with a more uniform patient mix and protocolized care, provide a unique opportunity to assess whether burdens differ by individuals’ sociodemographic backgrounds.

OBJECTIVE: To characterize patterns of contact days for older adults with cancer participating in clinical trials.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, data from 6 SWOG Cancer Research Network trials across prostate, lung, and pancreatic cancers that recruited patients aged 65 years or older from 1999 to 2014 were linked with Medicare claims data. Data were analyzed from December 14, 2023, to September 26, 2024.

EXPOSURES: Demographic variables, including age, sex, self-reported race and ethnicity, and insurance status; clinical factors, such as cancer type and study-specific prognostic risk score; and social factors, such as neighborhood socioeconomic deprivation.

MAIN OUTCOMES AND MEASURES: Number of contact days, defined as number of days with contact with the health care system, percentage of health care contact days (number of contact days divided by follow-up), and sources of contact days (eg, ambulatory or inpatient) in the first 12 months after trial enrollment. Sociodemographic and clinical factors associated with contact days were examined using negative binomial regression, including an offset variable for duration of observation.

RESULTS: The study included 1429 patients (median age, 71 years [range, 65-91 years]; 1123 men [78.6%]; and 332 patients [23.5%] with rural residence). The median number of contact days was 48 (IQR, 26-71), of a median of 350 days (IQR, 178-365 days) of observation; the median percentage of contact days was 19% (IQR, 13%-29%). The most common sources of contact days were ambulatory clinician visits (median, 17 [IQR, 7-25]), tests (median, 12 [IQR, 3-24]), and treatments (median, 11 [IQR, 3-22]). A median of 70% (IQR, 50%-88%) of ambulatory contact days had only a single service performed on that day (eg, only tests). In multivariable regression, factors associated with increased contact days included age (relative risk [RR] per year, 1.02 [95% CI, 1.01-1.02]), insurance type (Medicare alone or with Medicaid or private insurance vs other: RR, 2.47 [95% CI, 2.16-2.83]), prognostic risk score (above the median vs at or below the median: RR, 1.14 [95% CI, 1.04-1.25]), and type of cancer (pancreatic vs prostate cancer: RR, 1.69 [95% CI, 1.51-1.89]; lung vs prostate cancer: RR, 1.69 [95% CI, 1.54-1.85]).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults with advanced stage cancer participating in phase 3 randomized clinical trials, patients spent nearly 1 in 5 days with health care contact. These findings highlight the need to simplify trial requirements to minimize participant burden.

PMID:40080017 | DOI:10.1001/jamanetworkopen.2025.0778

J Agric Saf Health. 2024 Feb 6;30(1):17-34. doi: 10.13031/jash.15680.

ABSTRACT

HIGHLIGHTS: Microbial assessment of dairy workers in Arizona, U.S. Provides demographic and working information of an underserved group. Highlights the need for health and safety assessments and solutions in the dairy industry.

ABSTRACT: The dairy industry in Arizona, like many other agricultural industries in the United States, is dependent on the labor that migrant farm workers provide. Infections caused by zoonotic pathogens are commonly underreported or misdiagnosed, and possibly more so in migratory workers that face cultural, structural, legal, financial, and geographic barriers to health services. The objectives of this project were to: assess the demographics of Arizona dairy workers, determine the exposure potential of Arizona dairy workers to zoonotic organisms, and inform best management practices. A questionnaire including demographics, work tasks, and household characteristics was administered. Swab samples were collected from the shoulders, knees, and foreheads of employees at two dairy operations at the end of the work shift. The swabs were cultured for E.coli O157:H7 and Salmonella. Molecular DNA isolated from Salmonella and Cryptosporidium was quantified using droplet-digital Polymerase Chain Reaction (ddPCR). Twenty dairy workers were recruited, and 60 samples were collected. The majority of workers were male, preferred to speak Spanish, and identified as Latino/Hispanic (68.8%, 93.8%, and 93.8%, respectively). E. coli O157:H7 was detected in 13% of cultured knee and forehead samples. Salmonella spp. gene copies were detected on 60.0% of samples collected from forehead skin samples; 40.0% of shoulder clothing samples; and 15% of knee clothing samples, as measured via ddPCR. The positive cultural and molecular samples indicate the need for improved post-workday sanitation practices at farms. This study provides surveillance of a largely invisible population, including insights that can be used to create site-specific health and safety protocols for the dairy industry, inform risk assessment models, and foster preventive practices in the dairy industry.

