Publications

PURPOSE: To characterize central bouquet hemorrhages (CBHs) in retinal vein occlusion (RVO) and evaluate their association with long-term visual and anatomical outcomes, in particular macular atrophy. This is a retrospective longitudinal cohort study of 403 treatment-naïve eyes with RVO (mean age, 62.9 ± 15.4 years; 59% male).

METHODS: CBH was identified on spectral-domain optical coherence tomography as vertically oriented light-absorbing masses centered at the fovea, above the external limiting membrane. Clinical characteristics, imaging findings, and intravitreal treatment frequency were compared between eyes with and without CBH. Baseline and longitudinal visual acuity analyzed with multivariable regression models, the prevalence of CBH-related features, and the cumulative incidence and predictors of macular atrophy assessed with Cox regression models were assessed.

RESULTS: CBH were observed in 28% of eyes (n = 111) at baseline. Affected eyes were older, had more systemic vascular comorbidities, and presented with more severe macular edema, peripapillary hemorrhages, and cotton-wool spots (all P < 0.001). Ischemic markers-including arteriolar paracentral acute middle maculopathy (P = 0.04) and increased ischemic index on fluorescein angiography (P = 0.02)-were more common in CBH eyes. Over time, CBH reabsorbed, often leaving a plaque-like RPE thickening, which progressed to outer retinal atrophy in 69% of cases over 36 months. Severe cystoid macular edema and full-thickness macular holes were also common. CBH was independently associated with worse baseline visual acuity (β = 0.09 logMAR; 95% confidence interval [CI], 0.01-0.18; P = 0.04) and slower visual recovery (β for CBH × Time = -0.002 logMAR/month; P < 0.001). Intravitreal treatments reduced the risk of macular atrophy (hazard ratio, 0.28; 95% CI, 0.08-0.96; P = 0.04), and each additional injection conferred a protective effect (hazard ratio, 0.96; 95% CI, 0.93-0.99; P = 0.02).

CONCLUSIONS: CBH represents a characteristic hemorrhagic manifestation in RVO, likely reflecting the localized effects of elevated venous pressure and macular ischemia that contribute to structural disruption and poor visual outcomes. Its presence warrants close monitoring and sustained treatment to mitigate long-term retinal damage.

Editor's note: This is the 29th article in a series on clinical research by nurses coordinated by the Heilbrunn Family Center for Research Nursing at Rockefeller University. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation-and most can be read without knowledge of the preceding articles. To see all the articles in the series, go to https://links.lww.com/AJN/A204.

PURPOSE: Diabetic peripheral neuropathy (DPN), a common complication of type 2 diabetes mellitus (T2DM), lacks effective diagnostic tools. This study aimed to develop a nomogram that integrates corneal nerve parameters for individualized DPN risk prediction.

METHODS: A total of 111 patients with T2DM and 110 healthy controls were enrolled. All participants underwent bilateral corneal confocal microscopy (CCM). High-quality images were selected by four blinded investigators. Corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD), and corneal nerve fiber density (CNFD) were quantified using ACCMetrics and AiCCMetrics software. Diagnostic models-including single- and multi-parameter models-and a nomogram incorporating CNFL, CNBD, CNFD, and age were developed. Model performance was evaluated using receiver operating characteristic analysis with 500 bootstrap resamples, calibration curves, decision curve analysis, and clinical impact curves. Sensitivity analyses assessed robustness.

RESULTS: Patients with DPN were significantly older (P = 0.005). CNFL and CNFD were higher in the DPN- group (P < 0.05), whereas CNBD showed no group difference. Single-parameter models yielded area under the curve (AUC) values ranging from 0.495 to 0.727, whereas multivariate models demonstrated improved performance with AUCs between 0.737 and 0.782. In the nomogram, CNFL and CNFD were protective factors, whereas CNBD paradoxically increased DPN risk. The model demonstrated good discrimination, calibration, clinical utility, and robustness.

CONCLUSIONS: A nomogram combining multiple corneal nerve parameters may outperform single-parameter models, thereby representing a potential tool for DPN risk stratification in T2DM.

TRANSLATIONAL RELEVANCE: The corneal nerve-based nomogram may assist in personalized DPN risk prediction and holds potential translational value for individuals with T2DM.

The sensory recruitment hypothesis posits that Visual Working Memory (VWM) maintenance uses the same cortical machinery as online perception, implying similarity between the two. Characterizing similarities and differences in these representations is critical for understanding how perceptions are reformatted into durable working memories. It is unknown whether the perceptual appearance effect brought by attention is maintained in VWM. We investigated how VWM depends on attentional state by examining how transient modulations from reflexive (exogenous) attentional orienting affect the appearance of VWM representations; particularly whether VWM takes a "snapshot" at the time of encoding, or transient attentional dynamics continue into VWM. Specifically, we assessed whether the transient modulation to perceived contrast caused by exogenous attention is preserved when attended stimuli are encoded and maintained in VWM. Observers performed a delayed contrast comparison task in which one stimulus had to be held in VWM across a delay and compared to a second stimulus. Exogenous attention was manipulated through transient pre-cues appearing above the location of the first, second, or both stimuli before their onset. Model comparisons revealed that the transient attentional boost to perceived contrast persisted in VWM across the delay. This result indicates that VWM maintains a "snapshot" of the attentional-modulated perceptual representation at the time of encoding and suggests that attentional effects on vision enable us to select and protect in VWM visual information relevant to cognition and action.

