The purpose of this study was to prospectively evaluate the efficacy of a demineralized dentin matrix (DDM) in decreasing the initial inflammatory response of the gingiva and facilitating the repair and regeneration of soft tissue in alveolar ridge preservation.This clinical study employed a split-mouth design. Fourteen patients with a total of forty-four sites underwent extraction and alveolar ridge preservation (ARP) procedures. A Bilaterally symmetrical extraction operation were conducted on the premolars of each patient. The experimental group received DDM as a graft material for ARP, while the control group underwent natural healing. Within the first month postoperatively, the pain condition, color, and swelling status of the extraction sites were initially assessed at different time points Subsequently, measurements were taken for buccal gingival margin height, buccal-lingual width, extraction socket contour, and the extraction socket area and healing rate were digitally measured. Additionally, Alcian Blue staining was used for histological evaluation of the content during alveolar socket healing.Both groups experienced uneventful healing, with no adverse reactions observed at any of the extraction sites. The differences in VAS pain scores between the two groups postoperatively were not statistically significant. In the early stage of gingival tissue healing (3 days postoperatively), there were statistically significant differences in gingival condition and buccal gingival margin height between the two groups. In the later stage of gingival tissue healing , there were statistically significant differences in buccal-lingual width, extraction socket healing area, and healing rate between the two groups. Furthermore, the histological results from Alcian Blue staining suggested that the experimental group may play a significant role in promoting gingival tissue healing, possibly by regulating inflammatory responses when compared to the control group.The application of DDM in alveolar ridge preservation has been found to diminish initial gingival inflammation after tooth extraction. Additionally, it has shown the ability to accelerate early gingival soft tissue healing and preserve its anatomical contour.chictr.org.cn, identifier ChiCTR2100050650. After tooth extraction, the loss of both soft and hard tissue contours at the extraction site can occur due to normal physiological remodeling and the absence of stimuli from chewing function , 2, ThisIn previous studies of ARP, a wide range of biological materials were employed, including autogenous bone, allografts, xenografts, autologous blood-derived products, and bioactive agents , 10. AltCurrently, demineralized dentin matrix (DDM) derived from extracted teeth is an emerging bone graft material with high biocompatibility . Since iDuring the initial stage of tooth extraction wound healing, the migration of fibroblasts is a fundamental component of wound contraction, and the expression of myofibroblast-related genes plays a crucial role in the early stages of healing . It is wBased on previous research, this study hypothesizes that the application of DDM in ARP can promote early healing of the gingival tissue at the extracted tooth site. This split-mouth study involves the extraction of premolars required for orthodontic treatment. Immediately adjacent to the chairside, DDM is prepared and promptly filled into the extraction socket. The aim is to observe the potential promoting effects of DDM in ARP on gingival healing at the extracted tooth site.This was a single-center, parallel-group, split-mouth design trial with balanced randomization (1:1) conducted at the Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Fujian Medical University from September 2020 to March 2022.Recruiting patients from orthodontics requiring extraction of premolars to participate in this study. The primary researcher screened and recruited the patients. In the clinical research process, uninvolved researchers were tasked with using a coin-tossing method to select the experimental and control groups, where “heads” represented the experimental group and “tails” represented the control group.The study followed the principles of the Declaration of Helsinki for research involving human subjects, and all participants provided written informed consent. Approval was obtained from the institutional review board of the School and Hospital of Stomatology, Fujian Medical University . The trial was registered in the Chinese Clinical Trial Registry on 01/09/2021, which is a member of the World Health Organization’s international clinical trials registry, under the Registry Number ChiCTR2100050650. No significant changes were made to the trial design after the study had commenced.Inclusion criteria (1): Orthodontic patients (over 12 years old) who need symmetrical extraction of homonymous maxillary premolars (2); The patients had symmetrical left and right occlusion and alveolar bone (3); There is no bone metabolism disease such as diabetes and osteoporosis (4); Healthy periodontal tissue, no bone destruction such as cysts and tumors, and no history of orthodontic treatment (5); Preoperative blood tests indicated normal coagulation function and platelet count (6); The patient had no smoking history, no pregnancy, and good compliance.Exclusion criteria (1): Those suffering from any systemic diseases (2); History of trauma or surgery, fracture or even loss of alveolar bone (3); Systemic diseases or drug application that may affect the healing of soft and hard tissues.The sample size was determined for each of the two groups, with 22 tooth extraction sites in each group. It was determined by ensuring a test power of at least 85% and a significance level of no more than 5% (using G*Power 3.1.9.2 software from Dusseldorf University). This calculation of sample size was based on the effect size estimation derived from a previously published research study  to obtain DDM  for f three days.During the postoperative follow-up, measurements of the parameters were conducted by two experienced doctors, one being an oral and maxillofacial surgeon, and the other being a periodontist.Pain intensity of patients on the 1st day postoperatively was assessed using the Visual Analogue Scale (VAS) method . GingivaImmediately after the operation, photographs were taken of the buccal plane of the vertical extraction socket. Additional photographs were captured during the follow-up visits on the 3rd and 30th days  dimension of the alveolar ridge’s soft tissue  and buccal-lingual (B-L) extraction sockets post-operation was adopted from Suttapreyasri et al.   to capture intraoral digital optical impressions right after the operation, as well as at postoperative days, 7, 14, and 30. The extraction socket’s area was quantified utilizing Image J software, with scale adjustments applied  . Subsequently, Alcian Blue staining was conducted followed by microscopic observation.P-value below 0.05 denoted statistical significance in the observed discrepancies.All collected data underwent statistical analysis using SPSS 26.0 software . Normality and variance homogeneity of the data were assessed using the Shapiro-Wilk and Levene tests. In cases of ordinal data, the nonparametric rank-sum test for two independent samples was applied. If the assumptions of a normal distribution and homogeneity of variances are met, a paired t-test will be used. In cases where the data does not follow a normal distribution, the nonparametric Wilcoxon signed-rank test will be employed. A This study included 14 patients requiring bilateral removal of maxillary or mandibular premolars for orthodontic treatment, involving a total of 44 premolars. Among participants, there were 4 males and 10 females, with an average age of 22.1 ± 8.1 years. All patients received regular follow-up, and postoperative healing of the extraction sockets was excellent, with no complications or significant bone graft material loss observed (P>0.05).One day post-operation, the experimental group reported 9 painless sites, 11 sites with mild pain, 2 sites with moderate pain, and no sites with severe pain. In contrast, the control group displayed 5 painless sites, 12 sites with mild pain, 4 sites with moderate pain, and 1 site with severe pain. Despite these differences in pain levels, statistical analysis utilizing P<0.05). After a week of extraction, among the experimental group, 18 sites demonstrated gingival color matching the surrounding area, and 4 sites exhibited a reddish hue. Meanwhile, in the control group, 14 sites showcased harmonized color with the surrounding gingiva, and 8 sites appeared reddish. Nevertheless, the variation between the two groups lacked statistical significance (P>0.05) . After a week, within the experimental group, 20 sites showed no apparent swelling and slight swelling was observed in 2 sites. In contrast, the control group had 18 sites without apparent swelling, 3 sites with slight swelling, and 1 site with evident swelling. However, the distinction between the two groups lacked statistical significance (P>0.05)  and the control group (0.427 ± 0.558). While the experimental group displayed a slightly higher measurement, the disparity between the two groups lacked statistical significance  width of the alveolar crest soft tissue in the experimental group was 7.949 ± 1.460, while in the control group, it was 6.341 ± 1.257. The difference between the two groups was statistically significant(P>0.05). However, after 7, 14, and 30 days, the M-D and B-L widths of the experimental group were significantly lower than those of the control group.The difference was statistically significant (P<0.05) . However, on postoperative days 7, 14, and 30, the extraction socket areas of the experimental group were 5.352 , 3.451 , and 1.826 , respectively, while those of the control group were 5.650 , 3.873 , and 2.472 . The differences between the two groups were statistically significant in all cases (P>0.05) (At postoperative days 7, 14, and 30, the healing rates of the extraction sockets in the experimental group were 77.82 ± 11.81, 86.98 ± 6.29, and 92.66 ± 3.73, respectively, while in the control group, they were 71.05 ± 14.47, 80.33 ± 10.12, and 89.86 ± 5.13. The differences between the two groups were statistically significant in all cases (At 3 days postoperative, the results of Alcian Blue-hematoxylin and eosin staining, as shown in After a tooth extraction, the alveolar bone experiences a lack of typical physiological stimulation. Consequently, the residual alveolar ridge undergoes irreversible resorption, potentially resulting in bone loss and recession of soft tissue at the extraction site . This phPrevious research has employed diverse bone substitute materials such as deproteinized bovine bone mineral, nanocrystalline hydroxyapatite, allograft bone, bone ceramic, and BMP2-functionalized biomimetic calcium phosphate grafts. These materials aim to mitigate the effects of tooth extraction on subsequent orthodontic procedures –35. Howevia the process of endochondral osteogenesis (In 1967, Urist postulated that rabbit dentin possesses the capability to initiate bone formation by orchestrating the conversion of connective tissue into bone ogenesis , 37. Sinogenesis , 38–41.The present study utilized DDM for alveolar ridge preservation after orthodontic extraction. Initially, the focus centered on observing its promotional effect on gingival soft tissue. Employing a split-mouth design, premolars from a single patient’s dental arch were randomly assigned to either an experimental or control group. This design proves advantageous, facilitating equitable inter-group comparisons and mitigating the influence of external variables, such as diet and oral hygiene, on experimental outcomes. The experiment divulged no statistically significant variation in socket width and the area between the experimental and control groups post tooth extraction, signifying parity in initial conditions and the elimination of selection bias. Consequently, subsequent comparisons can be executed with a high degree of confidence.This study excluded methods like employing a collagen membrane, connective tissue graft, and sutures to close the socket when applying DDM to ARP following orthodontic extractions. This decision was rooted in the research’s objective to directly observe the impact of DDM on gingival soft tissue, unobstructed by external variables. Consequently, the alveolar socket was left unsealed. Nevertheless, a panoramic radiograph captured 30 days post-operation depicted the persistent high-density filling image of DDM at the alveolar ridge level , BrkovicComplications such as wound bleeding, surgical site swelling, and pain are common after tooth extraction . The stuIn this study, socket preservation was performed using DDM grafts, and the results were evaluated on the 3rd and 30th day. The findings indicate that the experimental group was able to maintain the buccal gingival margin height better than the control group, suggesting that DDM applied in ARP can reduce gingival recession. Other studies conducted by scholars have also demonstrated that DDM implantation in the socket can help maintain the height of the buccal bone plate, thereby preserving the width of the keratinized gingiva . After 3The study findings reveal that at immediate, 7-day, 14-day, and 30-day post-operation intervals, the mesial-distal and buccal-lingual dimensions of the extraction socket were narrower in the experimental group compared to the control group. Furthermore, the healing rate of extraction sockets was notably greater in the experimental group, and the difference was statistically significant. This outcome can be ascribed to the presence of pivotal growth factors such as TGF-β, FGF, VEGF, EGF, and PDGF within DDM, which wield a pivotal role in the initial healing of soft tissues. The presence of these growth factors stimulates the recruitment of fibroblasts to the site of injury, accelerating their proliferation and expediting the deposition of the extracellular matrix , 49. RinSeveral limitations of this study merit attention. Firstly, potential patient-related factors influencing wound healing were not accounted for. Subsequent research endeavors will delve into assessing the influence of DDM on gingival healing across diverse age groups. Secondly, the scope of histological analysis encompassed merely 4 of the 22 sites, potentially necessitating a broader sample and extended observation duration in future investigations. Thirdly, the specific demineralization rate and particle size of DDM were unreported. Therefore, a more comprehensive exploration of the physical and chemical attributes of DDM is imperative for optimizing its clinical efficacy. Furthermore, future investigations will compare the impact of various graft materials with DDM on gingival healing.This study demonstrates that the use of DDM in alveolar ridge preservation following orthodontic extraction can decrease the early inflammatory response of gingival tissue healing, accelerate the healing of gingival tissue, and maintain the contour of the tissue.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving humans were approved by institutional review board of School and Hospital of Stomatology, Fujian Medical University. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.JG: Writing – original draft, Writing – review & editing. XX: Writing – original draft, Writing – review & editing. DP: Writing – original draft. BZ: Writing – original draft. KL: Writing – original draft. SW: Writing – original draft. WZ: Writing – review & editing. MZ: Writing – review & editing. JY: Writing – review & editing.


