Search

Surgical intervention utilising open and (less commonly) closed reduction, are the main methods for the management of fractures of the mandible that do not involve the condyle or coronoid. Non-surgical management of these fracture patterns is rare. This systematic review aimed to collate current evidence surrounding this topic. A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were adults with mandibular fractures. Exclusion criteria included any form of surgical intervention including open or closed reduction, and fractures of the condyle or coronoid. Four studies satisfied the eligibility criteria and comprised 80 patients. A total of 69 patients (86%) who were managed non-surgically produced satisfactory clinical outcomes with no surgical intervention required. The evidence suggests that non-surgical management can successfully avoid surgery in most cases when certain criteria are applied. This has huge health economic implications as it reduces morbidity and requirements for theatre and inpatient stay. Further research is required to establish which fracture patterns are most amenable to this approach, the most effective non-surgical instructions, and the recommended follow-up period. [ABSTRACT FROM AUTHOR]

Cervical relaxation (CR) was performed in ewes during diestrus, to prospect a feasible protocol for non-surgical embryo transfer (NSET). In Trial 1, naturally mated ewes (n=13) received CR protocols with estradiol benzoate (EB, 1 mg on D6) and oxytocin (OT, 50 IU on D7) only (G-EB+OT) or associated with human chorionic gonadotropin (hCG, 300 IU on D7, G-EB+OT+hCG) and were compared to non-hormonally treated (G-control) ewes. Estradiol concentration increased (P<0.05) from D6 to D7 in G-EB+OT and G-EB+OT+hCG, then decreased (P<0.05) on D8. The G-EB+OT had reduced (P<0.05) progesterone on D8, and 0% (0/5) pregnancy, while G-control had 100% (3/3) conception rate. The treatment with hCG mitigated the progesterone drop on D8 and resulted in 50% (2/4) conception rate. In Trial 2, cervical transposing success after treatment with EB, OT, and hCG on D6 and D7 was assessed in nulliparous (n=25) and multiparous (n=30) ewes. The EB+OT+hCG protocol allowed efficient cervical transposition (~78% of cervical transposition success into ~5 min) in nulliparous and multiparous females and did not alter total and blood perfusion areas of corpora lutea (CL). The use of EB+OT+hCG was efficient to ensure effective cervical transposing in nulliparous and multiparous ewes, with no apparent deleterious effect on CL function, and may contribute to animal welfare, allowing a less invasive NSET procedure. [ABSTRACT FROM AUTHOR]

Advanced nurse practitioner Michelle McLean delves into the benefits of poly-L-lactic acid filler (PLLA) for skin rejuvenation and restoration as patients demand a 'less is more' approach to facial aesthetics. A recent surge in patients wanting to restore or preserve a youthful appearance has seen a surge in popularity for collagen stimulators due to their association with high levels of patient satisfaction, long-lasting efficiency, minor adverse events and sound safety profile (Christen, 2022). Patients are increasingly opting for a 'less is more' visual aesthetic, hoping to achieve subtle, natural-looking, undetectable results. To meet patient goals, clinicians are utilising combination approaches in facial aesthetics, utilising products with PLLA because of its desirable results. PLLA is a powerful, well-tolerated tool for clinicians to employ for the non-surgical augmentation of the ageing face. [ABSTRACT FROM AUTHOR]

Introduction: This systematic review summarizes the efficacy of conservative treatment strategies on pain and function in runners with iliotibial band syndrome (ITBS), a prevalent running injury constituting about 10% of all running-related injuries. The multifactorial nature of ITBS necessitates diverse treatment approaches; yet, a consensus on an optimal conservative regimen remains unreported. This review seeks to update and expand upon existing literature with recent rehabilitative approaches. Methods: A systematic search was conducted in Medline, Web of Science, and CINHAL databases, from inception to June 31, 2024. Inclusion criteria were: (1) reporting of conservative treatments for ITBS in adult runners and (2) pain and function defined as main outcome parameters. The methodological quality was evaluated using the NIH Quality Assessment Tool. Results: Thirteen out of 616 records met the inclusion criteria (201 participants), including five randomized controlled trials, one case-control study, one pre-test post-test study, and six case studies. Different active and passive treatment strategies were applied as single (five studies) or combined (eight studies) treatments. The average methodological quality was deemed good. Large between-study heterogeneity was present, impeding a meta-analysis to be performed. Hip abductor strengthening (HAS) exercise emerged as a common strategy. The intervention effects on pain reduction ranged from 27% to 100%, and functional improvement from 10% to 57%, over 2 to 8 weeks. Conclusion: A conservative treatment approach incorporating HAS exercises, possibly augmented by shockwave or manual therapy, is effective for mitigating pain and enhancing function in ITBS-afflicted runners. Finally, the potential of emerging strategies like gait retraining requires further exploration through rigorous trials and comprehensive evidence. Addressing these gaps could refine ITBS management, enhancing treatment outcomes and facilitating runners' return to sport. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the mid‐term clinical outcomes for the non‐surgical and surgical management of acute proximal hamstring avulsions. Methods: Sixty physically active individuals were offered surgical or non‐surgical management for their proximal hamstring avulsion injuries. Distal retraction was defined as greater than 2 cm. Primary outcome measures were the Victorian Institute of sport assessment‐proximal hamstring tendons (VISA‐H) and functional assessment scale for acute hamstring injuries (FASH). Secondary outcome measures included palpable gap (cm), return to sport (RTS) and the ability to perform Nordic hamstring curls. Outcome variables were adjusted in regression models for gender, age, and treatment. Results: Thirty‐one patients elected to undertake non‐surgical management, and 29 chose surgery with a mean follow‐up of 34.8 ± 8.7 and 34.9 ± 7.0 months, respectively. The mean VISA‐H for the non‐surgical and surgical groups were 87.3 ± 3.4 and 87.9 ± 4.1 (n.s.), respectively. The mean FASH for the non‐surgical group was 89.3 ± 2.4 and 88 ± 3.6 for the surgical group (n.s.). This was consistent after adjusting for confounders. The mean gap for the non‐surgical group was 4.5 ± 1.09 and 4.9 ± 1.19 cm for the surgical group (n.s.). No significant differences were found in the abilities to perform Nordic hamstring curls (n.s.). Both groups achieved comparable RTS rates (n.s.). On average, the non‐surgical group achieved RTS at 5.5 ± 1.2 months post‐injury, whereas the surgical group was at 5.7 ± 0.7 months (n.s.). Conclusion: Physically active individuals with acute proximal hamstring avulsions and distal retraction of the tendon stump can be managed non‐surgically, achieving similar functional levels and RTS compared to patients treated surgically. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