People generally look at positions that are important for their current actions, such as objects they intend to grasp. What if there are obstacles on their path to such objects? We asked participants to walk into a room and pour the contents of a cup placed on a table into another cup elsewhere on the table. There were two small obstacles on the floor between the door and the table. There was a third obstacle on the table near the target cup. Participants often looked at the items on the table from the beginning, but, as they approached and entered the room, they often looked at the floor near the obstacles, although there was nothing particularly informative to see there. Thus they primarily relied on peripheral vision and memory of where they had seen obstacles to avoid knocking over the obstacles. As they approached the table, they mainly looked at the object that they intended to grasp and the obstacle near it. We conclude that people mainly look at positions at which they plan to physically interact with the environment, rather than at items that constrain such interactions.

AIM: To compare fracture resistance (FR) of IPS e.max computer-aided design (CAD) and press endocrowns with different preparation depths (2 and 5 mm) and crowns retained by post and core.

MATERIALS AND METHODS: Thirty-six intact maxillary central incisors were utilized. Teeth were categorized into two primary groups (n = 18) according to the material fabrication technique; A: Computer-aided design/computer-aided manufacturing (CAD/CAM) technique and, B: Pressing technique, with each group then separated into three subgroups (n = 6); S1: Crown supported by post and core, S2: Long endocrown with a depth of 5 mm, and S3: Short endocrown with a depth of 2 mm. Restorations were luted using resin cement and subjected to thermocycling (5,000 cycles), followed by FR test. Data were gathered and subjected to statistical analysis utilizing a two-way analysis of variance test.

RESULTS: Results indicated that IPS e.max CAD exhibits superior FR than IPS e.max press across all configurations. The FR variations among designs for each material individually indicated that, within the CAD group, FR increased gradually from S1 to S3 (S1: 473.8 ± 22 ≤ S2: 608.6 ± 38.7 ≤ S3: 713.3 ± 22.5). In the press group, a notable disparity was observed, however with a distinct pattern: S1 (418.9 ± 5.6) exhibited lesser FR than both S2 and S3 (437 ± 5.7 ≤ 477.1 ± 28.1, respectively).

CONCLUSION: All groups showed clinically accepted FR results. Restorations fabricated by CAD/CAM technique showed a higher FR than those fabricated by pressing technique. Endocrowns showed a higher FR than full-coverage crowns held by post and core.

CLINICAL SIGNIFICANCE: For clinicians, using IPS e.max CAD anterior endocrowns with short depth (2 mm) could present a practical treatment modality to the traditional crowns held by post and core for restoration of endodontically treated maxillary central incisors. How to cite this article: Ahmed DH, Amgad SW, Bakry AM. Effect of Preparation Depth on Fracture Resistance of Anterior Teeth Restored by Endocrowns and Post-retained Crowns - In Vitro Study. J Contemp Dent Pract 2025;26(5):504-511.

AIM: This study evaluated the retrievability of NeoMTA 2 and AH Plus root canal sealers using R-Motion reciprocating rotary instruments with microcomputed tomography (micro-CT) analysis.

MATERIALS AND METHODS: Twelve extracted mandibular first molars (24 mesial canals) were divided into two groups: One obturated with gutta-percha (GP) and NeoMTA 2 sealer, the other with GP and AH Plus sealer. Retreatment was performed using an R-Motion single-file system without solvent, followed by micro-CT analysis of sealer remnants in apical, middle, and cervical thirds. Solvent (0.5 mL d-limonene) with ultrasonic activation was then applied, and a fifth micro-CT scan was conducted.

RESULTS: NeoMTA 2 left significantly more residual sealer in all sections, especially the cervical third. Solvent use reduced remnants for both, but AH Plus was more effectively removed.

CONCLUSION: NeoMTA 2 is harder to retrieve than AH Plus, even with solvent-assisted retreatment.

CLINICAL SIGNIFICANCE: Combining R-Motion rotary files with gutta-percha solvents may improve clinical outcomes in endodontic retreatment protocols. How to cite this article: Al-Habib MA, Alsulaiman M. Retrievability of NeoMTA 2 vs AH Plus Sealer from Retreated Mesial Canals of Mandibular First Molars: A Microcomputed Tomography Ex Vivo Study. J Contemp Dent Pract 2025;26(5):493-499.

AIM: This clinical case report describes the multidisciplinary treatment workflow for a complex rehabilitation case to correct skeletal class II malocclusion, bilateral congenitally missing premolars, and improve the esthetic smile in tetracycline-stained teeth.