Violence is a worldwide public health challenge and has been linked to depression in many settings. Depression is higher in women and differential exposure to violence is a potential risk factor – especially in countries with high-levels of violence. This paper provides a comprehensive characterization of the association between violence victimization and depression in Brazil, focusing on sex/gender inequalities.We used data from the 2019 wave of the National Health Survey (PNS) in Brazil to assess whether respondents had depression (using PHQ-9) and if they were victims of violence, differentiating by the type of violence, the frequency of victimization, and the primary aggressor. We used logit models to assess the association between victimization and the likelihood of having depression. We predicted probabilities of being depressed, considering the interaction between violence victimization and sex/gender, to analyze the differences between men and women.Rates of violence victimization and depression were higher among women than among men. The odds of being depressed were 3.8 (95%CI: 3.5–4.2) times higher among victims of violence than among non-victims, and 2.3 (95%CI: 2.1–2.6) times higher among women than among men, adjusting for socioeconomic factors. For any given income level, racial/ethnic or age group, victims of violence who were women had the highest predicted probabilities of being depressed – e.g., 29.4% (95%CI: 26.1–32.8) for lower-income women, 28.9% (95%CI: 24.4–33.2) for black women, and 30.4% (95%CI: 25.4–35.4) for younger women that suffered violence. Over one in three women that suffered multiple types of violence, experienced violence more frequently, or where the aggressor was an intimate partner or another family member were predicted to have depression.Being a victim of violence was strongly associated with higher risk of depression in Brazil, with women more likely to be both victims of violence and develop depression. Frequent, sexual, physical or psychological violence, and intimate partners or family member perpetrators were major risk factors for depression and should be a public health priority.The online version contains supplementary material available at 10.1186/s12939-023-01916-4. Violence is a worldwide public health concern. Reducing lethal and non-lethal violence is target 16.1 and eliminating all violence against women and girls is target 5.2 of the United Nations’ Sustainable Development Goals (SDGs) , 4 and nThe association between being the victim of non-lethal violence and a higher probability of depression is well established by previous research, including evidence from Brazil –18. EvidThe prevalence of depression is higher among women than men, and evidence suggests that differential exposure to violence might be a contributing factor , 16, 19.Brazil is a relevant context for studying gender inequalities in violence victimization and depression. Exposure to violence is highly prevalent and a major public health concern. In 2019, the prevalence of violence victimization among adults was 18.3%, and was higher among women, black and brown/mixed race individuals, and younger adults (aged 18 to 29) . That saThis paper provides a comprehensive characterization of the relationship between being a victim of violence and depression in Brazil, and explores gender inequalities, using data from a nationally representative health survey. We estimate gender inequalities in the prevalence of depression and violence victimization, overall and according to the violence suffered . We analyze the relationship between violence victimization and depression by gender using probabilities predicted from results of regression models to adjust for socioeconomic and demographic factors.We used data from the 2019 wave of the National Health Survey (PNS). The PNS is a cross-sectional and nationally representative household-based survey, administered by the Brazilian Institute of Geography and Statistics (IBGE) in partnership with the Ministry of Health. Data collection obeyed a three stages sampling design. First, it randomized census tracts within each state. Second, it randomized the participants’ households within the selected census tracts. Finally, in each household, it randomized one individual (15 years old or older) to answer an in-depth questionnaire on health, including self-perception of health status, lifestyle, and violence victimization. Microdata made available by the IBGE contains all information needed to account for the sampling design, including weights adjusted for non-response rates and population projections .We used two main variable groups from the detailed questionnaire: the Patient Health Questionnaire and the questionnaire on violence victimization. The Patient Health Questionnaire (PHQ-9) is a standard instrument extensively used for screening depression,  previousThe questions on violence victimization combine a series of Yes/No questions regarding exposure to violence in the previous 12 months. This includes questions about five forms of physical violence, five forms of psychological violence, and two forms of sexual violence. Table A1 in the Supplementary Material shows the list of questions included in each group. For each group of questions, individuals reported who the primary aggressor was, and the frequency that it happened (once / sometimes / many times).Additionally, we used data on family income per capita, sex/gender, race/ethnicity, age, highest educational level achieved, area of residence , state of residence, economic activity status, employment status, number of residents in the household, if the partner lives in the same household, registration with a Family Health Team , frequency of home visits received from any member of a FHT in the last 12 months, private health insurance, and consumption of tobacco products, physical activity in the last three months, and frequency of alcohol consumption.We excluded individuals younger than 18, as the PHQ-9 is validated for the adult population . We alsoWe computed variables identifying depression and victimization, as well as a list of covariates, for all individuals.For depression, we computed the PHQ-9 score and classified individuals with a total score ≥ 10 as depressed. This cut-off is frequently used as a sign of clinically relevant symptoms of depression – e.g., a study in Brazil found the PHQ-9 had a sensitivity of 72.5% and a specificity of 88.9% for diagnosing depression using this cut-off . We alsoFor victimization, we used the violence questionnaire to create a variable identifying individuals that have suffered at least one violent episode in the previous 12 months. We also generated three binary variables identifying victimization by the type of violence suffered, i.e., physical, psychological, and sexual.To assess the association between depression and victimization according to the type of violence, we created a categorical variable indicating if the individual had suffered only physical/sexual/psychological violence, two types of violence, or the three types of violence. To assess the association between depression and victimization according to the primary aggressor, we created a categorical variable indicating if in at least one violent episode the primary aggressor was the current or former intimate partner (“Partner”), if in no episode the primary aggressor was the current or former intimate partner and in at least one was another family member (“Family and not partner”), if in none of the violent episodes suffered the aggressor was a current or former intimate partner or another family member (“Other”) or if the person had not suffered any violent episode in the last 12 months (“None”). To analyze the association between the frequency of victimization and depression, we divided individuals into four groups, by frequency of victimization: high, moderate, low, and none. In our classification, high-frequency individuals reported having suffered one type of violence many times or reported having suffered more than one type of violence sometimes. Moderate-frequency individuals are those that suffered one type of violence sometimes or suffered more than one type of violence once. Low-frequency victims are those that suffered only one type of violence once in the last 12 months. Non-victims are those that have not suffered any type of violence.We included the following individual characteristics to explore how the association between violence and depression varies across individuals: sex/gender , income quintile (according to family income per capita), race/ethnicity , and age group . Finally, we added covariates that can be related to the prevalence of depression and/or victimization: region of residence , education , marital status , cohabitation , physical activity , alcohol consumption , a series of binary variables indicating if the person is employed / lives in an urban area / is registered in a public primary healthcare facility / is covered by private healthcare insurance / smokes tobacco.We computed prevalence estimates (using survey weights) and 95% confidence intervals for all variables included in our analyses according to sex/gender (women/men) and victimization . To assess inequality, we also computed the prevalence of depression and of victimization for men and women separately by income quintile, race/ethnicity, and age.To assess the relationship between victimization and depression, we estimated logistic models with depression as a dependent variable and included different forms of victimization and the set of covariates described above as independent variables. With post-regression prediction, we computed the predicted probabilities of being depressed, considering the interaction between violence victimization and sex/gender, to analyze the differences between men and women. Also, we separate estimates by different forms of victimization and/or relevant socioeconomic characteristics from models that included interaction terms between all variables of interest. We report odds ratios from analogous models without those interactions among predictors (to keep the results easily interpretable) in the Supplementary Material.All analyses were performed using Stata (version 16.1) employing survey weights.Table The victimization for both psychological violence – 18.6% (95%CI: 17.9–19.2) vs. 16% (95%CI: 15.3–16.7) – and sexual violence – 1% (95%CI: 0.8–1.3) vs. 0.4 (95%: 0.3–0.6) – were also higher among women than among men . However, the rates of experiencing physical violence were not statistically different between men and women. Women and men victims of violence also differed in their aggressors. For women, current or former intimate partners and other family members were the primary aggressors in over half of cases, but they represented less than one-third of cases for cases of violence