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PubMed2003

Long-term clinical performance and longevity of gold alloy vs ceramic partial crowns.

Cast gold partial crowns (CGPC) are an accepted means of restoring posterior teeth. For aesthetic reasons, gold alloys are being increasingly substituted with ceramics. The aim of the present study was to investigate retrospectively the long-term clinical performance and survival of CGPC and compare the results to the ones already reported for ceramic partial crowns (CPC). The CGPC group consisted of 42 patients (24 male, 18 female) randomly sampled from a total of 106 patients with CGPC, with one restoration per patient. The CPC group consisted of 22 patients with a total of 42 restorations. Both types of restoration were done by one experienced dentist. Another two experienced dentists who were not involved in performing the restorations rated both kinds of partial crowns using the modified United State Public Health Service (USPHS) criteria [14]. The Median age of the CGPC was 57 months (range 3-157) and of the CPC and 63 months (range 24-72). Forty-one (98%) of the CGPC and 27 (64%) of the CPC were placed in molars, the rest in premolars. In each group, 40 (95%) restorations were still functioning without any necessity of replacement. Two teeth with CGPC, in situ for 4.5 and 11 years, respectively, had been extracted for periodontal reasons. Two CPC fractured and had to be replaced after 2 and 6.5 years in situ. The USPHS criteria results were similarly good for the gold and ceramic groups. Kaplan-Meier analysis revealed survival probabilities of 72+/-21% and 96+/-4% after 13 and 7 years, respectively, for the CGPC. Survival of the CPC was 81+/-15% after 7 years. No statistically significant difference among survival functions of CGPC and CPC was found. From this data, it can be concluded that the longevity of CPC is not inferior to that of gold alloys. However, more long-term studies comparing the clinical performance and longevity of these two types of indirect restoration in the posterior region with larger numbers of restorations are desirable.

Bicuspid↗
PubMed2006

Two-year clinical performance of cast gold vs ceramic partial crowns.

Cast gold partial crowns (CGPC) are an accepted means of restoring posterior teeth with extended lesions. However, for esthetic reasons, CGPC are being increasingly substituted with partial ceramic crowns (PCC). The aim of the present prospective split-mouth study was to compare the clinical performance of PCC and CGPC. There were 29 patients (male 12, female 17) who participated in the investigation for a total of 58 restorations. In each patient, one CGPC (Degulor C) and one PCC (Vita MarkII/Cerec III) were placed. CGPC were inserted using conventional zinc-phosphate cement (Harvard); PCC were adhesively luted to the cavities (Variolink II/Excite). The restorations were clinically rated using modified United States Public Health Service (USPHS) criteria at baseline and 1 and 2 years after placement. The median patient age was 38 years (range 25-54). There were 29 of the CGPC and 14 PCC placed in molars, while 15 PCC were placed in premolars. All patients were available for the 1- and the 2-year recall. One PCC (1.7%) failed and had to be replaced after 2 years in situ. The rest of the restorations were functional without need of replacement. The evaluation using USPHS criteria revealed no statistically significant differences between CGPC and PCC with the exception of anatomic form: PCC showed occlusal chipping in two cases without need of replacement. From these data, it can be concluded that PCC may provide an esthetic and tissue-conservative alternative to CGPC. However, long-term studies comparing the clinical performance and longevity of cast gold and ceramic partial crowns for posterior teeth are desirable.

Adult↗
PubMed1999

In vivo comparison of a microfilled and a hybrid minifilled composite resin in Class III restorations: 2-year follow-up.