PMID:40080011 | DOI:10.13031/jash.15680

JAMA Oncol. 2025 Mar 13. doi: 10.1001/jamaoncol.2025.0110. Online ahead of print.

ABSTRACT

IMPORTANCE: Whether the conventional 1.5-month to 2.0-month time interval following radical prostatectomy (RP) for prostate cancer (PC) is sufficient to accurately document a persistent prostate-specific antigen (PSA) remains unanswered.

OBJECTIVE: To evaluate the time necessary to accurately document a persistent PSA level after RP.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated whether a significant interaction existed between (1) a pre-RP PSA level greater than 20 ng/mL vs 20 ng/mL or less and (2) persistent PSA vs undetectable PSA after RP on PC-specific mortality (PCSM) risk and all-cause mortality (ACM) risk, adjusting for known PC prognostic factors, age at RP, year of RP, and the time-dependent use of post-RP radiation therapy (RT) and androgen deprivation therapy (ADT). Whether an increasing persistent PSA level was associated with a worse prognosis was also investigated. Patients with T1N0M0 to T3N0M0 PC treated with RP between 1992 and 2020 at 2 academic centers were included. Follow-up data were collected until November 2023. Data were analyzed from July 2024 to January 2025.

EXPOSURE: RP.

MAIN OUTCOMES AND MEASURES: Adjusted hazard ratio (aHR) of ACM and PCSM risk.

RESULTS: Of 30 461 patients included in the discovery cohort, the median (IQR) age was 64 (59-68) years; of 12 837 patients included in the validation cohort, the median (IQR) age was 59 (54-64) years. Compared with patients with undetectable PSA, among patients with persistent PSA, a pre-RP PSA level greater than 20 ng/mL vs 20 ng/mL or less was significantly associated with reduced ACM risk (aHR, 0.69; 95% CI, 0.51-0.91; P = .01; P for interaction < .001) and PCSM risk (aHR, 0.41; 95% CI, 0.25-0.66; P < .001; P for interaction = .02). This result remained after adjustment for prostate volume and was confirmed in the validation cohort for PCSM risk and may represent a higher proportion of patients with a pre-RP PSA greater than 20 ng/mL vs 20 ng/mL or less who could have reached an undetectable PSA level if additional time for PSA assessment occurred before initiating post-RP therapy for presumed persistent PSA. Notably, there was more frequent and a shorter median time to post-RP RT plus ADT or ADT use in patients with a pre-RP PSA greater than 20 ng/mL (244 of 446 [54.7%] at a median [IQR] of 2.68 [1.51-4.40] months) vs 20 ng/mL or less (338 of 972 [34.8%] at a median [IQR] of 3.30 [2.00-5.39] months). These treatment times were shorter than the times to an undetectable PSA in observed patients (median [IQR] of 2.96 [1.84-3.29] months vs 3.37 [2.35-4.09] months, respectively). Increasing persistent PSA level was associated with an increased ACM risk (aHR, 1.14; 95% CI, 1.04-1.24; P = .004) and PCSM risk (aHR, 1.27; 95% CI, 1.12-1.45; P < .001).

CONCLUSIONS AND RELEVANCE: PSA level assessed for at least 3 months after RP may minimize overtreatment, and in this study, a higher persistent PSA level was associated with a worse prognosis.

PMID:40080000 | DOI:10.1001/jamaoncol.2025.0110

J Contemp Dent Pract. 2024 Dec 1;25(12):1179-1189. doi: 10.5005/jp-journals-10024-3799.

ABSTRACT

BACKGROUND: This systematic review and meta-analysis aimed to determine whether reciprocating file systems reduce postoperative pain more effectively than rotary file systems.

