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Effect of pulp protection technique on the clinical performance of amalgam restorations: three-year results.

This study evaluated the influence of the pulp protection technique on clinical performance of amalgam restorations after three years, with particular reference to post-operative sensitivity and secondary caries. One hundred and twenty (120) Class II amalgam restorations (68 premolars, 52 molars; 78 MOD, 42 OD/MO) were placed in 30 participants (four restorations per participant). The restorations were divided into four groups according to the pulp protection technique used: copal varnish; 2% neutral sodium fluoride; adhesive resin and no pulp protection. The parameters evaluated were post-operative sensitivity, staining of the dental structure, tooth vitality, partial or total loss of the restoration and secondary caries. One hundred and eight (108) restorations were available for evaluation after three years. No partial or total loss of restorations had occurred; all teeth were vital, no tooth structure staining or secondary caries was detected in any of the restored teeth. Post-operative sensitivity was observed only in two restorations at baseline and at seven-days. The three-year clinical performance of teeth restored with a high copper dispersed phase amalgam was not affected by the choice of pulp protection technique.

Adolescent↗

Histopathologic study on pulp response to single-bottle and self-etching adhesive systems.

This study compared the pulp response to seven adhesive resins (three single-bottle and four self-etching primers) and their companion resin composite systems with a commercial calcium hydroxide material when applied to exposed monkey pulps. The control group was capped with Dycal (DY), while the experimental groups were capped with one of the following adhesive resin systems: AQ Bond (AQ), Single Bond (SB), Imperva Fluorobond (IF), One Step (OS), Prime&Bond NT (PBNT), Perme Bond F (PBF) and One-up Bond F (OBF). Histopathologic evaluation of pulp tissue disorganization, inflammatory cell infiltration, reparative dentin formation and bacterial penetration at the 3rd, 30th and 90th post-operative days was done using light microscopy. Data were analyzed using the Kruskal-Wallis test followed by the Least Significant Difference Test to determine differences between the control group and the experimental groups at each observation period. The correlation of inflammatory cell infiltration and bacterial presence was investigated by the Kendall correlation analysis. All tests were performed at a 95% level of confidence. The pulpal responses of groups DY, SB, OS, PBF and OBF were generally characterized by none-to-mild pulp tissue disorganization and inflammatory cell infiltration. Also, initiation of reparative dentin formation was found earlier in Group DY, resulting in more complete dentin bridges at the 30- and 90-day observation periods. Groups AQ, IF and PBNT had significantly more inflammatory cell infiltration and a lower incidence of reparative dentin formation than Group DY. A significant correlation was detected between inflammatory cell infiltration and the presence of bacteria. It is concluded that the pulp response to SB, OS, PBF and OBF is not significantly different from the calcium hydroxide preparation. However, calcium hydroxide capping resulted in a higher incidence and faster rate of reparative dentin formation.

Acid Etching, Dental↗

Comparative analysis of pulpal circulatory reaction to an acetone-containing and an acetone-free bonding agent as measured by vitalmicroscopy.

Despite great progress in the production of new dental polymers, application of these products is still controversial. The unlined utilization of cytotoxic adhesive materials on pulpal dentin can adversely influence the pulp, leading to alterations in local microcirculation that can be an early sign of pathological changes. In a previous study by the authors, the effect of an acetone-free bondmaterial was examined on the vascular diameter of pulpal vessels by means of vitalmicroscopy. In this study, experiments comparing experimental data provided by an acetone-containing bondmaterial to these earlier findings with acetone-free ones have been performed. Thirty male Sprague-Dawley rats (weighing 333+/-9 g) were used for this investigation. The first lower incisor was prepared for vitalmicroscopy. Changes in vessel diameter were recorded prior to and 5, 15, 30 and 60 minutes after the investigated materials (Scotchbond Multi-Purpose Dental Adhesive System or Prime & Bond 2.1) were administered on dentin as recommended by the manufacturer. In control rats (saline administration), the vessel diameter was stable during the experiment. In the presence of acetone-free bondmaterial (Scotchbond), the vessel diameter was increased during the experimental period in relation to the baseline (12.15+/-2.85%; 16.36+/-2.39%; 14.16+/-3.48%; 12.12+/-3.72%). In the presence of acetone-containing bondmaterial (Prime & Bond 2.1), a similar result was observed (10.56+/-2.27%; 16.13+/-2.94%; 17.88+/-2.54%; 14.54+/-3.16%). The differences between the control values and those registered with test groups were significant (p<0.05; ANOVA). There was no significant difference among the test groups. The results of this study suggest that dental bond materials applied on a very thin layer of dentin may affect the blood supply to the dental pulp. However, no stasis or prestasis has been detected, indicating a possible reversible effect. The authors could not show any statistical difference between the vasodilatation caused by the acetone-containing and the acetone-free bond material.