An in vivo comparison was made of two different types of restorative resins over a 2-year period: a microfilled resin (-1158262462Silux Plus, 3M-1158262462, USA) and a hybrid minifilled composite resin (-1158262461Herculite XRV, Kerr-1158262461, USA); 56 restorations were placed in 28 patients by one experienced dentist and examined by two independent evaluators using the United States Public Health Service (UPSHS) rating system for marginal adaptation, marginal discoloration, surface roughness, anatomic form and modified criteria for color match (direct and indirect evaluation). Modified criteria divided the classic A score into A1 for "not detectable" filling and A2 for "slightly discernible filling". Restorations were evaluated at baseline, 1 week, 6 months, 1 year and 2 years later. After 2 years, all materials were considered satisfactory for marginal adaptation, anatomic form and surface roughness (no "Charlie", or "Delta" ratings). No recurrent caries was observed. Clinical evaluation showed a significantly higher rate of marginal discoloration for the microfilled composite resin than the other resin. Hybrid composite resin materials may be expected to perform well as an anterior restorative material. Photographic ratings confirmed the clinical evaluation. The modified evaluation for color match demonstrated differences, which are not discernible with the USPHS system and showed, more rapidly, differences that appear later with the USPHS system.

Adolescent↗
PubMed1991

Five-year clinical study of u.v.-polymerized posterior composites.

Four u.v.-polymerized composites (Estilux, Nuva-Fil, Nuva-Fil P.A. and Uvio-Fil) were clinically evaluated in Class I and II cavity preparations in permanent teeth. The restorations were evaluated at baseline, 1, 2, 3, 4 and 5 years using USPHS criteria for direct evaluation and at 3, 4 and 5 years using the Leinfelder method for indirect evaluation of wear. The wear measured by the USPHS method showed increasing wear rates in earlier reports, apparently due to the limited sensitivity of the scale to early wear. The wear by the Leinfelder method showed gradually decreasing wear rates. There were no statistically significant differences among the wear values for the four u.v.-cured materials or between these materials and the self-cured and visible light-cured controls.

Analysis of Variance↗
PubMed2005

Dentist-time expenditure for two different adhesive all-ceramic systems.

OBJECTIVES: The purpose of this clinical investigation was to compare a chair-side adhesive all-ceramic system to a laboratory processed adhesive all-ceramic system with respect to quality and time expenditure for the dentist. METHODS: The same dentist treated 10 patients, who were each to receive two large posterior single tooth restorations of similar location and extent. One restoration was made in the laboratory by using the IPS Empress system [LAB], the other one was done chair-side by utilizing the Cerec system [CHAIR]. The time expenditure was measured for [LAB] and [CHAIR] and compared by the Wilcoxon signed rank test. The restorations were also evaluated according to the USPHS criteria. RESULTS: The mean time expenditure for the dentist with low-level assistance was 111:03 min [S.D.+/-24:09 min] for [LAB] and 115:31 min [S.D.+/-15:54 min] for [CHAIR]. Time expenditure with medium level assistance for the operator was 100:53 min [S.D.+/-23:59] for [LAB] and 105:50 [S.D.+/-15:28] for [CHAIR]. Assuming a high level of assistance, the mean time values were 53:11 min [S.D.+/-14:29] for [LAB] and 54:29 min [S.D.+/-09:21] for [CHAIR]. The baseline investigation according to the modified USPHS criteria did not reveal any differences between [CHAIR] and [LAB]. CONCLUSION: There were no statistical significant differences with respect to time expenditure or quality between [LAB] and [CHAIR] in this study.

Aluminum Silicates↗
PubMedDate not supplied

The content of prenatal care. Update 2005.

INTRODUCTION: The Content of Prenatal Care report of the US Preventative Health Service (USPHS) Expert Panel established an important benchmark when published in 1989, but has not been significantly updated since that time. METHODS: The literature since 1989 is reviewed to assess which recommendations have been validated and/or implemented. Additionally, new findings that support the recommendations put forth or expand the scope of prenatal care outlined in the 1989 report are examined and discussed. RESULTS: The USPHS recommendation of a reduced prenatal visit schedule has support, and new content for the preconception visit has been identified, although this preconception visit has not been validated or widely implemented. CONCLUSIONS: We identified new opportunities and initiatives for the content of prenatal care, particularly improvement in the electronic medical record, attention to multidisciplinary approaches to patient education and improved patient literacy, and an extended maternal life span approach, including postgestation visits.

Benchmarking↗
PubMed1999

Does the evidence from clinical trials justify the treatment of hypertension?