among men. By the frequency of violence, women were victimized more often than men – over one fifth of victimized women suffered violence with a high frequency . For most income, race/ethnic or age groups, both violence victimization and depression were higher among women. Prevalence of both indicators are particularly high among specific demographic groups of women: lower income, black and indigenous .We present fully adjusted models in Table A2 in the Supplementary Materials, showing that sex/gender, income, age, and race/ethnicity are systematically associated with a higher likelihood of being the victim of a violent episode. Compared to men, women were 1.3 (95% CI: 1.2–1.4) times more likely to have suffered any type of violence, 1.4 (95% CI: 1.3–1.5) times more likely to have suffered psychological violence, 1.3 times more likely to have suffered physical violence (95% CI: 1.1–1.5), and 3.2 times more likely (95%CI: 2.3–4.4) to have suffered sexual violence in the last 12 months. Table A3 in the Supplementary Material show that the odds of being depressed were 3.8 (95%CI: 3.5–4.2) times higher among victims of violence than among non-victims, and 2.3 (95%CI: 2.1–2.6) higher among women than among men.From adjusted logistic model estimates, predicted probabilities were generated Fig. . In all We assessed if the association between violence and depression varied by type of violence, who the primary aggressor was, and the frequency. We present fully adjusted models in Table A3 in the Supplementary Materials, showing that individuals that suffered all three types of violence , were aggressed by an intimate partner  or other family member , and were aggressed more frequently  were the most likely to be depressed.Results in Fig. When exploring the role of the primary aggressor . An additional strength of this study is the characterization of inequality patterns in victimization and depression considering the interaction between gender and income quintile, race/ethnicity, and age. However, there are limitations. First, as mentioned above, the study design does not allow us to make causal claims about the relationship between violence victimization and depression. Second, while the PHQ-9 is a widely used instrument and has been shown to have high sensitivity and specificity in Brazil, it does not provide a clinical diagnosis of depression. Third, the PNS only samples individuals in permanent households, and individuals arguably more exposed to violence, such as homeless or incarcerated individuals, are excluded. Fourth, violence victimization might be underestimated, as there is likely to be under-reporting by victims and information on some relevant forms of violence  could not be included.Despite those limitations, this study highlights the relevance of violence victimization as a public health concern: it is highly prevalent, disproportionately affects some populations , and it is strongly associated with depression. This is especially relevant for women’s mental health, as the prevalence of depression is significantly higher among them. In particular, the fact that all types of violence, including psychological violence, are associated with depression is particularly challenging. Identifying the frequency and aggressors in each case is crucial, as those dimensions are relevant for understanding the interplay between violence victimization and mental health. Mental health policies should aim at reducing the prevalence of all types of violence victimization, especially among women, and recognize the urgent need to identify victims of all types of violence and provide support for them.Being a victim of violence was associated with an increased risk of depression in Brazil, with women more likely to be both victims of violence and develop depression. Socioeconomic disadvantage and severity of the violence further interacted to exacerbate the risk of depression, particularly for women reenforcing the multidimensional issue of violence and depression. Mental health policies should aim to reduce all types of violence, especially against women, and focus on protecting victims of violence from worsening mental health outcomes.Below is the link to the electronic supplementary material.Supplementary Material 1


In our study, mild (48.9%) and moderate-severe (2.12–4.25%) OCs accompanying OFs were observed after MFT. Conclusions: The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.Introduction: Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. Materials and Methods: Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. Results: OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement ( The maxillofacial region (MFR) consists of the upper face , mid face , and lower face (mandible). MFR fractures are among the most common types of trauma in trauma centers worldwide . It is sThe most common causes of MFT have been reported as road traffic accidents, assaults, falls, and sports and work-related injuries. The severity of MFT varies depending on the etiology, the magnitude and duration of the impact force, and the surface area where the impact occurs ,5. InjurThis study mainly aims to define and comprehensively analyze the important anatomical and etiological aspects of MFTs with orbital involvement. This study was approved by a tertiary hospital Ethics Committee and was conducted in accordance with the Declaration of Helsinki. It was created by the retrospective examination of patients who were admitted to the emergency department of a tertiary hospital with a history of MFT between 1 March 2020 and 1 March 2021 and underwent non-contrast maxillofacial computed tomography (MFCT) imaging by a radiologist with 10 years of experience. Informed consent was waived due to the retrospective design of the study. A total of 887 patients were included in the study. Of the cases admitted to the emergency department due to MFT, 169 (19%) were women, and 718 (81%) were men. The ages of the cases included in the study ranged from 0 to 97 years, and the average age of the cases was 29.75 ± 19.46 years. The exclusion criteria were established to exclude instances that were not related to trauma, cases with CT scans that had motion artifacts making evaluation impossible, cases with a history of previous surgery, and cases with insufficient data in their medical history.Non-contrast MFCTs of the patients included in the study were performed on images in the axial, coronal, and sagittal planes using standard soft tissue window and bone window settings. CT images were obtained using a Philips Brilliance 16-detector MDCT system  with: 120 kV; 105 mA; 0.8 mm slice thickness; 0.4 mm interval; 0.75 second rotation time; 16 × 0.75 collimations; and a 512 × 512 matrix. Data acquired in the axial plane were obtained. Coronal and sagittal images were reformatted from the axial data with a 1 mm slice thickness. All three planes were used to collect study data.During the examination, the patients’ orbital wall  fractures, craniofacial bones  fractures, and posttraumatic soft tissue changes, trauma type , and orbital-related complications were recorded.Ophthalmic complications after MFT are categorized as mild, moderate, and severe. Mild complications are periorbital edema, eyelid laceration, periorbital ecchymosis, and subconjunctival; moderate complications are enophthalmos, proptosis, restricted eye mobility, diplopia, telecanthus, dystopia, and dilated pupil; severe complications are chemosis, hyphema, perforated lens, corneal abrasion, detached retina, retrobulbar hemorrhage, traumatic optic neuropathy and blindness.n) and percentage values (%). The Student’s t-test was used to compare the normally distributed features in two independent groups, and the Mann–Whitney U test was used to compare the non-normally distributed features in two independent groups. Relationships between two independent variables at the categorical measurement level were tested with Pearson Chi-square or Exact Chi-square. As descriptive statistics, numbers and % values for categorical variables and mean ± standard deviation for numerical variables are given as min-max. SPSS Windows version 24.0 IBM Corporation, Armonk, NY, USA) package program was used for statistical analysis, and p < 0.05 was considered statistically significant.Statistical analysis: The conformity of the data to the normal distribution was examined with the Shapiro–Wilk test; numerical variables with a normal distribution were represented as mean ± standard deviation values, and categorical variables as numbers  were female, and 718 (81%) were male. The mean age of all subjects included in the study was 29.75 ± 19.46 years. No patient was excluded from the study.p < 0.001). In addition, while there is no statistically significant difference in terms of age in inferior and superior wall involvements in OFs (p > 0.05), there is a statistically significant difference in age in medial (39.96 ± 16.2) and lateral wall (54 ± 17.18) involvements. (p < 0.05)  patients who underwent non-contrast MFCT, while orbital wall fracture was not observed in 840 (94.7%) patients. When the mean age of patients with or without orbital wall fracture was compared, it was found that the mean age of patients with orbital wall fracture (38.98 ± 19.13) was statistically significantly higher than the mean age of patients without orbital wall fracture (29.2 ± 19.36). ( < 0.05) .In our cases, OFs accompanying MFTs were most common in the inferior wall (2.9%) and the second most common in the medial wall (2.6%). The location distribution of OFs is shown in n: 12, 25.5%), ethmoid , frontal , maxillary , sphenoid , and zygomatic  fractures and soft tissue damage  were observed, and the pathologies mentioned at these levels were found to be significantly higher than in patients without orbital involvement (p < 0.05). There was no significant difference in association with fractures at the mandible and temporal bone levels in patients with orbital involvement compared to those without  and those with orbital involvement . . .Traumas have been reported as the leading cause of absenteeism and death in people under the age of 40 . MFT conFactors such as geographical location, cultural differences, population density, and socioeconomic status of the country play a role in the etiology and incidence of fractures in MFTs . Given tThe incidence of MFT and related fractures has been reported more frequently in the 20–29 age group by some authors ,19,20,21In the literature, male predominance has been reported with rates ranging from 2.9:1 to 12:1, including cases accompanied by OFs in MFTs ,25,26,27n: 112). In the literature, it has been reported that the frequency of maxillofacial fractures in women due to domestic violence varies between 34% and 73% [In recent years, the male/female ratio tends to decrease in developed countries, where women