Acetone↗

[The epidemiology of malaria in the southwestern forests of the Ivory Coast (Tai region)].

An epidemiological study on malaria was undertaken between July 1995 and July 1996 in two villages (Zaïpobly and Gahably) and their encampments (Kouassikro, Hamanikro and Konankro), in the south-western forest area of Côte d'Ivoire (region of Taï). The parasitological scheme comprised a total of 2023 tests performed on children aged from 0 to 14 years. The species found were Plasmodium falciparum, P. malariae and P. ovale with a proportion of 84%, 14% and 2% respectively. The global parasite prevalence of all Plasmodium species was 85% and malaria was holoendemic. The average parasitic density decreased progressively as the age increased, in contrast to the plasmodic index which did not vary. All the malarial indexes were similar in the villages and their encampments. Only overall fever prevalence was permanent and in all age groups it was higher in the encampments than in the villages. The entomological findings showed that transmission was permanent and intense throughout the year, with a recrudescence during the rainy season. Transmission was attributed to Anopheles gambiae s.l. in 85% of the cases whereas An. funestus played a secondary role. The average sporozoïtic index was 7.6% and varied between 1.1% and 16.7%. The entomological inoculation rate was of 400 infected bites per person-year for An. gambiae s.l. In such conditions of intense transmission, acquisition of premunition starts at a very early age. This assertion is verified by the average parasite density and the frequency of high parasitic densities which were at their maximum between 1 and 4 years of age and decreased thereafter as the age increased. The paludometric and entomologic indexes obtained are the most elevated ever to have been observed in Côte d'Ivoire, as a result of considerable ecological changes linked to the deterioration of the forest environment over the past 30 years. This deterioration has probably been caused by demographic pressure resulting from internal and foreign immigration to the Taï region and more especially by the influx of Liberian refugees.

Adolescent↗

Changes in the lifestyle of Mongolian pastoralists in China in connection with urbanization.

The objective of this study was to elucidate changes in the health-related lifestyle of Mongolian pastoralists in China in connection with their urbanization. A total of 592 people participated in a survey that included a medical examination and an interview questionnaire. Files of 72 pastoral Mongolians, 78 urban Mongolians, 380 urban Han/Man and 21 urban Hui were used for this analysis. Urban Mongolians consumed meat and milk products less frequently than did pastoral populations (p < 0.001), and consumed fish and vegetables more frequently than did pastoral populations (p < 0.001). Urban Mongolian consumed mutton, beef, rengyo fish, milk, milk tea, curd, butter, yogurt, and sheep milk less frequently (p < 0.05) and pork, sword fish, and dried milk more frequently (p < 0.05) than pastoral Mongolian. Male pastoral Mongolians were more likely to drink and smoke than were urban Mongolians (p < 0.01), urban Han/Man (p < 0.01), or urban Hui (p < 0.01). The lifestyles of pastoral Mongolians in Inner Mongolia, China have changed in connection with urbanization. Understanding of the traditional pastoral lifestyle and the urban-living acculturation process will contribute to maximizing the positive impacts of urbanization on people's health in Inner Mongolia.

Acculturation↗

Head movements in the occlusal phase of mastication.

It has been recognized that mandibular movements evoke head movements during jaw tapping. However there have been only a few studies that investigated the aspects of head movements during mastication. The objective of this study was to demonstrate the hypothesis that the head moves actively in mastication in order to achieve effective destruction of a food bolus. Head and mandibular movements during gum, gummi candies and kelp chewing among nine adult volunteers have been recorded as time series data with a three-dimensional motion capture system and the vertical components of the movements have been analyzed. To focus on occlusal phase of mastication, the following parameters have been examined: time lag of the head movements at the beginning of occlusal phase, perpendicular velocity of the head at the beginning of the phase of occlusion, and average velocity of the head during occlusal phase. The results showed that the head moved downward in mastication and the velocity of the head movements increased in the order of gum, gummi candies and kelp chewing. There is a possibility that the elasticity of a food bolus affects the activity of head movements, and the kinetic energy was increased to achieve effective destruction of a food bolus.

Adult↗

Effectiveness of a stress management program for family caregivers of the elderly at home.