This study aimed to examine physical therapists' perspectives in conservative treatments of pediatric patients with adolescent idiopathic scoliosis (AIS). A cross-sectional survey design was used. A validated questionnaire was distributed to physical therapists, and the responses were analyzed. Preferred treatment frequency was 60 minutes (53.8%), twice weekly (41.5%), over 3 to 5 months (44.6%). Top 3 clinical interventions were core and trunk stability enhancement (90.8%), abdominal strengthening (83.1%), and postural correction (80.0%). Top 3 therapeutic goal-setting parameters were activity-based (78.5%), quality-of-life measure-based (56.9%), and participation-based (50.8%). The most common quality-of-life survey used was Oswestry low back pain disability questionnaire (15.6%) followed by Scoliosis Research Society-22 instrument (12.5%). According to our data, physical therapists believe that pediatric patients with AIS can benefit with addressing core and trunk stability, a 60-minute per session, twice weekly, over 3 to 5 months based on activity-based goal-setting and quality-of-life measures using Oswestry questionnaire. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to retrospectively evaluate the 3-year radiographic outcomes of periodontal intrabony defects treated with non-surgical subgingival therapy (NST), assessing radiographic bone gain (RBG) through experimental digital software, named "Bone Defect Analysis (BDA)". Methods: The study included 17 intrabony defects in 14 patients. BDA software (version 1) was used on radiographs to calculate RBG (in %) and variations in defect angle (in °) between baseline (T0) and 3-year follow-up (T1). Soft tissue conditions were registered, reporting bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Defects were analyzed according to angles less (group A) or greater (group B) than 30°. Results: Nine and eight defects were, respectively, analyzed in groups A and B. Three years after treatment, an average RBG of 12.28% was found overall, with 13.25% and 10.11% for groups A and B, respectively (p = 0.28). Clinically, a mean CAL of 6.05 mm at T1 (from 10.94 mm at T0) was found, with 6.88 mm and 5.12 mm in groups A and B, respectively (p = 0.07). Conclusions: BDA software demonstrated predictability in the evaluation of bone variations after NST, revealing better clinical findings for intrabony defects with an initial smaller angle. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of frailty regarding frail versus non-frail patients with carotid artery stenosis. Materials and Methods: The present study was a retrospective cohort study performed in a tertiary care setting. The study included the baseline characteristics and clinical outcomes of the participants. Univariate analysis and Cox proportional hazard regression model were used to include confounders. The primary outcome was the composite of the ischemic stroke and all-caused death in frail versus non-frail patients with carotid artery stenosis. Results: The present study included 450 patients with a 1-year follow-up. Composite events occurred in 33 patients (22.0%) in the frailty with carotid artery stenosis group compared with 35 patients (11.7%) in non-frailty with carotid artery stenosis group (HR 1.92, 95% CI 1.59 to 2.37, p<0.001). Conclusion: Frailty is strongly associated with unfavorable outcomes in older patients with carotid artery stenosis. Risk stratification and special consideration in frail older patients should be considered in the strategy plan of care. [ABSTRACT FROM AUTHOR]

Background and Objectives: The term "Juxtafacet cyst" refers to both synovial cysts and ganglion pseudocysts associated with the lumbar facet joint. As conservative treatment for the juxtafacet cyst has a minimal effect, complete excision through surgery is considered the first choice of treatment. In this study, we retrospectively reviewed the clinical outcomes of percutaneous epidural neuroplasty for symptomatic lumbar juxtafacet cysts. Materials and Methods: We conducted a retrospective review of 34 patients with symptomatic juxtafacet cysts who visited a single institute from January 2010 to September 2023. Patients who received conservative treatment for at least 6 weeks but experienced no or insufficient effects were eligible for this study. After neuroplasty, a medical history check and neurological examination were performed during follow-up at 2 weeks, 1 month, 2 months, 3 months, 6 months, and once a year thereafter. Results: The pain improved for all patients to a VAS score of 3 or less immediately after neuroplasty; however, four of those patients (11%) had pain that worsened eventually to the same level as before the procedure and required surgery. The results showed that, regardless of cyst size, in cases with severe stenosis of the spinal canal, the outcome of neuroplasty was poor and often eventually required surgery. The cyst size was not associated with the procedure results. In addition, if the cyst was present at the L4–L5 level, or if diabetes mellitus was present, the likelihood of future surgery was significant (p-value = 0.003). Conclusions: Percutaneous neuroplasty showed a better success rate than other non-surgical treatments. In addition, severe spinal stenosis (Schizas grade C or higher), L4–L5 level, or diabetes mellitus produced a high possibility of surgery due to recurrence. [ABSTRACT FROM AUTHOR]

Spinal epidural abscess (SEA) is a rare and life-threatening infection within the epidural space with significant functional impairment and morbidity. Active debate remains over whether to operate for SEAs, with limited existing data comparing the long-term survivability after surgical versus nonsurgical management. This study aims to determine the long-term survival of patients who underwent surgical and nonsurgical management for SEA. Retrospective cohort study. A total of 250 consecutive SEA patients. Survival and mortality rates, complications. All patients treated at a tertiary medical center for a primary SEA from January 2000 to June 2020 are identified. Data collection is by retrospective chart review. Cox proportional hazards regression models are used for all survival analyses while controlling for potential confounding variables and with multiple testing corrections. A total of 35 out of 250 patients died with an overall all-cause mortality of 14%. More than half of all deaths occurred within 90 days after treatment. The 90-day, 3-year, and 5-year survival rates are 92.8%, 89.2%, and 86.4%, respectively. Among surgery patients, the all-cause mortality was 13.07%, compared to 16.22% for medically-managed patients. Surgical treatment (decompression, fusion, debridement) significantly reduced the risk of death by 62.4% compared to medical therapy (p=.03), but surgery patients experienced a significantly longer mean length of stay (p=.01). Risk factors of short-term mortality included hypoalbuminemia (<3.5 g/dL), American Society of Anesthesiologists (ASA) 4+, and cardiac arrest. Risk factors of long-term mortality were immunocompromised state, elevated WBC count >12,000, sepsis, septic shock, ASA 4+, and cardiac arrest (p<.05). In terms of complications, surgically-managed patients experienced a higher proportion of deep vein thrombosis (p<.05). The overall long-term survivability of SEA treatment is relatively high at (86% at 5-year) in this study. The following SEA mortality risk factors were identified: hypoalbuminemia (short-term), immunocompromised state (long-term), leukocytosis (long-term), sepsis and septic shock (long-term), ASA 4+ and cardiac arrest (overall). For primary SEA patients, surgical management may reduce mortality risk compared to nonsurgical management. [ABSTRACT FROM AUTHOR]