are as much a part of society as men ,33,34. I and 73% . ConsideSimilar to OFs, it has been reported that the most common etiology in all maxillofacial fractures in developed countries in recent years is interpersonal violence (59.38%), the frequency of which is increasing rather than traffic accidents (8.41%) or sports injuries (3.56%) . In our In studies conducted in developing regions such as India, road traffic accidents (74.7–92.16%) were reported more frequently as the most common etiology in MFTs ,37,38,39Among the causes of road traffic accidents in developing countries, reasons such as poorly defined traffic rules, inadequate traffic lighting, inadequacy of signage, and uncontrolled vehicles have been reported ,39,40,41Another frequent cause of MFT has been reported as falling, especially in the elderly (68–87%) and pediatric age (17–71.42%) group ,43,44. TThe direction and effect of the force applied during trauma and the degree of damage to the tissue determine the location and shape of the fractures. Accordingly, the most commonly reported broken bones in MFT are mandibular and zygomatic bones. Fractures of the mandible are common because of mobility and less bone support compared to other facial bones, and it is the first bone to encounter a force trajectory during trauma or attack on the lower face. The zygomatic bone, on the other hand, has high-frequency fracture rates in MFTs due to its anatomical position and is associated with reflex lateral rotation and consequent impact, as in an attack or accident . AlthougIn one study, the frequency of maxillofacial orbital injury was reported as 23.6% after suspected facial trauma after severe trauma. In the same study, the most frequently fractured orbital wall was the inferior wall, with a rate of 66%. The most common etiology of trauma in the patients included in this study was road traffic accidents . AccordiIn cases admitted due to maxillofacial trauma, emergency service specialists or trauma surgeons should be aware of various symptoms and physical examination findings in order not to miss possible orbital wall fractures and their associated complications. Therefore, it is important to be aware of symptoms such as periorbital pain, diplopia, blurred vision, ophthalmoplegia, or findings that may be related to eyeball displacements such as telecanthus, enophthalmia, and exophthalmos ,57. In tIn our study, periorbital tissue emphysema in twenty-six cases (55.3%), periorbital edema 38.2%) in eighteen cases, periorbital fat tissue herniation in three cases (6.3%), and paresthesia in four cases (8.5%) due to fractures contacting the infraorbital canal were observed. In the literature, 29.03–98.38% mild and 1.7–20% severe ophthalmic injuries have been reported after MFT .2% in ei. EyeballGlobe rupture may present with suspicious CT findings such as intraocular bleeding, lens dislocation, intraocular foreign bodies, intraocular gas, globe deformity, and wall irregularity, and its diagnosis is important because it requires surgical exploration . The diaA prevalence of 44.6% has been reported for extraocular muscle entrapment associated with diplopia, enophthalmos, and limitation of eye movements, especially associated with burst fractures of the orbital floor and medial wall ,66. The Due to the orbital bone frame and tight anterior soft tissue cover, it is a risky area in terms of compartment syndrome, which can cause visual loss by affecting the high pressure in the orbit and related vascular nutrition in case of posterior ciliary artery injuries within the borders of the extraocular muscle. Imaging findings indicating elevation in intraocular pressure are proptosis, elongation of the optic nerve, and globe tenting ,70.In our study, in accordance with the literature, mild complications (48.9%) were the most common, while moderate-severe complications (2.12–4.25%) were less common. Mild complications, in order of frequency, were periorbital ecchymosis, periorbital edema, subconjunctival hemorrhage, and eyelid laceration. In two cases, diplopia, enophthalmia, and limitation of eye movements were observed due to fractures affecting the base level. One patient with a medial wall fracture had optic neuropathy findings, which was thought to be due to nerve compression, in a patient with a fracture involving the telecanthus and orbital canal.It is important to better understand OFs and some of the potentially serious complications associated with them, to refer the patient to the relevant branch in a short time, and to consult with them in order to reduce the devastating consequences. This study’s retrospective design constitutes a significant limitation. This is due to the fact that the data utilized is derived from the anamnesis information provided by the patient during the application process. Due to this situation, especially in situations such as interpersonal violence, victims may deliberately misreport the causes of trauma in order to avoid fear or some legal consequences, and in this case, misleading information about etiology may be obtained. This circumstance that we discussed might have generated bias. As part of the limitations of the study, we recommend that more samples be included, and observations be made with the participation of several centers in the future to gain a better understanding of facial fractures that cause ophthalmic injuries.As a result, the frequency and localization of MFTs vary depending on the differences in demographic, socioeconomic, and environmental factors, and such studies are needed to take preventive measures. In addition, according to the data of this study, there are accompanying ophthalmic injuries in cases with orbital wall fracture due to MFT. Knowing the risk and frequency of orbital injury accompanying MFTs can increase awareness of the radiologists about the diagnosis so that prompt diagnosis and intervention can be possible and the rate of complications can reduced.


Background and objectives: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have mentioned refractive error. This research is to investigate the potential relation between refractive error and recurrence after correction surgery in pediatric patients with simple congenital ptosis. Materials and Methods: We conducted a retrospective analysis of data from patients with simple congenital ptosis who were treated at Zhongshan Ophthalmic Center (ZOC) between 2017 and 2020. In total, 111 eyelids of 85 patients without surgery-related complications who underwent frontalis muscle flap suspension (FMFS) for simple congenital ptosis were included. Postoperative changes in eyelid height were assessed. Cycloplegic refraction was assessed before surgery and during the follow-up period (every 3 months after surgery). Recurrence in the postoperative period was defined as a marginal reflex distance 1 (MRD1) of <1 mm. Results: There were 16 recurrence and 69 non-recurrence cases, with no statistically significant differences, in terms of patient age at the time of surgery, patient sex, or preoperative MRD1, between the recurrence and non-recurrence groups. The postoperative cylindrical diopter , laterality , and preoperative MRD1  were associated with ptosis recurrence after surgery. Differences between the recurrence and non-recurrence groups in spherical diopter and spherical equivalent (SE) before and after surgery were not statistically significant. In addition, preoperative refractive error and postoperative spherical diopter were not significantly associated with ptosis recurrence after correction surgery. Conclusions: Ptosis recurrence after FMFS in pediatric cases of congenital ptosis is associated with refractive error. Timely refractive correction and amblyopia treatment may help to reduce ptosis recurrence. Congenital ptosis, defined as an abnormally low position of the upper eye lid at birth, may be simple or associated with other congenital conditions, such as Marcus Gunn syndrome, blepharophimosis, or congenital third cranial nerve palsy . CongeniMany surgical procedures have been introduced to correct ptosis, including levator palpebrae superioris shortening and frontalis muscle flap suspension (FMFS), which use autologous tissue, and those that utilize frontalis suspension materials, such as silicone tubes, nylon monofilaments, banked fascia lata, and polytetrafluoroethylene ,16. The Most previous studies on ptosis recurrence have focused on its association with comorbidities, surgical complications, and patient age at the time of surgery ,24,25,26This study was approved by the ethics committee of Zhongshan Ophthalmic Center (ZOC) (2017KYPJ124). Informed consent was obtained at the time of patient enrollment. At the time of admission, the physician explained the plan and intent of the study to each patient (those older than 18 years) or to the patient’s guardian, and the same pre and postoperative precautions and surgical risks were explained to each patient. If the patient agreed, an informed consent form was then signed and the follow-up examination would be performed and recorded. The study adhered to the tenets of the Declaration of Helsinki.The medical records of all patients diagnosed with simple congenital ptosis and treated with FMFS at ZOC between 1 January 2017 and 31 December 2019 were obtained. The inclusion criteria were as follows: (1) patients admitted for surgical treatment of congenital ptosis from 1 January 2017 and 31 December 2019 at ZOC, with no systemic disorder and no specific restrictions on age or laterality; and (2) patients themselves (older than 18 years old) or patients’ guardians gave consent for the study. The exclusion criteria were as follows: (1) aponeurotic, neurogenic, mechanical, and non-congenital forms of myogenic ptosis  and pseudoptosis; (2) patients with ocular diseases other than simple congenital ptosis that may affect visual acuity; (3) patients with a history of surgery or trauma involving the eyelids; (4) patients with complications, including punctate corneal epithelial erosion, granuloma formation, wound infection, postoperative entropion, conjunctival prolapse, poor eyelid contour, exposure to suture materials, and localized allergic reactions to suture materials.Preoperative cycloplegic refraction and marginal reflex distance 1 (MRD1) were measured at the time of the first visit and again at least 3 months after surgery during the follow-up. The date of birth, date of each visit, date of surgery, and treatment methods were recorded. The refractive data were first examined using an autorefractor keratometer  under cycloplegic conditions (0.5% tropicamide and 0.5% phenylephrine hydrochloride). All the patients then underwent medical optometry, which was carried out in ZOC by an experienced optometrist. The refractive power was measured at intervals of 0.25 diopter (D). All measurements were made three