The aim of this study is to investigate the efficacy of a structured intervention program in emotional and physical states of family caregivers for elderly. This program is a series of five weekly 90-minute sessions including psycho-education, problem-solving techniques, and relaxation training. Subjects were 56 primary caregivers looking after relatives with dementia or disability at home. Psychological inventories, i.e., Profile of Mood States (POMS) and General Health Questionnaire30 (GHQ-30) were administered at the period of 4 weeks before, pre-, post-intervention, and 2 months after intervention. They were taken a blood sample to measure natural killer (NK) cell activity at the 4 weeks before, pre-, and post-intervention. In the waiting list control group, there was no change in the POMS, the GHQ-30 and NK cell activity. The scores for depression, anger-hostility, tension-anxiety, confusion (POMS), and general illness, social dysfunction, anxiety and dysphoria, suicidal depression (GHQ-30) at the post-intervention decreased significantly when compared with pre-intervention scores. Moreover, there was persistence of the improvement during two months after intervention. Post-intervention NK cell activity was significantly higher than the pre-intervention. These results indicated that our program was effective in managing the stress of family caregivers.

Affect↗

Non-invasive assessment of bone quality.

A morphological filter and pipeline analysis was applied to computed radiographs (CR) to abstract the geometrical characteristics of the trabecular pattern and to analyze bone mechanical properties. By applying a morphological filter to the CR images, trabecular patterns were divided into 8 subset groups (n=O through 7) by the trabecular thickness. Sumset images were also derived from the thicker trabeculae group (n=2-5, 3-6, and 4-7) to examine the criteria relating the percentage of thicker trabeculae to the strength of the bone. A method to analyze the bone mechanical properties was developed, based on the hypothesis that data of connective line segments were loaded mechanically. By this method, trabeculae were analyzed in the fifth lumbar vertebrae from etidronic acid-treated and non-treated ovariectomized osteoporosis rat models, and in human third lumbar vertebrae. Consequently, it was shown that total loss of bone mass accompanied a reduction of consecutive trabecular number in the rat osteoporosis model, especially in parts of the bone having thick trabeculae. The reduction in number of connective trabeculae, from one cortical side to the other, occurred at a similar rate, along both the craniocaudal and anteroposterior axes in the vertebral bodies of the experimental osteoporosis rats. In the dynamic study with human third vertebral blocks, no significant correlation was observed between the bone mineral density of the bone specimens and their ultimate strength (R2=0.093). In contrast, the abstracted percentage of thicker trabeculae, derived from the sumset (n=2-5) images, showed a strong correlation with bony mechanical properties (Young's modulus: R2=0.915, maximum point load: R2=0.815). The result calculated by this methodology can serve as an excellent index to indicate bone strength under non-destructive, living conditions.

Aged↗

Root instrumentation with an erbium:yttrium-aluminum-garnet laser: effect on the morphology of fibroblasts.

OBJECTIVE: The purpose of this study was to evaluate the effect of erbium:yttrium-aluminum-garnet laser instrumentation of root surfaces on the morphology of fibroblasts from continuous lineage. METHOD AND MATERIALS: Dentinal slices with 4 mm2 of surface area were obtained from teeth extracted for severe periodontal involvement. Specimens were assigned to one of three treatment groups: group 1, application of the laser with an energy level of 250 mJ at 103 pulses per second; group 2, application of the laser with an energy level of 80 mJ at 166 pulses per second; and group 3, similar to group 2, but with concomitant water irrigation of the device. The specimens were incubated in multiwell plates containing cell culture media. After 24 hours, the specimens were submitted to routine preparation for scanning electron microscopy. Three independent and blind examiners used photomicrographs to evaluate the morphology of the fibroblasts: 0 = without cells; 1 = flat cells; 2 = round cells; and 3 = combination of round and flat cells. RESULTS: Statistical analysis indicated that there were significant differences among treatment groups and that group 3 was significantly different from groups 1 and 2. CONCLUSION: There was no difference between groups 1 and 2 in the morphology of fibroblasts. Laser instrumentation with concomitant irrigation impaired the adhesion of fibroblasts to dentinal surfaces.

Aluminum Silicates↗

A clinical and histologic evaluation of implant integration in the posterior maxilla after sinus floor augmentation with autogenous bone, bovine hydroxyapatite, or a 20:80 mixture.