El hallazgo de neumoperitoneo ha sido tradicionalmente una urgencia quirúrgica indicativa de disrupción del tracto gastrointestinal que requiere exploración quirúrgica inmediata; sin embargo, existen condiciones que implican manejo no quirúrgico. Se presentan dos casos de neumoperitoneo en asociación con neumonía viral (coronavirus del síndrome respiratorio agudo grave de tipo 2 [SARS-CoV-2]) sin antecedentes de neumatosis intestinal ni otro factor de riesgo de neumoperitoneo espontáneo que obtuvieron un resultado favorable sin intervención quirúrgica. Este es el segundo informe de neumoperitoneo simultáneo y enfermedad por coronavirus de 2019 (COVID-19) en la literatura. También se incluye una breve revisión sobre esta relación y datos más recientes entre el neumoperitoneo y el mecanismo fisiopatológico del SARS-CoV-2. Este trabajo busca ampliar el conocimiento con estos dos casos para replantear, en parte, el dogma quirúrgico del manejo del neumoperitoneo y llevar al lector un poco más allá desde el punto de vista de la fisiopatología. [ABSTRACT FROM AUTHOR]

The demographics of aesthetic clinic attendees are changing, and the aesthetic practitioner should be cognisant of the needs and patient-related factors of the growing variety of individuals encountered in their practice. This includes transgender individuals who wish to seek gender-affirming surgical or non-surgical procedures as part of their transition. Francesca Ramadan explores the transformative power of gender-affirming healthcare and the treatment considerations and recommendations for this demographic, so that aesthetic practitioners are well-equipped to help their patients reach their full potential. [ABSTRACT FROM AUTHOR]

Objective: This umbrella review aimed to summarize (and update) the effectiveness of non-pharmacological and non-surgical interventions for patients with knee osteoarthritis. Methods: The study followed the PRISMA guidelines. Manual and electronic databases were searched, to identify systematic reviews, following the P (knee osteoarthritis) I (non-pharmacological and non-surgical treatments) C (pharmacological, surgical, placebo, no intervention, or other non-pharmacological/non-surgical conservative treatments) O (pain, function, quality of life, and other knee-specific measures) model. The quality of evidence was assessed using the R-AMSTAR checklist and GRADE principles. Results: The search yielded 4086 records, of which 61 met the eligibility criteria. After evaluation with R-AMSTAR, four systematic reviews were excluded, resulting in 57 included systematic reviews, with an overall score of 29.6. The systematic reviews were published between 2018 and 2022 (29.8% in 2022), conducted in 19 countries (52.6% in China), and explored 24 distinct interventions. The systematic reviews encompassed 714 trials (mean of 13 ​± ​7.7 studies per systematic review), and 59,343 participants (mean 1041 ​± ​1002 per systematic review, and 82 ​± ​59.2 per study). The majority of participants were older obese women (61.6 ​± ​4.2 years, 30.2 ​± ​3.6 ​kg/m2, 70%, respectively). Conclusions: Based on the systematic reviews findings, Diet Therapy, Patient Education, and Resistance Training are strongly supported as core interventions for managing patients with knee osteoarthritis. Aquatic Therapy, Balance Training, Balneology, Dietary Supplements, Extracorporeal Shockwave Therapy, and Tai Ji show moderate support. For other interventions, the evidence quality was low, results were mixed or inconclusive, or there was not sufficient efficacy to support their use.

IntroductionThis systematic review summarizes the efficacy of conservative treatment strategies on pain and function in runners with iliotibial band syndrome (ITBS), a prevalent running injury constituting about 10% of all running-related injuries. The multifactorial nature of ITBS necessitates diverse treatment approaches; yet, a consensus on an optimal conservative regimen remains unreported. This review seeks to update and expand upon existing literature with recent rehabilitative approaches.MethodsA systematic search was conducted in Medline, Web of Science, and CINHAL databases, from inception to June 31, 2024. Inclusion criteria were: (1) reporting of conservative treatments for ITBS in adult runners and (2) pain and function defined as main outcome parameters. The methodological quality was evaluated using the NIH Quality Assessment Tool.ResultsThirteen out of 616 records met the inclusion criteria (201 participants), including five randomized controlled trials, one case-control study, one pre-test post-test study, and six case studies. Different active and passive treatment strategies were applied as single (five studies) or combined (eight studies) treatments. The average methodological quality was deemed good. Large between-study heterogeneity was present, impeding a meta-analysis to be performed. Hip abductor strengthening (HAS) exercise emerged as a common strategy. The intervention effects on pain reduction ranged from 27% to 100%, and functional improvement from 10% to 57%, over 2 to 8 weeks.ConclusionA conservative treatment approach incorporating HAS exercises, possibly augmented by shockwave or manual therapy, is effective for mitigating pain and enhancing function in ITBS-afflicted runners. Finally, the potential of emerging strategies like gait retraining requires further exploration through rigorous trials and comprehensive evidence. Addressing these gaps could refine ITBS management, enhancing treatment outcomes and facilitating runners’ return to sport.