Hypertension is the most common reason for physician office visits. An estimated 43 to 50 million people in the United States have elevated blood pressure (BP). The prevalence of hypertension varies from a small percentage among individuals in their teens and 20s to more than 70% of the elderly (those > 75 years of age). The US Public Health Services (USPHS) has set a goal of having 50% of individuals with hypertension "under control"--that is, reducing their BP to < 140 mm Hg systolic and < 90 mm Hg diastolic--by the year 2000. Current information suggests that we will fall far short of reaching that goal. In the early 1990s, such levels had been achieved by only 27% of hypertensive Americans 18 to 74 years old and by only 20% of those > 75 years old. Is this a cause for concern? Is the goal defined by the USPHS justified? Should we push even harder to reach that goal, should we strive to do even better, or should we be satisfied? Since we are now in the era of evidence-based medicine, the only way to answer these questions is to review what we have learned from the many large, prospective, well-controlled, long-term clinical trials that have addressed these questions over the past 3 decades.

Adrenergic beta-Antagonists↗
PubMed2000

ART restorations and sealants placed in Chinese school children--results after three years.

OBJECTIVES: These were to assess whether ART restorations and sealants could be provided to children in a school environment in China, to assess patient acceptability of the ART approach, and to evaluate on a longitudinal basis the treatments performed. METHODS: This study was conducted in Deyang, Sichuan Province, in western China. A total of 294 ART restorations were placed in 197 children and 191 fissure sealants were placed in 140 children by five middle-level dentists in four secondary schools. Standard instruments and procedures for ART were used. The restorative material used was a high-strength glass-ionomer (Ketac-Molar, ESPE). The treatments were evaluated annually after placement by the same examiner who had not been involved in the placement of the restorations nor sealants using explorers and mouth-mirrors. At the 3-year examination an independent external examiner evaluated the restorations using USPHS criteria. RESULTS: Most of the children did not report discomfort during treatment and 92% were willing to receive ART restorations again. The cumulative 1-year and 3-year survival rates of small Class I restorations were 99% and 92% respectively. The corresponding figures for large Class I restorations were 90% and 77%. After 3 years, 72% of the sealants were either partially or completely retained. Only 2% of the sealed teeth developed fissure caries and these involved teeth where the sealants had been lost. Similar success rates were found using USPHS criteria. CONCLUSIONS: The ART approach for preventing and treating tooth decay in Chinese school children was shown to be appropriate, effective and acceptable. The 3-year survival rates of the restorations were high but were related to the size and type of the restoration.

Adolescent↗
PubMed1998

A 3-year clinical evaluation of two composite resins in class-II cavities.

The purpose of this investigation was to study the clinical performance of a new system with a proposed expanding liner for composite restorations introduced in the late 1980s. The present study reports on baseline data and the result after 3 years. One hundred and four class-II cavities in 95 patients were alternatively restored by Superlux Molar and the reference material P-50 APC by 12 general practitioners in 3 public dental health clinics. After 3 years 82 restorations (79%) were available for examination. The restorations were evaluated on the basis of USPHS criteria after 1 week and again after 3 years. Stone casts were used to quantitatively categorize wear in accordance with the Leinfelder method. Color slides and bitewings were taken to supplement the clinical evaluation of color match and marginal adaptation, respectively, and secondary caries. The failure rate (USPHS rating, Charlie) was four restorations of Superlux Molar and seven of P-50 APC. The average wear after 3 years of Superlux Molar was 131 microm and of P-50 APC, 128 microm. There were no statistically significant differences between the two materials with regard to, for example, handling characteristics, anatomic form, color match, marginal discoloration, or failures. A significantly higher wear rate was found after 3 years in patients with a high level of salivary lactobacilli (> 10(5) colony-forming units (CFU)/mL at base line) compared with those with lower levels. This suggests that an acidic environment might enhance the wear rate.

Analysis of Variance↗
PubMed2005

The association between patient-reported receipt of tobacco intervention at a primary care visit and smokers' satisfaction with their health care.