times, and the average value was recorded. The diopter of sphere (DS), diopter of cylinder (DC), and spherical equivalent (SE) were measured. The SE was calculated as follows: SE = DS + ½ × DC. Cylindrical power was recorded as (−). As the majority of our patient population was aged <5 years, the results of subjective refraction and levator function measurements were difficult and unreliable due to poor cooperation. Thus, we excluded these parameters from our study. We defined MRD1, recorded in millimeters, as the distance from the margin of the upper eye lid to the central corneal light reflex. The ptosis severity was defined according to the MRD1: non-ptotic (MRD1 ≥ 3), mild-to-moderate (0 < MRD1 < 3), and severe (MRD1 ≤ 0).All the surgeries were performed under general anesthesia.In the FMFS procedure Descriptive results are presented as mean (standard deviation [SD]) or median (interquartile range [IQR]) for continuous data and number (frequency) for categorical data. Statistical analysis was performed using a chi-square test for categorical data. The continuous variables were statistically analyzed between groups using the Wilcoxon signed-rank test or Kruskal–Wallis one way analysis of variance test, with Bonferroni correction for multiple tests. The primary comparison groups were recurrence versus non-recurrence groups. Binary logistic regression analysis was performed to evaluate the associations between recurrence (MRD < 1 mm) and other clinical parameters. The data in the single regression analysis, including study group, age, sex, and all variables significant at the level of p = 0.099). In the unilateral group, the laterality of the affected eye was nearly equal .Among 158 patients with congenital blepharoptosis, 28  were excluded for having strabismus, neurofibroma of the eyelid or a history of eyelid surgery. Then, 12 patients who underwent levator palpebrae superioris shortening were also excluded. Of the 118  patients enrolled in the study, 33 (28.0%) of them were lost to follow-up due to failure of contact . Eventuap = 0.943 and p = 0.108, respectively).Among the unilateral cases, 30 (51%) patients were less than 5 years old, and 29 (49%) patients were more than 5 years old. In the bilateral group, 13 (50%) patients were less than 5 years old, and 13 patients were more than 5 years old. There was no significant difference in the age distribution and postoperative follow-up time between the unilateral and bilateral groups (p = 0.014), and the preoperative and postoperative DS in the unilateral group were significantly larger than those in the bilateral group . The preoperative and postoperative DC were not significantly different in the unilateral and bilateral groups . The difference in the postoperative MRD1 of the two groups was not statistically significant (p = 0.087). In both groups, there was a significant difference in the postoperative MRD1 versus the preoperative MRD1 (p < 0.001).Postoperative refraction and MRD1 were measured at a mean follow-up of 293.63 days. There were 8 (13.6%) mild-to-moderate cases and 51 (86.4%) severe cases in the unilateral group and 3 (11.5%) mild-to-moderate cases and 23 (88.5%) severe cases in the bilateral group. . The preoperative MRD1 in the unilateral group was significantly less than that in the bilateral group (p = 0.038). The median DC values in the non-ptotic, mild-to-moderate, and severe groups were −0.50 D, −0.50 D, and −0.75 D, respectively (p = 0.004). However, there was no significant difference in astigmatism in the mild-to-moderate group versus the non-ptotic group (p = 0.578) or severe group (p = 0.450).In the comparison of cylinder power, the severity grading was classified as non-ptotic, mild-to-moderate, or severe according to preoperative MRD1. There were three unilateral and eight bilateral cases in the mild-to-moderate group and 23 unilateral and 51 bilateral cases in the severe group . Age at ectively . The adjp = 0.032). When the optometry data were compared, the preoperative cylindrical power in the recurrence group was significantly greater than in the non-recurrence group . Similarly, the postoperative cylindrical power in the recurrence group was significantly larger compared with the non-recurrence group . However, there were no statistically significant differences in postoperative spherical diopter or SE .The differences in age, sex, follow-up time, and MRD1 were not statistically different in the recurrence and non-recurrence groups . The proThe univariate analysis showed that laterality, preoperative MRD1, and postoperative DC were significantly correlated with ptosis recurrence . The mulThis study shows, for the first time, that refractive error is associated with ptosis recurrence after FMFS. Previous studies evaluated the roles of different surgical designs and suture materials in ptosis recurrence. Wagner et al.  reportedExcessive forceful eye closure should be avoided after ptosis correction surgery, especially in the early postoperative period. Over blinking or eye-closing movements can place excessive pulling force on the fixation material, which can affect the position of the sutures or sling material, subsequently leading to a change in the postoperative MRD1 and ultimately ptosis recurrence. In our study, we found no significant difference in the preoperative MRD1 between the recurrence and non-recurrence groups, although preoperative and postoperative astigmatism were significantly larger in the recurrence group. The multivariate analysis also showed a significant association between postoperative DC and ptosis recurrence. Based on the findings of our study, it is reasonable to speculate that, in patients with a large degree of astigmatism, squinting the eye to obtain clearer vision may lead to a decrease in postoperative MRD1. In our study, we did not include best-corrected visual acuity data, as most of the participants in our study were too young to cooperate. However, according to previous research, the risk of amblyopia development is increased in ptotic eyes ,9,15,30.n = 33,103, age distribution from <20 years to >60 years), Kim et al. [n = 37) of patients with unilateral ptosis (age range: 7 months to 58 years), the authors found no significant differences in axial length between the ptotic eyes and fellow eyes [In our study, the differences in preoperative SE between the different severity groups were not statistically significant, which is similar to the findings of some ,32, but m et al.  reportedm et al. . In a stThe effect of patient age on refractive status cannot be neglected. Refractive status is strongly associated with age , especiaIn our study, the DC of eyes with severe ptosis was significantly larger than that of eyes without ptosis, which is in accordance with the findings of previous studies ,4,5,6,8.Interestingly, our analysis showed that patients with bilateral ptosis are more likely to experience postoperative ptosis recurrence than patients with unilateral ptosis. Similar results were reported in a previous study . PreviouOur study has some limitations due to its retrospective design. Based on our study, we can only speculate that delayed correction of refractive error may be a cause of postoperative ptosis recurrence. A longer follow-up study is needed to clarify this issue. In addition, a prospective study is needed to explore the causal relationship between refractive error and ptosis recurrence. The preoperative MRD1 in the unilateral group in our study was smaller than in the bilateral group, which could have caused some bias. However, postoperative recurrence was still higher in the bilateral group than in the unilateral group, which supports the idea that bilateral ptosis is a risk factor for recurrence. Patient loss to follow-up in our study may also have introduced some bias. In addition, the exclusion of levator function and best-corrected visual acuity from this study, due to the young age and therefore poor cooperation of our patients, has implications for our findings.In conclusion, our study suggests that postoperative astigmatism is significantly associated with ptosis recurrence after FMFS in patients with simple congenital ptosis. Timely refractive correction or amblyopia treatment may help decrease the recurrence rate of ptosis after correction surgery. We recommend that patients should receive refractive correction or adhere to amblyopia treatment, such as masking, as soon as possible after the completion of surgery, especially in children under 12 years old.


Disorders of sex development (DSD) are caused by defects in the complex sexual differentiation cascade, resulting in discordance among an individual's genetic, gonadal, and genital sexes. It affects one in 4,500 live births. A wide spectrum of genital phenotypes can be found depending on the underlying pathogenic mechanism and the developmental stage that is affected. We herein report a newborn with female external genitalia but palpable gonads at labia majora with normal testicular function and structure, which is typical of complete androgen insensitivity syndrome (CAIS). The genetic study revealed 45,X/46,XY mosaicism and c.2081A>C missense androgen receptor gene mutation, indicating the likelihood of co-existing CAIS. This case demonstrated the importance of correlating genital phenotype and the underlying pathogenic mechanism, to provide appropriate management of DSD. Important considerations on managing the gonads about the risks of gonadal malignancies are also discussed. SRY gene on the Y chromosome or develop into ovaries in the absence of the gene. Subsequently, the internal and external genitalia develop into male morphologies in the presence of testicular hormones and into female morphologies otherwise. Disorders in any of these events in the sexual differentiation cascade can cause discordance of the genetic, gonadal, and genital sexes of an individual, collectively described as disorders of sex development (DSD) [Genetic sex is primarily determined by the sex chromosomes of an individual at fertilization. However, sexual differentiation involves a complex cascade of events during embryonic development where the sexually indifferent gonads develop into male or female sexual characteristics with corresponding internal and external genitalia . At the nt (DSD) .DSD affects approximately one in 4,500 live births . A wide We herein report a baby affected by 45,X/46,XY mosaicism as well as an androgen receptor (AR) gene mutation, who presented with complete androgen insensitivity syndrome (CAIS). We demonstrate the importance of correlating genital phenotype and the underlying pathogenic mechanism, to provide appropriate management of DSD.Baby Y was born at 39 weeks of gestation by normal spontaneous vaginal delivery, with a birth weight of 3.52 kg. A noninvasive prenatal test of baby Y (SafeT21) was arranged in