Background and purpose: Delivery of high precision radiotherapy lymph node boosts requires detailed information on the interfraction positional variation of individual lymph nodes. In this study we characterized interfraction positional shifts of suspected malignant lymph nodes for rectal cancer patients receiving long course radiotherapy. Furthermore, we investigated parameters which could affect the magnitude of the position variation. Materials and Methods: Fourteen patients from a prospective clinical imaging study with a total of 61 suspected malignant lymph nodes in the mesorectum, presacral, and lateral regions, were included. The primary gross tumor volume (GTVp) and all suspected malignant lymph nodes were delineated on six magnetic resonance imaging scans per patient. Positional variation was calculated as systematic and random errors, based on shifts of center-of-mass, and estimated relative to either bony structures or the GTVp using a hierarchical linear mixed model. Results: Depending on location and direction, systematic and random variations (relative to bony structures) were within 0.6–2.8 mm and 0.6–2.9 mm, respectively. Systematic and random variations increased when evaluating position relative to GTVp (median increase of 0.6 mm and 0.5 mm, respectively). Correlations with scan time-point and relative bladder volume were found in some directions. Conclusions: Using linear mixed modeling, we estimated systematic and random positional variation for suspected malignant lymph nodes in rectal cancer patients treated with long course radiotherapy. Statistically significant correlations of the magnitude of the lymph node shifts were found related to scan time-point and relative bladder volume.

Purpose: Report the rate and severity of degenerative disc disease (DDD) in non-surgical adolescent idiopathic scoliosis (AIS) patients and correlate these findings with patient-reported symptomatology scores. Additionally, to quantify the rate of concurrent pathological radiological findings in this group. Methods: This was a retrospective chart review study at a single tertiary centre. AIS patients aged 10–16 who had received a whole spine MRI between September 2007 and January 2019 and who had not received surgical intervention to their spine were included. MRI scan reports were screened to extract those who had evidence of DDD. These were then reviewed by a blinded second reviewer who graded every disc using the Pfirrmann grading system. SRS-22 scores were extracted for patients when available. Results: In total, 968 participants were included in the study. Of these, 93 (9.6%) had evidence of DDD, which was Pfirrmann grade ≥ 3 in 28 (2.9%). The most commonly affected level was L5/S1 (59.1% of DDD cases). A total of 55 patients (5.7%) had evidence of syringomyelia, 41 (3.4%) had evidence of spondylolisthesis (all L5/S1), 14 (1.4%) had bilateral L5 pars defects, and 5 (0.5%) had facet joint degeneration. Spondylolisthesis and bilateral pars defects were more common in patients with DDD identified on MRI scan (p < 0.001 and p = 0.04, respectively). Function (p = 0.048) and pain (p = 0.046) scores were worse in patients with DDD. Conclusion: We present a baseline for the rate and severity of DDD in the non-operative AIS cohort. This should assist in decision-making and counselling of patients prior to surgery. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Introduction. Endodontic iatrogenia, such as iatrogenic perforation, formation of ledges, blockage of canals, instrument breakage, unaddressed anatomical complexities, can have a substantial impact on the long-term outcome of endodontic treatment. The most frequent complications during endodontic treatments are root canal perforations, ledges, and instrument fractures. Prevention and management. Endodontic iatrogenia can be prevented by the use of AAE’s assessment tool (low, moderate, high difficulty cases), operator microscope, static/dynamic guided endodontics systems. Steps in management of endodontic iatrogenia consists of: assessment and diagnosis, communication with patient, immediate management, referral to specialist for non-surgical or surgical approach if necessary, monitorisation of healing process. Conclusions. Clinicians must possess a comprehensive understanding of the causes, prevention strategies, and reliable corrective measures for specific endodontic iatrogenia. Endodontic iatrogenia must be managed by individualised therapeutic approach using effective instrumentarium and biomaterials for positive long-term outcomes. Interdisciplinary collaboration of general dentist with specialists (endodontic specialist, oral surgeon) can be required in complex cases.

To evaluate the safety, tolerability, and efficacy of topical artesunate ointment for treatment of biopsy-confirmed Human papillomavirus (HPV)-associated Vulvar intraepithelial neoplasia (VIN) 2/3. Participants were enrolled on a prospective, IRB-approved, dose-escalation phase I trial testing either 1, 2 or 3 treatment cycles (5 days), every other week, as applicable. Clinical assessments were completed prior to each dose cycle and included exam and review of adverse event (AE) diary cards. HPV testing and colposcopy was completed at 15 and 28 weeks. AEs were assessed according to CTCAE 4.0 criteria. Complete responders (CR) underwent biopsy of the treated site at the 28-weeks while partial (PR) and non (NR)-responders underwent surgical resection or biopsy and ablation. Fifteen patients consented to and began treatment. Per-protocol assessments were completed in 100% at 15- and 80% at 28-weeks. All patients completed prescribed cycles with no grade 3 or 4 AEs. Vulvovaginal burning/ was the most common AE occurring in 93.3%. AEs were grade 2 in 23.7% and included vulvovaginal pruritus (n = 3), swelling (n = 3) and candidiasis (n = 2). The highest ORR was in the 3-cycle group (88.9% with 55.6% CR). HPV-16 was detected either alone (46.7%) or with other subtypes (33.3%) in 80% of lesions and 5 of 8 (62.5%) with CR had complete viral clearance. Topical artesunate for treatment of high-grade VIN shows high tolerability, low toxicity and evidence for clinical response in this initial small series. The safety and observed responses support further study in a Phase II trial. [Display omitted] • Treatment of HPV-associated VIN2/3 with self-applied topical artesunate ointment is feasible, tolerable, and safe. • The most common adverse events associated with artesunate topical ointment are vulvovaginal pain, burning and pruritus. • We observed preliminary evidence of histologic regression and HPV clearance of VIN2/3 treated with artesunate ointment. [ABSTRACT FROM AUTHOR]