U.S. Public Health Service (USPHS) clinical guidelines for tobacco treatment recommend that providers routinely counsel smokers using a five-step algorithm (5A's): ask about tobacco use, advise smokers to quit, assess interest in quitting, assist with treatment, and arrange follow-up. A potential barrier to compliance is providers' concern that addressing smoking might alienate smokers, especially those not ready to quit. A survey was mailed to 1,985 patients seen at one of eight Boston-area primary care practices from January 1 to March 31, 2003, and identified as smokers by chart review. The survey assessed respondents' receipt of the 5A's at their visit and their satisfaction with the provider's tobacco treatment and with their overall health care. We used multivariable logistic regression models to assess the association between satisfaction with care and patient-reported receipt of each 5A step, adjusted for age, sex, education, race, health status, smoking intensity, readiness to quit, and length of relationship with provider. Of 1,160 respondents (58% response rate), 765 reported that they smoked at the time of the visit. They reported high levels of satisfaction with their tobacco-related care and overall care. Patient-reported receipt of each 5A step was significantly associated with greater patient satisfaction with tobacco-related care and with overall health care, even after adjusting for a smoker's readiness to quit smoking. Satisfaction with overall health care increased as counseling intensity increased. Patient reports of smoking cessation interventions delivered during primary care practice are associated with greater patient satisfaction with their health care, even among smokers not ready to quit. Providers can follow USPHS guidelines with smokers without fear of alienating those not yet considering quitting.

Adult↗
PubMed2000

Determinants of antimicrobial prophylaxis use and treatment for wasting among patients with advanced human immunodeficiency virus disease in the United States, 1995-1998.

Despite US Public Health Service (USPHS) recommendations for antimicrobial prophylaxis for patients with advanced human immunodeficiency virus (HIV) disease, the proportion of patients who receive prophylaxis is not known. We measured the prevalence of antimicrobial prophylaxis use, and treatment for HIV wasting at baseline among 531 patients with advanced HIV disease enrolled in a multicenter randomized trial of red blood cell transfusion. Use of antimicrobial prophylaxis and treatment for wasting in the 30 days before enrollment was ascertained in patients eligible for primary prophylaxis, secondary prophylaxis, or both, according to USPHS guidelines. There was high utilization of primary and secondary Pneumocystis carinii pneumonia prophylaxis, variability in primary Mycobacterium avium complex prophylaxis by center, and low use of primary cytomegalovirus prophylaxis. Treatment of wasting was more common in white than nonwhite patients and in patients with HIV disease who lived in the region west of the Mississippi River of the United States versus those whose lived in the eastern region.

AIDS-Related Opportunistic Infections↗
PubMed2002

2001 anthrax crisis in Washington, D.C.: clinic for persons exposed to contaminated mail.

An anthrax prophylaxis clinic is described. In October 2001, four workers from the U.S. Postal Service's Brentwood facility in Washington, D.C., were hospitalized with inhalational anthrax; many others may have been exposed to anthrax spores. U.S. Public Health Service (USPHS) teams were deployed to establish an anthrax prophylaxis clinic that would provide education and medication to workers and people who visited the mail facility. The temporary clinic was set up at D.C. General Hospital and was staffed primarily by health care professionals from USPHS. The protocol at the clinic involved three major phases. Phase 1 consisted of gathering information from the patient and distributing educational materials. Phase 2 involved presentations by a physician and a pharmacist concerning anthrax, followed by a question-and-answer session. In phase 3, a pharmacist selected the most appropriate prophylactic agent, dispensed the medication, counseled the patient, and referred patients with flu-like symptoms or skin lesions to a physician. Two floor plans were used to maximize the number of patients seen per hour without jeopardizing patient care. The clinic operated 14 hours a day for 14 days. The 136-member health care team included 52 pharmacists, and medication was dispensed to more than 18,000 patients. The clinic may serve as a model for pharmacists and other professionals in designing and implementing disaster plans. A multidisciplinary team established and operated a clinic to treat persons who may have been exposed to anthrax through contaminated mail.

Ambulatory Care Facilities↗
PubMed1995

Comparison of multiple drug therapy regimens for HIV-related disseminated Mycobacterium avium complex disease.