the first trimester to screen for trisomies, and it showed 46,XY karyotype. However, subsequent serial antenatal ultrasonography demonstrated undervirilization of the external genitalia. As a result, amniocentesis was performed at 21 weeks of gestation and similarly demonstrated 46,XY karyotype.Postnatal examination of the external genitalia revealed unfused labioscrotal folds with normal pigmentation and absence of rugae. Gonads were identified at the upper labial folds without a palpable phallus. Urethral meatus was found at the perineum, with a separate vaginal opening, and the patient's anus was identified at the normal anatomical position. Overall, the external genitalia were typical of a female phenotype Figure . The ExtFurther investigations were carried out to ascertain the diagnosis Tables -3. FirstSecond, to evaluate the testicular function, anti-Mullerian hormone (AMH) was measured to assess Sertoli cell function, while a prolonged human chorionic gonadotropin (HCG) stimulation test was performed to assess Leydig cell function. AMH was slightly above the male infant range. Adequate rise of testosterone demonstrated normal Leydig cell function. This result has ruled out Swyer syndrome as a cause of discordance of phenotypic sex and karyotype.The presence of normal electrolytes, cortisol, testosterone, and precursor levels indicated a lower likelihood of adrenal steroidogenesis defects. At prolonged HCG stimulation test, the testosterone:androstenedione (T:A) ratio remained high after stimulation, which excluded 17-beta hydroxysteroid dehydrogenase 3 deficiency that typically has a T:A ratio <0.8. Urine steroid profile after HCG stimulation also showed no evidence of atypical congenital adrenal hyperplasia (CAH) leading to undervirilization of males, such as steroidogenic acute regulatory (StAR) deficiency or P450 oxidoreductase deficiency.At three months of age, the urine steroid profiling showed a normal ratio of 5-alpha to 5-beta reduced steroid metabolites, ruling out the possibility of 5-alpha reductase 2 deficiency.For imaging evaluation of internal genital organs, ultrasonography of the pelvis was performed on day six of life and identified testes at bilateral lower inguinal canals with comparable sizes and normal parenchymal echogenicity. The vaginal canal was present, while the uterus and ovaries could not be detected, reflecting Mullerian regression and adequate action of AMH. Wolffian derivatives were absent. The urinary system was normal.To our surprise, karyotyping on 50 leukocytes revealed a mosaic pattern with one cell line of four cells showing one X chromosome, and a second cell line of 46 cells with a normal diploid male pattern of one X chromosome and one Y chromosome, that is, 45,X(4)/46,XY(46) mosaicism was found in this patient Figure .As the patient had bilateral testes of normal infantile size and normal testicular function, the extent of undervirilization could not be explained by the abnormal karyotype alone. Therefore, further genetic testing for AR mutation was performed. A hemizygous missense c.2081A>C variant was detected in the AR gene, which was classified as a variant of unknown significance. The same hemizygous mutation was also detected in the mother. The nine-year-old elder sister had normal female genitalia and 46,XX karyotype. The seven-year-old elder brother had normal male genitalia and 46,XY karyotype. AR mutation was not detected in both siblings.The baby was assigned to be reared as a female after a thorough multidisciplinary discussion with the family. Prophylactic gonadectomy in early childhood was considered to clarify the nature of gonads and eliminate the risk of future malignancy.Fortuitous finding of 45,X/46,XY mosaicism in a patient with CAIS45,X/46,XY mosaicism is a chromosomal disorder of sexual differentiation, which affects approximately 1.5 in 10,000 live births . Rather,A testicularized gonadal phenotype with greater Sertoli cell and Leydig cell function is associated with a virilized genital phenotype, while a less differentiated gonad is more likely associated with nonvirilized genitalia . The stuIn baby Y, with inguinal gonads of normal size and echogenicity, normal baseline and HCG-stimulated testosterone level, normal AMH level, and absence of Mullerian structures on ultrasonography, her gonads were most likely testes with normal Leydig and Sertoli cell function, although gonadal biopsy or gonadectomy was not yet performed to elucidate the gonadal histology.Androgen insensitivity syndrome (AIS) is an X-linked recessive genetic disorder caused by mutations in the AR gene located in the Xq11-q12 region. Affected individuals manifest a variable degree of androgen insensitivity and are clinically classified into complete, partial, and mild AIS . CAIS afFor the genital phenotype, CAIS patients typically have normal testes found in the intra-abdominal cavity, inner inguinal ring, or labia majora. In the absence of testosterone responsiveness at the target tissue, Wolffian structures do not develop. Owing to the normal secretion of AMH by Sertoli cells, Mullerian structures regress and lead to the absence of a uterus and fallopian tubes. They have female external genitalia with blind-ending vaginas of variable length ,19.likely pathogenic in the Varsome search engine.In baby Y, a hemizygous missense c.2081A>C variant was detected, which leads to the substitution of the 694th codon from glutamine to proline, in the ligand-binding domain (LBD) region of the AR protein. The mutation has not been documented in databases, including ClinVar, the Human Gene Mutation Database, the Single Nucleotide Polymorphism Database, the Genome Aggregation Database, as well as the Androgen Receptor Gene Mutations Database . It was,From the aforementioned discussion, baby Y had the typical clinical and biochemical features of CAIS. The 45,X/46,XY mosaicism was likely a fortuitous finding, which produced no effect on the genital phenotype at the current infantile stage. In a study by Hornig et al. , in six It was observed that phenotypic males with 45,X/46,XY karyotypes have a strong chance of testicular function adequate for spontaneous pubertal onset with variable needs of subsequent testosterone replacement . AlthougMalignancy risk and gonadal managementManagement of DSD includes the assignment of sex of rearing, the decision of gonadectomy and its timing, hormonal replacement, surveillance of tumor risk, fertility management, as well as psychosocial aspects of gender identity and sexual health. Nowadays, patients’ autonomy and shared decision-making are advocated, especially concerning irreversible genital surgeries. By postponing gonadectomy, patients are allowed to make informed decisions in their management and may benefit from endogenous sex hormone production in the progression of pubertal development. This has to be balanced against the risk of gonadal malignancy.The estimated prevalence of testicular germ cell tumors in patients with AIS was 5.5%, while that for CAIS was 0.8% . VariousAs for 45,X/46,XY mosaicism and its variants, gonadal tumor risk was estimated to be 15% to 40%, significantly higher than 46,XY DSD caused by defective androgen production or action . In a stThe assessment of gonadal tumor risk and, consequently, the determination of gonadal management, is less obvious in baby Y. The clinical presentation of 45,X/46,XY mosaicism is complicated by the concomitant CAIS. Baby Y has gonads at the labial folds with normal testicular features on ultrasonography with normal androgen and AMH production, suggesting that they have appropriate testicular differentiation with a low risk of malignant transformation. However, this cannot be reflected by the degree of virilization of external genitalia because of concomitant CAIS. The family was taken through a thorough discussion, and a joint decision was made to rear the baby as a female and to consider prophylactic gonadectomy in early childhood to clarify the nature of gonads and eliminate the risk of future malignancy. The risk of surgery under general anesthesia, the need of lifelong hormonal replacement, and the implications on fertility were discussed with the family.We have presented a baby with typical clinical presentation of complete androgen insensitivity syndrome, i.e. external genitalia of female phenotype but palpable gonads of good size at labia majora with normal testicular hormonal secretion and normal structure on ultrasonography. Subsequent karyotyping revealed 45,X/46,XY mosaicism and genetic test showed a hemizygous missense mutation at androgen receptor gene in the LBD region. This case demonstrated the importance of identifying the underlying cause of DSD to explain the clinical phenotype. The underlying diagnosis affects the approach of management, especially the decision on gonadectomy based on the risk of malignant transformation.


This research employed a network meta-analysis (NMA) to examine the effectiveness of five traditional Chinese medicine (TCM) monomers for promoting motor function recovery in rats with blunt spinal cord injury (SCI).Wangfang, China National Knowledge Infrastructure, Web of Science, Embase, Chinese Scientific Journal Database, PubMed, and the Chinese Biomedical Literature Databases were searched for retrieving relevant articles published from their inception to December 2022. Two reviewers performed screening of search results, data extraction, and literature quality assessment independently.For this meta-analysis, 59 publications were included. Based on the recovery of motor function at weeks 1, 2, 3, and 4 in NMA, almost all TCM groups had significantly increased positive effects than the negative control animals. In terms of cumulative probability, the tanshinone IIA (TIIA) group ranked first in restoring motor function in the first week after blunt SCI, and the resveratrol (RSV) group ranked first during the last 3 weeks.The NMA revealed that TCM monomers could effectively restore motor function in the rat model of blunt SCI. In rats with blunt SCI, TIIA may be the most effective TCM monomer during the first week, whereas RSV may be the most effective TCM monomer during the last 3 weeks in promoting motor function recovery. For better evidence reliability in preclinical investigations and safer extrapolation of those findings into clinical settings, further research standardizing the implementation and reporting of animal experiments is required.https://inplasy.com/, identifier INPLASY202310070. In addition, the incidence of SCI is increasing . Of all Ligusticum chuanxiong, a Chinese herbal medicine  monomers , 15. At medicine , 19. RSVmedicine , 21. GSspurposes , 23. Almpurposes . TIIA isza Bunge , 26. Ani2.2.1.The guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed throughout this investigation . The res2.2.The following databases were searched: Chinese