Background: Thread lifting is a minimally invasive aesthetic procedure that lifts and realigns sagging tissue. Definisse double‐needle threads are the latest fourth generation absorbable, monofilament, suspension barbed threads of synthetic origin with convergent bidirectional barbs. Definisse thread produces dual action; mechanical action gives a lifting effect and over a period, it promotes histological revitalizing action. Objectives: To evaluate the real‐world efficacy and safety of Definisse double‐needle threads for lower facial lifting for jaw line reshaping in Indian patients. Methods: This is an observational, retrospective study involving patients who underwent treatment for lower‐face reshaping using Definisse double‐needle 12 cm threads. Results: Fifty patients with a mean age of 47.44 years were included in the study with an average follow‐up of 5.14 months. All the patients have undergone Jawline Reshaping (JR) procedure, while 70% of patients also underwent Malar Reshaping (MR) technique simultaneously. Mean of Physician and Subject Global Aesthetic Improvement Scale (PGAIS and SGAIS) showed improvement immediately after the procedure (mean scores 2.82 and 2.7, respectively) and showed further improvement at the follow‐up (3.72 and 3.58, respectively). Moreover, most of the patients immediately after the procedure rated the improvement in PGAIS and SGAIS as "much improved" compared to pre‐procedure appearance (78% and 66%, respectively), while, at follow‐up, 76% and 66% of the patients, respectively, rated "improved very much" compared to pre‐procedure appearance. Conclusion: Current study has demonstrated the effectiveness of the latest Definisse threads in Indian patients in performing tissue repositioning to provide a noticeable lifting effect. Procedure was also well tolerated and none of the patients developed serious complications. [ABSTRACT FROM AUTHOR]

Purpose of Review: To summarize the recently published scientific evidence on fracture risk in hypoparathyroidism. Recent Findings: Hypoparathyroidism is characterized by a low bone turnover and a high bone mineral density. Data on fracture risk are sparse and due to the rarity of the disease, available studies have only been able to include relatively few patients. Risk of non-vertebral fractures does not seem to be affected to any major degree, although epidemiological studies suggest a decreased risk of fractures at the humerus in postsurgical hypoparathyroidism, whereas an increased risk of fractures at the upper arm has been shown in non-surgical hypoparathyroidism. Several, but not all, studies have also pointed towards an increased risk of vertebral fractures, especially in non-surgical hypoparathyroidism. Summary: Fractures at the appendicular skeleton do not seem to be of specific concern in hypoparathyroidism, but emerging data suggest an increased risk of vertebral fractures, which needs to be clarified further in upcoming studies. [ABSTRACT FROM AUTHOR]

This document is a compilation of research articles that discuss various aspects of endodontic procedures and complications. The articles cover topics such as iatrogenic errors during root canal treatment, the quality of root canal fillings, radiographic evaluation of treatment, instrument fracture, retreatment and surgery outcomes, ledge formation, and the use of navigation technology. Other topics include the detection of errors using radiographs and cone beam computed tomography, the retrieval of separated instruments, repair of perforations, and management of procedural errors. The document also includes a case report on the use of CBCT segmentation and additive manufacturing for managing root canals with ledges. [Extracted from the article]

Background and Objectives: The term “Juxtafacet cyst” refers to both synovial cysts and ganglion pseudocysts associated with the lumbar facet joint. As conservative treatment for the juxtafacet cyst has a minimal effect, complete excision through surgery is considered the first choice of treatment. In this study, we retrospectively reviewed the clinical outcomes of percutaneous epidural neuroplasty for symptomatic lumbar juxtafacet cysts. Materials and Methods: We conducted a retrospective review of 34 patients with symptomatic juxtafacet cysts who visited a single institute from January 2010 to September 2023. Patients who received conservative treatment for at least 6 weeks but experienced no or insufficient effects were eligible for this study. After neuroplasty, a medical history check and neurological examination were performed during follow-up at 2 weeks, 1 month, 2 months, 3 months, 6 months, and once a year thereafter. Results: The pain improved for all patients to a VAS score of 3 or less immediately after neuroplasty; however, four of those patients (11%) had pain that worsened eventually to the same level as before the procedure and required surgery. The results showed that, regardless of cyst size, in cases with severe stenosis of the spinal canal, the outcome of neuroplasty was poor and often eventually required surgery. The cyst size was not associated with the procedure results. In addition, if the cyst was present at the L4–L5 level, or if diabetes mellitus was present, the likelihood of future surgery was significant (p-value = 0.003). Conclusions: Percutaneous neuroplasty showed a better success rate than other non-surgical treatments. In addition, severe spinal stenosis (Schizas grade C or higher), L4–L5 level, or diabetes mellitus produced a high possibility of surgery due to recurrence.

Medical records from three veterinary referral centres and a university veterinary teaching hospital in Australia and the USA were reviewed to identify dogs with a diagnosis of distal gastrocnemius musculotendinous junction rupture (DGMJR) that were treated without surgery between 2007 and 2020. All dogs (n = 11) presented with unilateral, pelvic limb lameness and bruising, swelling or pain on palpation at the distal musculotendinous junction. The diagnosis was confirmed with ultrasound or MRI in six dogs; radiographs were used to excluded stifle and tarsus pathology in four dogs; and five dogs were diagnosed on physical examination findings. All dogs were managed conservatively, either with complete confinement alone (n = 10; median 9 weeks), external coaptation alone (n = 1), or a combination of both (n = 4). Sporting dogs (n = 7) were completely confined (median 22 weeks) for longer periods than companion dogs (n = 3; median 5 weeks). A good to excellent outcome was achieved for all cases in this cohort. The seven sporting dogs achieved an excellent outcome; returning to their previous level of sport, with complete resolution of lameness and recovery of a normal tibiotarsal stance. The four companion dogs achieved a good outcome; returning to their previous level of activity but with persistently increased tibiotarsal standing angle compared to the contralateral limb. Conservative treatment represents a viable treatment option for dogs with a rupture of the gastrocnemius muscle at its distal musculotendinous junction. [ABSTRACT FROM AUTHOR]

The sound health of the supporting tissues is critical to the long-term success of Fixed Prosthodontic treatment, especially when it involves the Maxillary Anterior region. This will contribute immensely to a lasting esthetic outcome. The final prosthetic value may be may be compromised by factors such as extend of gingival display, gingival architecture, coronal dimensions clinically, and tooth position. Surgical correction for optimization of soft tissue contour possesses certain drawbacks as it is an invasive procedure which could involve a longer and unpredictable healing period as well as the possible risk of an infection. This article describes a non-surgical approach for the re-contouring of the soft tissue through the sustained application of pressure using a provisional fixed prosthesis, which could avoid potential complications that a surgical approach may invite and provide a reliable option to enhance anterior aesthetic value in the final fixed prosthesis. [ABSTRACT FROM AUTHOR]