MATERIALS AND METHODS: This review followed the preferred reporting items for systematic review guidelines to ensure rigorous and transparent reporting. The databases searched included MEDLINE, Cochrane Library, and Google Scholar, targeting articles published in English between January 2000 and April 2024. Randomized controlled trials involving children aged 4-12 years requiring pulpectomy, comparing reciprocating file systems with rotary systems. Outcomes included quality of obturation, instrumentation time, and postoperative pain. The participants, settings, interventions, comparators, outcome measures, study designs, statistical analyses, results, and all other relevant data were meticulously and accurately extracted from all included studies. Data extraction was performed and recorded in Excel sheets, with separate documentation maintained for each primary outcome.

RESULTS: Out of 279 studies initially identified, 272 were excluded due to duplication, non-English language, or not meeting criteria. Seven studies that met the necessary criteria were included in the systematic review. Among them are five comparisons for instrumentation time, four for postoperative pain, and two comparisons for quality of obturation. Results of the meta-analysis showed that instrumentation time was lower in the rotary file systems than in reciprocating file systems. Postoperative visual analogue scale (VAS) scores after 6 hours and 24 hours were almost similar among both file systems.

CONCLUSION: Given the limitations of this review, it can be said that the postoperative pain scores were comparable between reciprocating and rotary file systems. The root canal preparation time was significantly shorter with the reciprocating system compared to the rotary system.

CLINICAL SIGNIFICANCE: In pediatric dentistry, behavior management plays a vital role in successful treatment. Therefore, opting for the correct file system is fundamental and helps in minimizing pain and instrumentation time, thereby enhancing the overall patient experience. How to cite this article: Sawant S, Kalaskar R, Chandanakunnummal A, et al. Comparative Evaluation of Effectiveness of Reciprocating and Rotary Files in Children: A Systematic Review and Meta-analysis. J Contemp Dent Pract 2024;25(12):1179-1189.

PMID:40079998 | DOI:10.5005/jp-journals-10024-3799

J Contemp Dent Pract. 2024 Dec 1;25(12):1156-1161. doi: 10.5005/jp-journals-10024-3795.

ABSTRACT

AIM: This study aims to clinically evaluate whether the local administration of vitamin D3 enhances postorthodontic tooth stability over a period of 3 months immediately after debonding.

MATERIALS AND METHODS: Patients aged 15-30 years with dental malocclusion and moderate crowding in the lower arch (Little’s irregularity score of 4-6) were selected and randomly split into the experimental and the control groups. After complete alignment and leveling, vitamin D3 injection was delivered to the experimental group and the control group was given a placebo injection with 0.9% normal saline mixed with 2% lignocaine. Fourteen days after the injection, the lower archwires were removed from the control and experimental groups.

RESULTS: Relapse was significantly higher in control than in the experimental group at all-time intervals. Statistically significant values of relapse were observed at T2 and T3 intervals between the two groups, with greater relapse in the control group than in the experimental group. Inter-canine width, arch perimeter, and intermolar width showed mild changes over 3-month period, but there were no significant differences between the two groups.

CONCLUSION: Relapse was seen in both the control and the experimental in the first 4 weeks of the study. Still, the control group showed a greater relapse rate in the following 8th week and 12th week when compared to the experimental group. How to cite this article: Kothandaraman T, Anbarasu P, Dinesh SPS, et al. Impact of Vitamin D3 on Postorthodontic Treatment Stability: A Randomized Controlled Trial. J Contemp Dent Pract 2024;25(12):1156-1161.

PMID:40079995 | DOI:10.5005/jp-journals-10024-3795

J Contemp Dent Pract. 2024 Dec 1;25(12):1148-1155. doi: 10.5005/jp-journals-10024-3790.

ABSTRACT

AIM: The tenet of the study is to evaluate the efficacy of low-level laser therapy (LLLT) as an adjunct to surgical periodontal therapy [open flap debridement (OFD)] on clinical parameters, gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels in GCF and wound healing.