Biomedical Literature, Wanfang, Chinese Scientific Journal, China National Knowledge Infrastructure, Web of Science, Ovid-Embase, and PubMed (inception to December 2022). Potentially eligible papers were identified using the following terms as topic words, keywords, free-text terms, or Medical Subject Heading terms: “curcumin,” “turmeric yellow,” “curcumin phytosome,” “ginsenoside,” “panaxosides,” “resveratrol,” “trans-resveratrol,” “cis-resveratrol,” “tanshinone,” “tanshinone IIA,” “tetramethylpyrazine,” “ligustrazine,” “chuanxiongzine,” “spinal cord injuries,” “spinal cord injury,” “spinal injury,” “spinal cord trauma,” and “spinal cord contusion.” An individualized database-specific approach was used for each search. Methods of blinding, languages used, and publishing dates were unrestricted. The detailed search strategy of each database is provided in All enrolled studies followed the criteria: (1) Animals: rat with blunt SCI (contusion and compression model); (2) Intervention: five TCM monomers ; (3) control: placebo or no treatment; (4) Outcome: Weekly Basso-Beattie-Bresnahan (BBB) Locomotor Rating scale scores over 4 weeks. (5) Study type: control studies. Studies were excluded if (1) SCI was induced by other means, such as complete transverse SCI, hemisection SCI, and spinal cord ischemia/reperfusion injury; (2) BBB scores were not reported; (3) studies were duplicated; and (4) if complete raw data were not provided or if data could not be extracted.2.3.Two trained researchers were involved in selecting articles and extracting data from eligible studies in full compliance with the criteria for inclusion/exclusion as well as in cross-checking them. Disagreements were resolved by a third researcher. Relevant data were extracted according to a standard checklist, which included two major parameters: basic data  and outcomes (BBB score).Using SYRCLE’s Risk of Bias tool for animal research, the reviewers conducted independent assessments of the quality of the articles that were included in the analysis . The fol2.4.All variables included in our study were continuous variables. These variables were retrieved for NMA using STATA version 16, and the standardized mean difference (SMD) and the respective 95% confidence interval (CI) were calculated. Subsequently, the evidence network diagram was created to compare the five TCM monomers and allow a visual assessment of the relationship between each monomer and sample size. The thickness of the line segment indicated the number of studies that examined both interventions, whereas the size of the circles indicated the sample sizes used. Various intervention probabilities were ranked using SUCRA (surface under the cumulative ranking area). The SUCRA scores varied from 0 to 100%, reflecting the gradual increase from the poorest to the best treatments . Publica3.3.1.The search of the relevant literature yielded a total of 1827 articles, with 958 of them being written in Chinese and 869 in English. Following the removal of duplicates and publications that did not fulfill the criteria for inclusion, 59 articles (29 English and 30 Chinese) assessing the efficacy of TCM monomers in SCI were finally included. 3.2.In total, 56 randomized controlled trials (RCTs) and three controlled studies were included. Animals used in these investigations were either SD rats (55 articles) or Wistar rats (4 articles), see 3.3.The assessment results showed a medium quality for all the included literatures. Only five of the 56 RCTs (8.5%) that were examined provided evidence that randomization was carried out with the aid of a random number table or a computer. However, in these publications, the use of concealed grouping was not reported at any point. Overall, 98.3% of the articles (58 out of 59) indicated that the subjects’ baseline characteristics, including age, sex, and body weight, were matching. Moreover, the random allocation of rats throughout the experiment was indicated by 55.9% (33/59) of the reports. Since the included publications only provided a limited amount of information, it was not possible to obtain blinding information from those publications. However, only 15.3% of studies (9/59) indicated they randomly selected animals for measuring outcomes. Blinding of outcome assessors was applied in 57.6% (34/59) of studies. In 96.6% (57/59) of the studies, all rats were included in the final analysis. The purity of TCM monomers has not been reported in any studies. All expected results were clearly reported, but not all studies provided access to the protocol. Therefore, there is a high risk of performance bias in literature quality assessment. 3.4.3.4.1.A total of 57 studies were included for network meta-analysis. The evidence network showed there was no direct comparison between all types of TCM monomers. At the same time, the number of studies on TMP was the largest, see 3.4.2.A total of 54 studies were included for network meta-analysis. The evidence network showed there was no direct comparison between all types of TCM monomers. At the same time, the number of studies on TMP was the largest, see 3.4.3.A total of 36 studies were included for network meta-analysis. The evidence network showed there was no direct comparison between all types of TCM monomers. At the same time, the number of studies on TMP was the largest, see 3.4.4.A total of 32 studies were included for network meta-analysis. The evidence network showed there was no direct comparison between all types of TCM monomers. At the same time, the number of studies on CUR was the largest, see 4.As far as we know, this is the first NMA that evaluates the motor function recovery in rat blunt SCI models following treatment with TCM monomers The BBB Locomotor Rating scale  is a sensitive measure of motor function recovery. Accordingly, this tool was used for assessing motor function recovery in SCI rat models . AccordiSeveral key conclusions emerge from the studies evaluated in this meta-analysis. TIIA may have a better effect on early recovery of motor function than the other monomers. This conclusion has been supported by a few various researchers. Our team established in a previous research report that TIIA has great potential in remodeling the spinal pathway and exhibits neuroprotective effects in the early stage of SCI . In addiIn addition, according to the findings of this investigation, RSV could be the TCM monomer that is most efficient in promoting the restoration of motor function in rats with blunt SCI during the last 3 weeks of treatment. Secondary injury, including inflammation, oxidative stress responses, and neuronal apoptosis, occurring after the initial SCI results in further neurological damage. This pathophysiological status is alleviated by RSV owing to its ability to relieve inflammation, inhibit oxidative damage, and prevent apoptosis. Furthermore, previous studies have demonstrated that RSV suppresses the inflammatory response in SCI by upregulating the SIRT-1 signaling pathway and downregulating the NF-κB signaling pathways , 37. SCIin vivo data have shown that TMP regulates the spinal cord microenvironment  can also play an indispensable function in SCI treatment. Studies have shown that CUR inhibits the overactivation of microglia by regulating the expression of microglia TLR4, thereby reducing inflammation-induced neuronal injury . In addiironment . In a raironment . A few sironment , 49. Simironment , 50. In ironment . These fTCM monomers thus exhibit neuroprotective activity and could remarkably enhance motor function in rats with blunt SCI, especially TIIA, and RSV. Furthermore, combining multiple therapeutic approaches would benefit spinal cord functional recovery; these include the use of two or more TCM monomers and the use of TCM monomers combined with molecular therapy, cell therapy, or tissue engineering. Therefore, in the future, TCM monomers will be an important focus in the quest for blunt SCI treatment.5.This research faced several shortcomings. Firstly, the data that are now available on TCM monomers and the decline in motor function linked to SCI are inadequate because of the restricted number of rats involved in each trial, the limited sample sizes, and the insufficient examination of the data on BBB scores. Secondly, We only considered the BBB score since it is the most common and best shows the impact of TCM monomers treatment; however, we failed to assess any further outcome measures due to few reports. Thirdly, we were unable to determine where the heterogeneity originated in an accurate manner. Therefore, in our investigation, we used a model with random effects, which resulted in highly conservative findings. Fourth, this study compared five TCM monomers that are commonly used for the treatment of SCI; thus, the potential therapeutic role of other TCM monomers may have been overlooked. Fifth, drug dose and administration route may have affected the recovery of motor function. However, subgroup analyses were not performed owing to a smaller number of included studies. Sixth, the purity of TCM monomer is closely related to the therapeutic effect and dosage, but it has not been reported in any study, which may bring a certain risk of bias; In addition, the number of animals in different studies varies, and the quality of the literature included in the studies needs to be carefully evaluated.6.The NMA revealed that TCM monomers could effectively restore motor function in the rat model of blunt SCI. TIIA may be the most effective TCM monomer to improve motor function recovery in the first week of rats with blunt SCI, and RSV may be the most effective TCM monomer during the last 3 weeks.The existing animal experiments on the use of TCM monomers for SCI still encounter various difficulties with blinding, allocation concealment, randomization, and reporting of results, according to a systematic review of the included research. Because of these limitations, animal research may not provide reliable findings. The quality of evidence in preclinical investigations may be improved by standardizing the implementation and reporting of animal experiments, and the risk of extrapolating preclinical findings into clinical settings can be reduced.The original contributions presented in the study are included in the article/LX conceived the study. LX, YY, WZ, WL, CL, ZG, and XY contributed to the study design. LX drafted the manuscript. YY and XY edited the manuscript. All authors contributed to the article and approved the submitted version.This work was funded by the National Natural Science Foundation of the People’s Republic of China (No. 81973882).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.https://www.frontiersin.org/articles/10.3389/fneur.2023.1165076/full#supplementary-materialThe Supplementary material for this article can be found online at: Click here for additional data file.