Background: Patellar dislocations mainly affect adolescents and young adults. After this injury, patients are usually referred to physiotherapy for exercise-based rehabilitation. Currently, limited high-quality evidence exists to guide rehabilitation practice and treatment outcomes vary. A full-scale trial comparing different rehabilitation approaches would provide high-quality evidence to inform rehabilitation practice. Whether this full-scale trial is feasible is uncertain: the only previous trial that compared exercise-based programmes in this patient population had high loss to follow-up. This study aims to assess the feasibility of conducting a future full-scale trial comparing the clinical and cost-effectiveness of two different rehabilitation approaches for people with an acute patellar dislocation. Methods: Two-arm parallel external pilot randomised controlled trial and qualitative study. We aim to recruit at least 50 participants aged ≥ 14 years with an acute first-time or recurrent patellar dislocation from at least three English National Health Service hospitals. Participants will be randomised 1:1 to supervised rehabilitation (four to six, one-to-one, physiotherapy sessions of advice and prescription of tailored progressive home exercise over a maximum of 6 months) or self-managed rehabilitation (one physiotherapy session of self-management advice, exercise, and provision of self-management materials). Pilot objectives are (1) willingness to be randomised, (2) recruitment rate, (3) retention, (4) intervention adherence, and (5) intervention and follow-up method acceptability to participants assessed through one-to-one semi-structured interviews (maximum 20 participants). Follow-up data will be collected 3, 6, and 9 months after randomisation. Quantitative pilot and clinical outcomes will be numerically summarised, with 95% confidence intervals generated for the pilot outcomes using Wilson's and exact Poisson methods as appropriate. Discussion: This study will assess the feasibility of conducting a full-scale trial comparing supervised versus self-managed rehabilitation for people after acute first-time or recurrent patellar dislocation. This full-scale trial's results would provide high-quality evidence to guide rehabilitation provision for patients with this injury. Trial registration: ISRCTN registry ISRCTN14235231. Registered on 09 August 2022. [ABSTRACT FROM AUTHOR]

Introduction: Anterior cruciate ligament (ACL) reconstruction is considered the first line treatment in ACL rupture. However, some patients return to high intensity sport activities and show a normal knee function without ACL reconstruction. Therefore, aim of this study was to evaluate the rate and prognostic factors of spontaneous healing in patients with ACL rupture and the short-term functional outcome. Methods: The rate, prognostic factors and short-term functional results of spontaneous healing in patients with ACL rupture were evaluated in 381 patients. Morphology of ACL rupture and extent of posterior tibial slope (PTS) were classified by MR- and x-ray imaging. In patients with normal knee stability in anesthesia examination and healed ACL during the arthroscopy 6 weeks after trauma ACL reconstruction was canceled. IKDC -, Tegner Activity Score, KT 1000 testing and radiological characteristics were collected 12 months postoperatively in these patients. Results: 14.17% of the patients with ACL rupture showed a spontaneous healing after 6 weeks. Femoral ACL-rupture (p < 0.02) with integrity of ligament stump > 50% (p < 0.001), without bundle separation (p < 0.001) and decreased PTS (p < 0.001) was found significantly more often in patients with a spontaneous healed ACL. The average IKDC score was high at 84,63 in patients with healed ACL at 1 year follow-up, but KT 1000 testing was inferior compared to non-injured side. Conclusion: Spontaneous healing of a ruptured ACL happened in 14% of the patients. Especially in low-demand patients with femoral single bundle lesions without increased posterior tibial slope delayed ACL surgery should be considered to await the possibility for potential spontaneous ACL healing. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to compare clinical efficacy of red injectable platelet-rich fibrin (i-PRF) and hyaluronic acid (HA) as adjuncts to professional mechanical plaque removal (PMPR) in non-surgical management of stage III periodontitis. Methods: 75 patients were split into groups: group one (G1) received HA, group two (G2) received red i-PRF, and group three (G3), received only PMPR. Periodontal evaluation was done at baseline, 4th, 8th, and 12th weeks following treatment. Results: The plaque index, gingival index, and bleeding on probing were significantly improved in all groups. Moreover, the probing depth in all three groups displayed lower levels over the three months, with G1 and G2 experiencing the greatest declines. Additionally, G1 and G2 showed a considerable increase in clinical attachment level, while G3 showed no improvement. Conclusions: Thus, the application of HA and red i-PRF in conjunction with PMPR significantly improves all periodontal metrics, however, there is no statistically significant distinction between them. [ABSTRACT FROM AUTHOR]

Despite advances in current treatment options, Hepatocellular Carcinoma (HCC) recurrence still presents as a significant clinical challenge. After initial treatment, HCC recurrence occurs in a considerable portion of patients without an available standardized protocol for managing such an incident. Recurrence of advanced liver disease may make surgical treatment options impossible, in which case, locoregional therapy should be considered as an alternative. This review article discusses recurrent HCC after initial treatment and available non-surgical treatment options. Along with systemic therapy, liver-targeted therapies for recurrent HCC including, radiofrequency, microwave ablation, transarterial chemoembolization, and stereotactic body radiation therapy are promising options. Thermal ablation with radiofrequency or microwave ablation is a suitable treatment option for patients who experience smaller tumor recurrences but are not operable because of comorbidities, impaired liver functions, or tumor locality. Transarterial chemoembolization or radioembolization using Yttrium-90 can be used for patients with an incurable disease and have comparatively low adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to identify patient and implant indicators influencing the non-surgical therapeutic outcomes of peri-implantitis at 6 months of follow-up. Methods: This case series involved patients with at least one implant diagnosed with peri-implantitis according to the 2017 World Workshop criteria. Non-surgical therapy consisted of mechanical debridement of the peri-implant pockets combined with metronidazole 500 mg 3 times a day for 7 days. At baseline and at 6 months, clinical and radiographic variables were collected to calculate treatment success (probing pocket depth reduction to 5 mm without bleeding on probing or < 5 mm irrespective of bleeding on probing at all implant sites, and lack of bone loss progression). The primary outcome was treatment success (%) at 6 months. The influence of the patient and implant/prosthetic variables upon disease resolution was assessed through simple and multiple logistic regression analyses at patient and implant level, using generalized estimation equations models. Results: A total of 74 patients and 107 implants were analyzed at 6 months. Disease resolution was established in 25.7% of the patients and 24.1% of the implants. Patients with stage IV and grade C periodontitis, inadequate oral hygiene at baseline, and wide diameter (≥ 4.5 mm) presented significantly greater treatment failure, whereas smokers and former smokers demonstrated a tendency toward failure. At 6 months, there was a significant decrease in probing pocket depth and bleeding on probing of 1.08 ± 1.06 mm and 14%, respectively. Radiographically, a significant gain in marginal bone level of 0.43 ± 0.56 mm was observed. Conclusion: Disease resolution after non-surgical treatment of peri-implantitis is negatively influenced by the loss of support of the adjacent periodontium, poor baseline oral hygiene, and wide diameter implants (≥ 4.5 mm). Clinical relevance: This study helps to discriminate the clinical situations in which non-surgical treatment is less likely to achieve treatment success at short term. [ABSTRACT FROM AUTHOR]