MATERIALS AND METHODS: Thirty subjects afflicted with chronic periodontitis showing evidence of horizontal bone loss on the radiograph, pocket probing depth (PPD) between 4 and 7 mm, and ≥20 natural teeth present in the oral cavity were included in the study. In every patient, OFD+LLLT was done in one quadrant and OFD in another was performed. The clinical parameters were assessed at baseline, 3 and 6 months visits while the GCF sample was collected at baseline visit and 6 months recall. Wound healing indices were recorded 1-week post-op surgery for each group.

RESULTS: The results showed an evident improvement in all the clinical parameters [pocket probing depth, gingival index (GI), plaque index (PI), and CAL] from baseline-6 months values; however, no statistically significant difference was seen on the intergroup comparison. Wound healing was statistically significantly superior in the OFD + LLLT group in comparison to the OFD group, indicating a positive effect of lasers on healing. Gingival crevicular fluid ALP levels in the two groups decreased after 6 months and a statistically significant reduction in the laser group indicated an anti-inflammatory effect.

CONCLUSION: The results clearly indicated the efficacy of lasers in terms of acceleration of wound healing and control of inflammation.

CLINICAL SIGNIFICANCE: Lasers as an adjunct to surgical periodontal therapy evidently have an anti-inflammatory effect (decrease in GCF ALP levels) as well as accelerate the wound healing process. How to cite this article: Gupta R, Arora SA, Gupta G, et al. Effect of Open Flap Debridement with and without LLLT in Patients with Periodontitis on Wound Healing, GCF ALP Levels, and Clinical Parameters. J Contemp Dent Pract 2024;25(12):1148-1155.

PMID:40079994 | DOI:10.5005/jp-journals-10024-3790

J Contemp Dent Pract. 2024 Dec 1;25(12):1141-1147. doi: 10.5005/jp-journals-10024-3797.

ABSTRACT

AIM: The study aims to assess the long-term clinical outcomes and biocompatibility of resin-modified glass ionomer cement and light-curable tricalcium silicate cement in preserving pulp vitality and preventing further carious progression in deep carious lesions.

MATERIALS AND METHODS: A total of 46 participants with deep carious lesions and reversible pulpitis were selected and divided into two groups (n = 23): Group I was treated with resin-modified glass ionomer cement (RMGIC) and group II was treated with TheraCal LC (a light-curable tricalcium silicate cement). Once the indirect pulp capping (IPC) material was placed on the pulpal/axial walls, the cavity was temporized using intermediate restorative material, while the permanent restoration was done at 3rd-week recall period. Clinical and radiographic assessments were evaluated at intervals of 24 hours, 3 weeks, 3 months, and 6 months. Data were recorded and statistically analyzed.

RESULTS: The mean visual analog scale (VAS) scores for the RMGIC group were 20.21, 12.90, 1.33, 0.00, and 0.00 at baseline, 24 hours, 3 weeks, 3 months, and 6 months, respectively, while the TheraCal LC group showed mean scores of 12.60, 5.95, 2.58, 1.50, and 0.00 at the same intervals. The Mann-Whitney U-test revealed no significant difference in VAS scores between the two groups at any time point (p > 0.05). Intragroup comparisons using the Friedman test indicated statistically significant reductions in VAS scores over time within both groups (p < 0.001). At the 6-month follow-up, there were no significant differences between the groups regarding pain on palpation, swelling, percussion, or mobility (p > 0.05 for all comparisons using the Chi-square test). All teeth in the RMGIC group remained vital at the end of the study, while the vitality rate in the TheraCal LC group was 81%.

CONCLUSION: The study concluded that both RMGIC and TheraCal LC are effective as IPC materials for deep carious lesions with reversible pulpitis, though RMGIC showed a slight advantage in maintaining pulp vitality, reducing symptoms, and minimizing periapical changes over time.

CLINICAL SIGNIFICANCE: The clinical significance of this study is to offer evidence-based guidance for dental practitioners in choosing suitable materials for IPC in cases of deep carious lesions with reversible pulpitis. This research aims to support clinicians in making informed decisions that promote optimal patient care and improve the success and longevity of restorative treatments. How to cite this article: Deshmukh SN, Shenoy VU, Margasahayam SV, et al. Comparative Evaluation of Efficacy of Resin-modified Glass Ionomer Cement and Light-curable Tricalcium Silicate Cement as Indirect Pulp Capping Materials: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(12):1141-1147.