In June 1993, the United States Public Health Service (USPHS) made recommendations for treatment of disseminated Mycobacterium avium complex (MAC) in patients infected with the human immunodeficiency syndrome (HIV). It was suggested that every treatment regimen include either azithromycin or clarithromycin plus one or more of the following drugs: ethambutol, clofazimine, rifabutin, rifampin, ciprofloxacin, or amikacin. This study compares the effect of multiple drug therapy regimens on the survival of patients of the HIV outpatient department of the Medical Center of New Orleans, Louisiana. A retrospective chart review of 122 confirmed cases of MAC was conducted. Three treatment groups were considered: no/monotreatment (n = 40), multitreatment without clarithromycin (n = 32), and multitreatment with clarithromycin (n = 50). Azithromycin, amikacin, and rifabutin were not used in this clinic during the study period. Both multitreatment without clarithromycin (p < 0.03) and multitreatment with clarithromycin (p < 0.005) were significantly protective for survival after adjusting for CD4 cell count at time of diagnosis, nonadherence to treatment, number of concomitant opportunistic infections at diagnosis, and weight loss > 10%. Neither of the groups that received multidrug therapy were significantly less likely to have MAC-related symptoms than the no/mono group at 3 and 6 months postdiagnosis. These findings support the USPHS recommendation for multiple drug treatment either with or without clarithromycin. Prospective controlled clinical trials will clarify the optimal regimen for disseminated MAC disease.

AIDS-Related Opportunistic Infections↗
PubMed1996

Short-term results of IPS-Empress inlays and onlays.

PURPOSE: A leucite-reinforced, glass-ceramic material was recently introduced for clinical use. In this clinical trial, IPS-Empress inlays and onlays were evaluated using the modified United States Public Health Service (USPHS) criteria. MATERIALS AND METHODS: The teeth of 36 patients were restored with 105 posterior inlays and 25 onlays, fabricated by an indirect technique. After etching the restorations with hydrofluoric acid, they were silanized and luted using composite cements. The restorations were evaluated visually, clinically with a mirror and probe, and by bitewing radiographs and clinical photographs, using modified USPHS criteria. Restorations having neither charlie nor delta criteria were defined as successful, and their survival rate was calculated according to Kaplan-Meier analysis. RESULTS: The mean observation period for the 130 restorations was 23.4 +/- 6.1 months. After 2 years, 127 restorations were successful with an estimated survival rate of 97.5%. Three restorations failed because of fractures. The esthetic results were excellent. CONCLUSIONS: The initial clinical results of this esthetic restorative material are encouraging. However, because of fatigue phenomena for all ceramic materials, a longer observation period is needed to provide a definitive prognosis of the long-term clinical behavior.

Aluminum Silicates↗
PubMed2005

Inlay-fixed partial dentures adhesively retained and reinforced by glass fibers: clinical and scanning electron microscopy analysis after five years.

Fifty-three posterior glass fibre-reinforced composite inlay-fixed partial dentures (IFPDs) in 36 patients were followed for 5 yr. For statistical analysis, one IFPD per patient was randomly selected. The survival rate and influence of discrete predictors (gender, location) and continuous variables (age, abutment surfaces) were determined. Clinical observations were recorded by using modified United States Public Health System (USPHS) criteria. Replicas of 17 randomly selected abutments were analysed by scanning electron microscopy (SEM) for marginal adaptation and the results were compared by using a repeated-measures analysis of variance (anova). The main reason for failure was veneering material delamination from the framework. The cumulative survival rate after 5 yr was 73% (95% confidence interval: 57-89%) for not delaminating and 96% (95% confidence interval: 88-100%) for not debonding. No significant influence of the tested predictors was found. Significant changes between baseline USPHS criteria and counterparts recorded at recall were fractures of the veneering material (chipping), wear, surface texture, and staining. Significant margin changes were only found between baseline and 1 yr. Thereafter, marginal adaptation remained stable. After 5 yr, 90% of the margins were termed as perfect. It was concluded that hard-tissue saving IFPDs with the current design maintained acceptable retention and marginal integrity. Future studies should aim at reducing delaminations by searching for improved framework designs and materials.