Background: Overactive bladder (OAB) syndrome affects 10–15% of women, severely impacting their quality of life. First-line treatments include behavioural and physical therapy, and second-line medical treatments include medications such as vaginal oestrogen, anticholinergic medications, and ß3-adrenergic agonists—with potential adverse side effects including dizziness, constipation, and delirium, particularly affecting elderly populations. Third-line treatments include more invasive measures, including intradetrusor botulinum injections or sacral nerve modulation, with percutaneous tibial nerve stimulation (PTNS) being a potential alternative treatment. Aims: The aim of this study was to explore the long-term efficacy of PTNS treatment for OAB in an Australian cohort. Materials and Methods: This is a prospective cohort study. Patients underwent Phase 1 treatment, whereby women received PTNS treatment once per week for 12 weeks. Following Phase 1, women entered Phase 2, whereby they received 12 PTNS treatments over 6 months. Their response to treatment was measured by obtaining data before and after each phase using ICIQ-OAB and the Australian Pelvic Floor Questionnaire (APFQ). Results: Phase 1 included 166 women, with 51 completing Phase 2. There was a statistically significant reduction in urinary urgency (29.8%), nocturia (29.8%), incontinence (31.0%), and frequency (33.8%) compared to the baseline. Patients who completed Phase 2 also showed a statistically significant reduction in urinary frequency (56.5%). Conclusions: Overall, the results from this study are positive and support that PTNS is a minimally invasive, non-surgical, non-hormonal, and effective treatment for OAB. These results suggest that PTNS may be a second-line treatment for patients with OAB not responding to conservative management or for patients aiming to avoid surgical approaches. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the use of patient reported experience measures (PREMs) in humeral shaft fractures managed with or without surgery against patient reported outcome measures (PROMs). Methods: Adult patients treated for a humeral shaft fracture between June 2015 and August 2017 were included in non-surgery and surgery (early and late surgery) groups. The PREM questionnaire was based on patient and clinician feedback obtained during focus groups and was posted to patients. PROMs included the short form-12 (SF-12) and visual analogue scale (VAS) for pain, stiffness, function and satisfaction. Results: Eighty-one patients responded, 54 patients were treated in a brace and 27 with surgery (13 early, 14 late). There was moderate positive correlation between PREM and VAS satisfaction and function and moderate negative correlation with VAS pain and stiffness. There was also moderate positive correlation between PREM and SF-12 mental and weak positive correlation with SF-12 physical. The late surgery group had poorer PREMs (expectations, p = 0.002 and friends & family test, p = 0.0001) and PROMs (VAS satisfaction, p = 0.005) compared to the early surgery group. Conclusions: PREMs can be used in conjunction with PROMs to improve the patient's quality of care and as a means of identifying, at an early stage, those patients not doing well and to offer surgery. [ABSTRACT FROM AUTHOR]

Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence‐based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are:Weight loss, and reduced alcohol consumption should be recommended, where appropriateIf clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advisedPositional therapy should be considered in supine dominant snorersIn dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physicianContinuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to trySurgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non‐surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association. [ABSTRACT FROM AUTHOR]

Background: Proximal radius of the forearm (DR) frequently sustains fractures. As life expectancy rises, more individuals are at risk for radial fractures because of the rising occurrence of these injuries. The majority of distal radial fractures occur in youngsters, teenagers, and the elderly. Between various age categories, fracture patterns, care, and consequences vary. Reviewing these distinctions, identifying which fracture patterns are emergent, and promptly referring patients for additional therapy are essential for physicians. Objective: To assess the care of distal radial fractures will be discussed in this activity. Methods: We searched PubMed, Google Scholar, and Science Direct for information on distal, radial fractures, youngsters, teenagers and the elderly. However, only the most current or comprehensive study from January 1986 to May 2020 was considered. The authors also assessed references from pertinent literature. Documents in languages other than English have been disregarded since there aren't enough resources for translation. Unpublished manuscripts, oral presentations, conference abstracts, and dissertations were examples of papers that weren't considered to be serious scientific research. Conclusion: Early Closed reduction and percutaneous pinning of distal radius fracture gives a better result. The results of meta-analysis are based on observational studies and, thus, further attention should be directed to studies of good methodological quality. Therefore, multicenter prospective cohort studies are required and will be able to answer these questions with more certainty and a higher level of evidence. [ABSTRACT FROM AUTHOR]