PMID:40079993 | DOI:10.5005/jp-journals-10024-3797

J Contemp Dent Pract. 2024 Dec 1;25(12):1127-1134. doi: 10.5005/jp-journals-10024-3787.

ABSTRACT

AIM AND BACKGROUND: The balance between mechanical properties, esthetics, and therapeutic benefits in restorative materials, especially for high-risk patients, is lacking. Effective comparative study designs are required. This randomized clinical trial evaluated the clinical performance of Alkasite bioactive restorative material vs resin-modified glass ionomer (RMGI) in cervical carious lesions according to United States Public Health Service (USPHS) criteria over 1 year.

MATERIALS AND METHODS: Twenty-eight high-risk adult patients with Class V cavities in anterior or premolar teeth were randomly assigned to two groups (n = 14 each). The first group received restorations with an RMGI. In contrast, using a selective etching technique and a universal adhesive, the second group was restored with a bulk-fill alkasite. All materials were applied according to the manufacturer’s instructions. The restorations were evaluated at baseline (1 week), after 6 months, and after 12 months using modified USPHS criteria. Data were recorded and statistically analyzed.

RESULTS: Regarding the primary outcome of marginal integrity, no statistically significant difference was found between the alkasite and RMGI restorations at any follow-up interval. However, within the RMGI group, a statistically significant change in marginal integrity was observed across different follow-up periods. All secondary outcomes showed no statistically significant differences in either intragroup or intergroup comparisons at the various follow-up intervals, except for anatomic form, where a statistically significant difference was observed within the RMGI group over different follow-up periods.

CONCLUSION: Both restorations have shown similar clinical performance over a year, indicating their effectiveness in cervical restorations. Alkasite restoration can successfully replace RMGI for cervical restorations in patients with a high caries index.

CLINICAL SIGNIFICANCE: This study addressed the need for restorative materials that balance mechanical strength, esthetics, and therapeutic benefits in high-risk patients. Alkasite restorations are promising alternatives to RMGI. The findings will guide material selection for enhanced functionality, esthetics, and long-term caries prevention.

CLINICAL TRIAL REGISTRATION NUMBER: NCT04716517. How to cite this article: Al-Salamony H, Akah M, Naguib EA, et al. Clinical Evaluation of Bulk-fill Alkasite Restoration vs Resin-modified Glass Ionomer in Class V Carious Lesions: 1-year Randomized Clinical Trial. J Contemp Dent Pract 2024;25(12):1127-1134.

PMID:40079991 | DOI:10.5005/jp-journals-10024-3787

J Contemp Dent Pract. 2024 Dec 1;25(12):1118-1126. doi: 10.5005/jp-journals-10024-3792.

ABSTRACT

AIM: To assess the root-crown ratio (RCR) of maxillary and mandibular anterior permanent teeth from cone-beam computed tomography (CBCT) acquired from a sample of Yemeni adults.

MATERIALS AND METHODS: This was a retrospective radiographic observational cross-sectional study. The study included 233 CBCTs. Root length, crown length, and RCR of all anterior teeth were measured using Ez-3Di software. Factors considered for correlation included gender differences, skeletal classifications (class I, II, and III), overjet (OJ), and overbite (OB). The data were entered and analyzed using the Statistical Package for the Social Sciences software. Significance was set at a value of p < 0.05.

RESULTS: Mean RCR of maxillary and mandibular anterior teeth ranged between 1.2 and 1.3 for central incisors, 1.3 and 1.4 for lateral incisors, and 1.5 and 1.6 for canines. The length of roots and crowns was generally greater in males, except for the mean crown length of the left mandibular central incisor. Class III participants exhibited the longest root length for maxillary and mandibular canines, 15.75 and 14.7 mm, respectively, compared with class I and II participants. Participants with increased OJ (>4 mm) showed the lowest root and crown lengths in all canines and lateral incisors while displaying the highest root length in all central incisors. However, no statistically significant variances were observed in root length and the RCR (p > 0.05). Those with a deep bite had the longest roots for maxillary lateral and central incisors and the shortest roots for maxillary canines. In contrast, participants with an open bite displayed the opposite measurements.