Adult↗
PubMedDate not supplied

Atraumatic restorative treatment with resin-modified glass ionomer material: short-term results of a pilot study.

OBJECTIVES: The aim of this study was to assess the feasibility of the resin-modified glass ionomer (RMGI) material in atraumatic restorative treatment (ART) approach and compare RMGI with the high-strength traditional glass ionomer cement (GIC) in permanent teeth with one or more surface-carious cavities. MATERIALS AND METHODS: This study was conducted in a village school in rural southeastern Anatolia, Turkey. The RMGI and GIC restorations with the ART technique were placed randomly employing a split mouth design. In addition, the ART approach was used when necessary for both primary and/or permanent teeth with no pulpal involvement and no perceived pain before treatment. Ninety-one fillings were placed on contralateral molar pairs of 37 children. Baseline and 6-month evaluation of the fillings were made with the classic ART, modified Ryge and USPHS criteria. RESULTS: Based on the ART criteria, 100% of RMGI and 92.4% of GIC restorations were classified as successful after 6 months, and the difference between the 2 groups was statistically significant (p=0.009). While marginal discoloration was the commonest failure in the RMGI group according to both the modified Ryge and USPHS criteria, unsatisfactory surface texture and low anatomic form were the commonly seen failures in the ART technique. CONCLUSION: Generally, for each rating system, RMGI exhibited better clinical performance than GIC in all categories, except for marginal discoloration. Results based on the 6-month evaluation show that RMGI can be an alternative material to the GIC.

Adolescent↗
PubMed1984

Clinical evaluation methods for posterior composite restorations.

Two methods of evaluating the in vivo wear of posterior composite restorations are described and compared with the USPHS direct clinical evaluation system. The three methods were consistent among themselves and over the two years of the study. In order of increasing sensitivity, the methods were: USPHS, total ranking of models, and categorizing of models according to a set of standards. The last procedure identified statistically significant differences (p less than 0.05) between the composite formulations as early as the nine-month recall. All formulations experienced increasing wear with time, but at a decreasing rate.

Bisphenol A-Glycidyl Methacrylate↗
PubMed2002

Use of HIV postexposure prophylaxis by dental health care personnel: an overview and updated recommendations.

BACKGROUND: The authors conducted a study on the use of postexposure prophylaxis, or PEP, for exposure to human immunodeficiency virus, or HIV, among dental health care personnel, or DHCP, enrolled in a surveillance system established by the Centers for Disease Control and Prevention, or CDC. They also discuss updated U.S. Public Health Service, or USPHS, recommendations for managing occupational exposures to HIV, as well as considerations for dentistry. METHODS: The authors analyzed occupational exposures reported by DHCP to the CDC to describe characteristics of the exposure (for example, type and severity), the source patient's HIV status and use of PEP. RESULTS: From June 1995 through August 2001, DHCP reported 208 exposures--199 percutaneous injuries, six mucous membrane exposures and three skin exposures--to the CDC. One-third of these percutaneous injuries were caused by small-bore hollow syringe needles, and most (66 percent) were moderate in depth. Nearly half the devices involved (46 percent) were visibly bloody at the time of injury. Per the criteria described in USPHS guidelines, one-half of the injuries were categorized as "less severe." Twenty-four (13 percent) known source patients were HIV-positive; 14 had symptomatic HIV infection or a high viral load. In this study, three in four DHCP exposed to an HIV-positive source warranted a three-drug PEP regimen. Twenty-nine (24 percent) DHCP exposed to a source patient who subsequently was found to be HIV-negative took PEP; six took PEP for five to 29 days. No exposures resulted in HIV infection. CONCLUSIONS: Findings of this study are consistent with earlier reports indicating that the risk of HIV transmission in dental settings is low. Strategies such as rapid HIV testing of source patients and follow-up counseling may reduce unnecessary use of PEP. CLINICAL IMPLICATIONS: Dental practices should develop comprehensive, written programs for preventing and managing occupational exposures to blood.

Anti-HIV Agents↗