Background: Collagenase clostridium histolyticum‐aaes (CCH‐aaes) is approved in the United States for moderate‐to‐severe cellulite in the buttocks of adult women. Aim: Interim analysis to evaluate efficacy/safety of CCH‐aaes in the treatment of thigh cellulite. Methods: Data were analyzed from a phase 3, open‐label study (REAL). Women with mild‐to‐moderate cellulite on both thighs (Clinician Reported Photonumeric Cellulite Severity Scale score, 2 or 3) received ≤0.84 mg (volume, 18 ml) of CCH‐aaes subcutaneously, in up to 12 dimples per posterolateral thigh, in up to 3 treatment sessions (Days 1, 22, and 43). Follow‐up was on Day 90 (interim cutoff). A subset of women participated in the concurrent study (PIXELS), which included high‐definition photography and 3D‐image scanning of treatment areas. Results: Twenty‐two women (44 thighs) were included in the interim analysis (mean age, 42.3 years; thighs with mild cellulite, 68.2%). Investigators reported high percentages of responders (score of "improved" or better on Investigator Global Aesthetic Improvement Scale) at Day 90 for either thigh (86.4%; primary endpoint) or both thighs (72.7%). Patient‐reported bother due to cellulite was reduced at Day 90; mean change was 15.3 points (85.5% reduction) in BODY‐Q Appraisal of Cellulite Scale total score (possible range, 11–44). In PIXELS analysis, Day 90 3D‐image scans showed improvement from baseline in skin roughness in some of the treated thigh areas. The most commonly reported adverse events were injection‐site bruising and pain (95.5% and 50.0% of patients, respectively). Conclusions: CCH‐aaes treatment of mild‐to‐moderate thigh cellulite was effective and generally well tolerated, with markedly reduced cellulite‐related bother. [ABSTRACT FROM AUTHOR]

Abstract Background The outcome of non-surgical treatment is generally good, but the treatment course can be long and painful with approximately a quarter of the patients acquiring a nonunion. Both surgical and non-surgical treatment can have disabling consequences such as nerve injury, infection, and nonunion. The purpose of the study is to compare patient-reported outcomes after surgical and non-surgical treatment for humeral shaft fractures. Methods A pragmatic randomized controlled trial (RCT) is planned with two study groups (SHAFT-Young and SHAFT-Elderly). A total of 287 eligible acute humeral shaft fractures are scheduled to be recruited and randomly allocated to surgical or non-surgical treatment with the option of early crossover due to delayed union. The surgical method within the allocation is decided by the surgeon. The primary outcome is the Disability of Arm, Shoulder, and Hand (DASH) score at 52 weeks, and is assessor blinded. The secondary outcomes are DASH score, EQ-5D-5L, pain assessed by visual analog score, Constant-Murley score including elbow range of motion, and anchor questions collected at all timepoints throughout the trial. All complications will be reported including; infection, nerve or vascular injury, surgical revisions (implant malpositioning, hardware failure, aseptic loosening, and peri-implant fracture), major adverse cardiovascular events, and mortality. Discussion The SHAFT trial is a pragmatic multicenter RCT, that will compare the effectiveness of the main strategies in humeral shaft fracture treatment. This will include a variety of fracture morphologies, while taking the dilemmas within the population into account by splitting the population by age and providing the orthopedic society with an interval for early crossover surgery. Trial registration Clinicaltrials.gov NCT04574336 . Registered on 5 October 2020.

Bupivacaine (BUP) is an anesthetic from the family of aminoacyl anesthetics and has the highest myotoxicity among other groups of anesthetics. Intramuscular injection of BUP first causes acute libriform lysis and subsequently with the regeneration process, stronger myofibrils are formed within 3–4 weeks. Satellite cells, which are actually myogenic stem cells, are preserved in the early stage and during the destruction of muscle fibers. In fact, these cells are responsible for the subsequent regeneration of fibers. BUP is one of the few medicines that is able to increase muscle strength. In animal studies on rabbits, a decrease has been observed in the diameter of the global layer in the first week and an increase in type-I myosin occurs after 60 days, especially in the global muscle layer. There are numerous studies according to BUP injection for the non-surgical management of horizontal strabismus. To intensify the effects of the injection, botulinum toxin injection can also be used simultaneously in the antagonist muscles. In general, although the rate of improvement in strabismus varied among different studies, BUP injection alone corrects about 5–8 prism diopters. Together with botulinum toxin, BUP corrects about 15 prism diopters. The stability of this improvement is up to 10 years after injection. No significant difference has been observed in response rate between patients with esotropia and exotropia. Unlike the large molecule of botulinum toxin, which spreads slowly to its site of action, the BUP molecule is small and must be in direct contact with myofibrils before absorption into the bloodstream to exert its effect. Therefore, the injection volume should be about 3 cc with a concentration of 0.75 g per deciliter. Although BUP is promising non-surgical strabismus management, especially in small angle and residual horizontal strabismus, however, it has its own limitations. The need for direct infusion of a relatively large volume of BUP may be one of its major drawbacks that limits its usage in an office method. [ABSTRACT FROM AUTHOR]

Objective: To review the management, success, and complication rates of women who presented with a cesarean scar ectopic pregnancy at an Australian tertiary referral center. Methods: A retrospective case series was undertaken. Patients were identified through the hospital's clinical information services coding system and data were collected from medical records. Results: A total of 38 cases were identified. Patients who were hemodynamically stable were predominantly managed according to local expertise via intramuscular, intra‐sac methotrexate or a combination of these two. In some cases, surgical management was preferred. Conclusion: Cesarean scar ectopic pregnancy may be managed both surgically and medically. At institutions where surgical expertise is unavailable, medical management would be valuable with few adverse outcomes identified, provided women have closely monitored follow‐up. [ABSTRACT FROM AUTHOR]

This systematic review sought to assess the efficacy of combining either sodium hypochlorite or povidone-iodine as disinfection solutions with non-surgical treatment of periodontitis. An electronic search was conducted through PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar from inception until 10 September 2022. Outcomes included clinical outcomes (probing pocket depth, plaque index, clinical attachment level, relative-horizontal attachment level, bleeding on probing, gingival recession, the position of gingival margin) and biochemical (BAPNA level) properties. A subgroup analysis was conducted according to the assessment timepoint. Ten studies reporting the use of povidone-iodine and five studies reporting the use of sodium hypochlorite were included in this review. Overall, in the meta-analysis of povidone-iodine, no significant changes were noted in any of the assessed outcomes; however, minor changes were noted in probing pocket depth and clinical attachment level at a specific timepoint. Regarding sodium hypochlorite, a significant reduction in all clinical outcomes, except for bleeding on probing, was noted. In conclusion, the use of povidone-iodine does not result in an improvement in clinical outcomes, whereas sodium hypochlorite has promising properties that result in significant improvement in probing pocket depth and clinical attachment level. However, more studies are needed to confirm these observations. [ABSTRACT FROM AUTHOR]