CONCLUSIONS: Gender differences in RCR were insignificant except for the mandibular right central incisor. No significant differences were observed among the three skeletal classes in all study parameters. Furthermore, RCR variations based on OJ and OB were not statistically significant, except for the mandibular left lateral incisor in relation to OB.

CLINICAL SIGNIFICANCE: Understanding RCR variations supports clinicians in treatment planning, especially in anchorage selection, force application, and predicting treatment outcomes. This knowledge is important for minimizing potential complications and improving treatment effectiveness in various orthodontic cases. How to cite this article: Alhaidary SA, Al-Haddad KA, Al-Harazi GA, et al. Root-crown Ratio of Maxillary and Mandibular Anterior Permanent Teeth in Yemeni Adults using CBCT. J Contemp Dent Pract 2024;25(12):1118-1126.

PMID:40079990 | DOI:10.5005/jp-journals-10024-3792

J Contemp Dent Pract. 2024 Dec 1;25(12):1110-1117. doi: 10.5005/jp-journals-10024-3794.

ABSTRACT

AIM: The aim of this study was to compare and evaluate the phase transformation and effect on the bond strength and fracture toughness of monolithic zirconia after surface treatment with alumina and synthetic diamond particles.

MATERIALS AND METHODS: Forty samples of monolithic sintered zirconia discs (Y-TZP) were divided into two groups of 20 samples each. Group A – air abrasion with alumina particles (n = 20); group B – air abrasion with synthetic diamond particles (n = 20). Pretreatment phase and posttreatment of each zirconia sample from group A and group B were evaluated using an X-ray diffraction machine. The surface roughness of each zirconia sample was evaluated using a profilometer. Composite discs were fabricated and bonded to the air-abraded surface of each zirconia sample from group A and group B using a dual-cured resin cement, respectively. These samples were mounted in an acrylic block to determine the bond strength of zirconia with resin cement using a universal testing machine. This was followed by a fracture toughness test of the samples using a Vickers indentation hardness tester. The results were subjected to statistical analysis using a t-test, and relevant statistical conclusions were drawn.

RESULTS: The mean ± SD of monoclinic content in group A (alumina particles) and group B (synthetic diamond particles) was 0.82 ± 0.010% and 0.76 ± 0.015%, respectively. The mean ± SD of surface roughness in group A (alumina particles) and group B (synthetic diamond particles) was 0.507 ± 0.106 and 0.513 ± 0.116 µm, respectively, and the mean ± SD of bond strength in group A (alumina particles) and group B (synthetic diamond particles) was 6.11 ± 1.47 and 6.49 ± 0.83 MPa, respectively. The mean ± SD of fracture toughness in group A (alumina particles) and group B (synthetic diamond particles) was 2.63 ± 0.46 0.5 and 5.70 ± 1.03 MPam^0.5, respectively. p < 0.05 was considered statistically significant.

CONCLUSION: The distribution of mean monoclinic content was significantly higher in zirconia samples abraded by alumina (Group A) as compared to synthetic diamond particles (Group B). The mean surface roughness and bond strength results were statistically insignificant between both groups. The distribution of mean fracture toughness was significantly higher in group B compared to group A.

CLINICAL SIGNIFICANCE: Synthetic diamond particles for air abrasion of Y-TZP can be a promising alternative to alumina as they cause minimal changes in the structural integrity without compromising the bond strength. How to cite this article: Kazi AI, Dugal R, Madanshetty P, et al. Evaluation of Physical Changes and Bond Properties of Monolithic Zirconia Following Surface Treatment with Alumina and Synthetic Diamond Particles: A Comparative X-ray Diffraction Analysis. J Contemp Dent Pract 2024;25(12):1110-1117.

PMID:40079989 | DOI:10.5005/jp-journals-10024-3794