Escherichia coli Bl21, and randomly divided into three study groups: UV device (UVG), impressions disinfection solution (SG), and control (CG). The experiment was repeated thrice, and disinfection efficacy assessed by colony forming units (CFU) count. A 2.5-min UV exposure achieved full disinfection for all materials. Significantly different results were found between groups , except for indelible pencils, where UVG and SG were both highly effective. UV cabinets surpass SG’s disinfection efficacy. Compact UV devices can offer affordable, portable, and efficient disinfection for non-sterilizable dental objects, with careful consideration of wavelength, exposure, intensity, and safety.Non-sterilizable items such as prosthodontics items constitute a high risk of transmitting dangerous pathogens, including Coronavirus, between patients and healthcare personnel. Although UV rays are recognized for their germicidal efficacy, large and expensive UV devices previously hindered their adoption in dental offices. During the COVID-19 pandemic, small UV devices became available for domestic use, albeit with varying designs and effectiveness. Our study assesses the disinfection capacity of a UV light cabinet for four dental materials and discusses crucial design features for effective performance. Specimens of each material  were contaminated with  It is for this reason why, at the beginning of the COVID-19 pandemic, dental practices in many parts of the world closed down voluntarily or by government-imposed law, except for the management of emergency cases and under exceptional precautions2. Disinfection protocols in dental clinics have been tightened but remained widely concerning personal protecting equipment (PPE), surface sanitization, and distancing5.Dentistry is one of the healthcare professions with the highest potential for contamination with patients’ fluids and for transmitting healthcare-associated infections (HAIs)6, Pseudomonas aeruginosa, and Staphylococcus aureus.Dental patients and healthcare workers are typically at risk of acquiring infectious pathogens due to exchanging objects and materials between the dental clinic and laboratory, including the SARS-CoV-2, HIV, Hepatitis A, B, and C viruses7. Chemical disinfection, however, is technique sensitive and is known to have a detrimental effect on rubber- or plastic-based dental instruments8.While sterilization by heat, wet or dry, is the gold standard, chemical sterilization is sometimes needed in dental settings for the decontamination of heat- or moisture-sensitive instruments or equipment that cannot withstand autoclaving9. Similarly, immersion of gypsum or die stones in disinfectant solutions may induce dimensional changes and affect setting time10. For this reason, dental impressions are routinely disinfected by spraying without affecting their dimensional accuracy. However, the technique is prone to human error as it does not ensure reaching all the hidden surfaces and undercuts, thereby increasing the risk of cross-contamination10. Furthermore, improper use of chemicals, inadequate contact times, and application techniques can all contribute to incomplete disinfection and the spreading of pathogens11. Ultraviolet (UV) radiation has the ability to reach all surfaces by reflecting light in all directions, and hence, it might be a better alternative for disinfection in dental settings.Complete immersion of hydrocolloid and polyether impressions in a disinfectant solution provides better exposure but may also induce dimensional changes owing to imbibition, hence, inducing dimensional inaccuracies13. Therefore, UV radiation can be used as an alternative to heat- and chemical-based disinfection procedures14. Besides, the International Ultraviolet Association has reported that UV disinfection may also prove beneficial in reducing the transmission of COVD-1915. However, UV light works only on surfaces within the field of view, and its strength decreases with distance16. Moreover, low dosages do not effectively inactivate some viruses and spores13.Furthermore, UV rays have long been known as efficient bactericidal properties due to their potential to cause DNA damage and cessation of bacterial reproduction17. However, given their large size and cost, these devices were not popular in dental practices, and disinfection had been routinely carried out using disinfecting solutions, both by spraying and immersion18. Recently, the surge in public awareness of the importance of infectioncontrol has led to the thriving of manufacturing UV devices for personal use20. These devices have become available in various smaller sizes and at relatively low costs, which made them a viable and effective alternative to chemicals in dental practice22. However, many of these did not possess the appropriate UV wavelength, intensity, or design to shine the UV radiation on all aspects of the object to be disinfected20. The use of smaller-sized UV devices with the right UV wavelength and intensity can offer reliable, cost-effective, and time-efficient disinfection options in dental settings22.UV hoods devices are considered the gold standard method for disinfection in microbiology laboratoriesThis research paper aims to test the UV light’s disinfection efficacy of four dental-related objects, silicone putty impressions, stone casts, acrylic denture bases, and indelible pencils compared to the current practice of spraying a disincentive solution.The experimental in vitro study was carried out at the College of Dental Medicine and the Research Institute of Medical & Health Sciences at the University of Sharjah. The study groups comprised the UV light group (UVG), the spray group (SG), and a negative control group (CG) where no disinfection was performed Fig. . The disEscherichia coli (E. coli) strain BL2123. The contamination solution was prepared to a concentration of 0.5 McFarland. Using an aseptic technique, 20 ml of an aliquot of 0.5 McFarland E. coli solution was transferred into a sterile glass beaker containing 200 ml of sterile phosphate buffer saline (PBS) . The specimens were fully immersed in the diluted E. coli stock solution and were then incubated for 2 min at 37 °C to dry. After completion of the drying period, the contaminated samples were divided randomly into three groups, each of which was subject to one of the disinfection methods.The specimens were contaminated with 2. The lamps were distributed: two on the top side and two on the bottom side, and the interior design of the chamber was composed of mirror walls to reflect the UV rays. A UV flux sensor  exclusively designed for UVC light detection was employed to assess the intensity of UVC irradiation within the cabinet. This recorded a maximum UVC intensity of 1024 μW/cm2 which was attained after 2 min of irradiation.The first group of specimens was placed in a UV light chamber for an exposure time of 2.5 min (150 s). The germicidal disinfection cabinet  was designed and manufactured in United Arab Emirates, UAE, and assembled in China. The device is equipped with four germicidal lamps  with a wavelength of 253.7 nm and an intensity of 1024 μW/cmThe second group (positive control) was disinfected using Zeta 7 spray . The solution is composed of 83 g ethanol, 10 g 2-propanol, non-ionic surfactants, additives, auxiliaries, and water to 100 g, with a distance of 10 cm to ensure maximum coverage/exposure. They were then allowed to evaporate for 3 min. The third group received no treatment and acted as a negative control. The experiment was repeated three times to ensure the reproducibility of the results.After exposure, the specimens were placed in small to medium-sized zip lock bags and washed with 50 ml of PBS. The suspension was placed in a shaking incubator for 1 min. This allowed the suspension of the microorganism in the solution. Next, an amount of 20 ml of the PBS of each sample was aseptically plated into Mueller Hinton agar media by pouring plate method for the observation and counting of colonies. The media plates were incubated at 37 °C for 24 h.Colony Forming Units (CFUs) were counted for each of the four materials, and compared among the three groups  using the GraphPad software.As can be seen in Figs. In the wake of the COVID-19 pandemic that resulted with forceful closure of dental practices due to cross-contamination concerns, we aimed to reassess the disinfection efficacy of common non-sterilizable dental materials. These items, widely exchanged in dental settings, pose a significant cross-contamination risk among patients, dentists, and lab technicians. Our study included indelible pencils, chosen for their permanence in marking dentures and labeling impressions. Despite their single-use nature, some clinics reuse them, warranting attention to this issue.E. coli, as evidenced by a colony-forming unit (CFU) count of 0 across all materials  achieved a marked and consistent complete eradication of als Fig. . On the 24. UV chambers with eye-protective doors and safety features are now accessible to dental facilities. However, commercially available devices differ in design and equipment, so selecting one with suitable features is crucial for effective disinfection.UV light disinfection is highly effective against diverse microorganisms, safe, and cost-effective, reducing aerosol spread compared to chemicals. Handheld UV wands work well but may harm eyes without proper distance control25. The main bactericidal effect of UV irradiation is the result of photoproducts. When DNA absorbs UVC radiation, pyrimidine dimer production causes nucleic acid damage, which leads to bacterial cell death25.Effectiveness of the UV disinfection unit is dependent on multiple parameters, including the UV radiation wavelength and intensity, the design of the UV chamber, the distance between the UV machine's bulb and the specimen, and the time of exposure to the radiation. Based on wavelength, there are three types of UV rays: UV-A (320–400 nm), UV-B (280–320 nm), and UV-C (100–280 nm). UV-C radiation has the most bactericidal effect and was chosen in our study2) for 90 s eradicates Candida albicans26. Dental impressions contaminated with HBV and HIV were UV-disinfected in 30 s only, but with the use of very high intensity (7000 μW/cm2)27. In our study, 100% bacteria eradication was achieved using four germicidal lamps, two on the upper and two on the lower walls, each with a 16W lamp producing 1024 μW/cm2. This was achieved in less than 3 min, the time recommended for disinfection with spray27.The importance of light intensity is well established. Previous research showed that UV exposure of 24 Watt  group, as their smooth surface facilitated uniform disinfection. UV disinfection offers a safe way to reuse indelible pencils in dental settings, despite initial discouragement due to cross-contamination concerns.Direct access of the disinfectant to microorganisms is essential to ensure disinfection of all surfaces. Lualdi et al.31. In our study, we tested UV exposure durations of 30 s, 2.5 min, and 5 min. Complete bacteria elimination was achieved at just 2.5 min, towards the lower end of the above time range. This is likely because of the strategically placed UV bulbs and use of reflective walls ensuring uniform exposure.The UV exposure times vary significantly in the literature, ranging from 30 s to 20 min for various materials and under different lamp intensities and exposure conditionsThe required sample size was estimated based on the desired effect size. The aim of this study was to establish if the UV method has a significantly better antibacterial effect than current practice (spraying) to the extent that would warrant change in practice. An 80% reduction in the CFU would be considered a sufficiently large effect size. The required sample size was calculated using G*Power to achieve a power of 95% for one-way ANOVA between three groups of equal allocation  and an effect size of 80%. The calculation identified that a sample size of 9 (3 in each group) would achieve a power of 99.6%.Since our study would be able to statistically detect the required “clinically significant” effect size with a sample of nine at a sufficient at a “high” power, increasing the sample size to detect a smaller and “statistically significant but non-clinically significant” difference would be counterproductive. However, in order to ensure reproducibility and independence of observations, we obtained three technical replicates for each experiment, and repeated the experiment on three different days to achieve biological replicates.32, indicating UV-C’s superiority over 70% alcohol for disinfecting elastic bands33. Other studies reported microbial growth after using ethanol- and di Didecyldimethylammonium chloride-based sprays34. Resendiz et al.35 also demonstrated UV-C outperforming isopropanol-based spray against anaerobes. In contrast, André et al.36 found no significant difference between UV light and 70% ethanol for 1-min exposure. The difference between these results and ours may stem from methodological variations, such as full immersion in ethanol by André while the current study employed the spray disinfection technique commonly used in clinical dentistry. Umezawa et al.37 demonstrated similar disinfection effects between a portable UV device and ethanol wipes.The negative control group confirmed the necessity of using disinfectants. This aligns with Rossi’s findings39. These findings lay the groundwork for enhanced disinfection strategies in dental practice, bolstering infection control and public health.In conclusion, our study highlights the differing effectiveness of UV irradiation and spray treatment in eliminating microbes from various materials, with statistically significant differences confirmed through effect size and power analyses. While UV irradiation effectively eradicated microbes in our study, it is advisable to pre-clean dental materials to ensure optimal UVC light penetration. Future research should explore additional materials, pathogenic microbes, and compare to standardized sodium hypochlorite immersion for further validationE. coli was used as the test organism since it has been studied extensively in the past, which facilitates comparability with other studies in the field. Additionally, submergence disinfection, which is a well-established method of impression sterilization, was not used and should be explored in future studies. Future studies are needed to test the efficacy on other dental-related microbes, including the Coronavirus, and to measure the cost-effectiveness and effects on the dimensional stability of UV machines.The study has opted to examine which of the tested methods  provides better “accessibility” and exposure to items with complex surface design such as dental impressions and models. The results of this study provide valuable insights into the efficacy of UV light and an impression disinfection solution in the disinfection of four dental materials. A complete eradiation of the organisms was attained in the UV group after exposure to UV light for 2.5 min, underscoring its reliability and potency. With the adherence to proper design, operational protocols, and safety measures, cost-effective UV sterilization devices stand out as promising disinfection methods in the field of dentistry.