BACKGROUND: The anterior esthetic zone plays a crucial role in the overall appearance of a patient's smile. Tooth discoloration and congenitally missing premolars are frequently reported in young adults, affecting both esthetics and function. The tetracycline-stained teeth and visible absence of premolars can impact a patient's self-esteem by creating noticeable gaps in the smile. Missing premolars may also cause the remaining teeth to shift, impair the ability to chew effectively, which may lead to uneven wear or malocclusion. Treatment options require a multidisciplinary approach involving an orthodontist, an oral surgeon, and a prosthodontist.

CASE DESCRIPTION: A 34-year-old female presented to a private hospital with complaints of chewing difficulties due to bilateral congenitally missing premolars and was unsatisfied with her smile due to tetracycline-stained teeth. She had a history of taking tetracycline for respiratory infections over the past 30 years. This clinical case report describes the treatment workflow for this complex rehabilitation case, utilizing digital planning to correct skeletal class II malocclusion and create sufficient restorative space for the missing premolars (teeth 12, 13, 20, and 29 according to the universal numbering system) to allow for implant placement with clear aligners. The esthetic smile was enhanced using CAD/CAM technology to fabricate final lithium disilicate restorations. Follow-up over 18 months confirmed the success of the treatment, with the patient expressing satisfaction with both the functional and esthetic outcomes.

CONCLUSION: A multidisciplinary management for the treatment of a complex rehabilitation case involving orthodontic treatment before implant placement and subsequent restorative intervention resulted in predictable outcomes with minimal tooth reduction. This technique provided functional stability, improved esthetics, and increased patient satisfaction.

CLINICAL SIGNIFICANCE: With careful planning and precise execution, the gradual incorporation of digitally guided orthodontic-restorative planning, in conjunction with CAD/CAM technology, can simplify the treatment workflow, leading to accuracy and predictability in complex rehabilitation cases. How to cite this article: Tapananon A, Kamolroongwarakul P, Buranaprasertsuk P. Minimally Invasive Multidisciplinary Management of Tetracycline-stained and Congenitally Missing Teeth. J Contemp Dent Pract 2025;26(5):512-518.

AIM: The aim of this systematic review is to critically evaluate the current evidence regarding diagnostic value of contrast-enhanced cone-beam computed tomography (CBCT) in increasing the detectability of cracks and fractures in teeth.

MATERIALS AND METHODS: Literature was reviewed from PubMed, Science Direct, Web of Science, and Saudi Digital Library in January 2025. The searched keywords included "Cone-beam computed tomography", "CBCT", "Contrast agents", "Tooth cracks", and "Tooth fractures". Only articles in the English language were included. The final analysis included four publications that satisfied the eligibility requirements.

RESULTS: The evidence indicates that CBCT imaging with contrast improves the sensitivity, specificity, and accuracy of diagnosis. Enhanced sensitivity and specificity were over 80%. Contrast-enhanced CBCT successfully reduced artifacts and detected subsurface cracks, with accuracy gains ranging from 4.4 to 72.1%. Imaging protocols affected the performance, while using sodium iodide, dimethyl sulfoxide, ethyl alcohol, and ethyl acetate produced the best accuracy (100%, p < 0.01).

CONCLUSION: In contemporary dentistry, contrast-enhanced CBCT is a promising development.

CLINICAL SIGNIFICANCE: The use of contrast-enhanced CBCT imaging could significantly improve the diagnostic precision of teeth cracks and fractures identification, which could lead to earlier detection and advanced treatment planning with better patient outcomes. How to cite this article: Sabban H, Abdel-Wahed N. Effectiveness of Contrast Agents in Cone-beam Computed Tomography for Diagnosing Tooth Cracks and Fractures: A Systematic Review and Meta-analysis. J Contemp Dent Pract 2025;26(5):519-525.

PURPOSE: The purpose of this study was to update the recent progress in the diagnosis, management, and treatments for Stargardt disease.

METHODS: On November 22, 2024, Stargardt's Connected held its inaugural meeting of their Research Network, attended by clinicians, researchers, industry partners, and patient representatives. This meeting aimed to provide an update on Stargardt disease management and research and develop a call to action for the wider community. The format was rapid-fire presentations followed by a roundtable discussion. This review presents the meeting proceeding, along with a summary of best up-to-date evidence and key calls to action.

RESULTS: Topics included: (1) advances in the understanding of Stargardt disease: natural history, genetic basis, animal models, and emerging therapies; (2) supporting individuals with Stargardt disease: disease impact, technological advancements, and lifestyle modifications; and (3) advancing research through stakeholder engagement, research registries, and patient input. The network acknowledges the importance of collaboration among patients, clinicians, researchers, and industry to address critical gaps in the diagnosis, management, and treatment of Stargardt disease. Patient engagement was emphasized as being crucial for driving progress in the field.

CONCLUSIONS: Recent years have seen significant progress in understanding and managing Stargardt disease. Key calls to action included the areas of improving genetic testing and counseling, advancing research registries, supporting research and clinical trials, growing multidisciplinary care, addressing lifestyle and dietary modifications, and enhancing technological support.

TRANSLATIONAL RELEVANCE: This Stargardt's Connected Research Network initiative outlines a multistakeholder engagement model to discuss ongoing research and emerging treatments for Stargardt disease, a condition with promising therapeutic developments.