PURPOSE: This study was designed to clinically and histologically evaluate the integration of titanium implants in different grafting materials used for maxillary sinus augmentation procedures. MATERIALS AND METHODS: A total of 21 patients and 36 maxillary sinuses were augmented with (1) autogenous particulated bone from the mandibular ramus, (2) bovine hydroxyapatite (BH) with membrane coverage, or (3) an 80/20 mixture of BH and autogenous bone. The grafts were allowed to heal for 6 to 9 months prior to placement of microimplants for histology and standard implants for prosthetic rehabilitation. After another 6 months of healing, when abutments were connected, the microimplants were retrieved for histologic and morphometric analyses. The outcome of the standard implants was clinically evaluated after 1 year of loading. RESULTS: The mean bone-implant contact was 34.6 +/- 9.5%, 54.3 +/- 33.1%, and 31.6 +/- 19.1% for autogenous bone, mixture of 20% autogenous bone/80% BH, and 100% BH, respectively. The corresponding values for the bone area parameter were 37.7 +/- 31.3%, 39.9 +/- 8%, and 41.7 +/- 26.6%. The BH area was found to be 12.3 +/- 8.5% and 11.8 +/- 3.6% for 20% autogenous bone/80% BH and 100% BH, respectively. There were no statistically significant differences for any parameter between any of the groups. After 1 year of loading, 6 of the 33 implants placed in autogenous bone grafts, 2 of the 35 implants placed in the BH/autogenous bone mixture, and 2 of 43 implants placed in BH were lost. There were no statistically significant differences between any of the groups. DISCUSSION: The histomorphometric analysis showed no differences between the 3 groups, indicating that autogenous bone graft can be substituted with bovine hydroxyapatite to 80% or 100% when used for maxillary sinus floor augmentation. The effect of adding autogenous bone remains unclear but may allow for a reduction of the healing time. CONCLUSION: The results from this clinical and histologic study indicate that similar short-term results can be expected when using autogenous bone, BH, or a mixture of them for maxillary sinus floor augmentation and delayed placement of dental implants.

Absorbable Implants↗

Reduced neuropsychologic measures as predictors of treatment outcome in patients with temporomandibular disorders.

AIMS: To determine via a prospective investigation whether the presence of neuropsychologic or cognitive deficiencies could be identified in patients with temporomandibular disorders (TMD) and used to predict treatment outcome. This was based on the theory that measurable reductions in neuropsychologic and cognitive function might have a negative impact on treatment outcome in patients with essentially nontraumatic TMD, as has been shown for patients with posttraumatic TMD. METHODS: Various neuropsychologic, psychosocial, and clinical parameters (including but not limited to the Peterson-Peterson Consonant Trigram Test and the California Verbal Learning Test) were used to pretest patients suffering from TMD prior to treatment. Patients were then entered into treatment, after which determination of treatment success was made both by the use of visual analog scales for pain and global transitional outcome measures (e.g., "better," responders versus "same/worse," nonresponders). After determination of treatment success was made, treatment response was correlated with the various clinical, cognitive, and neuropsychologic test scores. RESULTS: Overall, the nonresponders did worse in both the neuropsychologic and psychosocial assessments, with greater memory deficits, sleep disturbances, depression, and fatigue and lower energy levels as compared to responders. Among the best predictors of treatment outcome were the Peterson-Peterson Consonant Trigram Test scores, as well as the scores on the California Verbal Learning Test (i.e., poorer test outcomes predicted nonresponse). Neither responders nor nonresponders could be distinguished from one another based on clinical parameters of maximum interincisal opening or muscle tenderness. Three psychosocial variables were also found to be predictors of poor outcome: sleep disturbance, fatigue, and income. Pretreatment pain on chewing was also found to be a reliable predictor of poor treatment outcome. CONCLUSION: We conclude that various neuropsychologic, psychosocial, and some clinical parameters may provide pretreatment prediction of treatment outcome in an idiopathic TMD population.

Adolescent↗

A comparative evaluation of four adhesive tooth coloured restorative materials. An invitro study.

Four adhesive tooth colored restorative materials, Fuji II, Fuji II LC, Dyract and TPH composite resin were evaluated for the amount of microleakage in enamel and cementum. The TPH composite resin showed maximum microleakage, significantly higher than Fuji II, which showed least microleakage. All the four materials showed more micro leakage in cementum when compared to enamel.

Acridine Orange↗

The influence of computer-assisted instruction on acquiring early skills in intraoral radiography.

The purpose of this study was to determine if there was a significant difference in the diagnostic quality of the initial full-mouth series (FMS) exposed by first-year dental students after viewing a Computer Assisted Instruction (CAI) module on radiographic technique as compared to those who did not and to determine if students who used the CAI module expressed a preference to using it and would recommend its use prior to exposure. Fifty-nine first-year dental students were randomly selected and assigned to two groups (students who did not view a CAI CD and students who did) before exposing their initial FMS on a Dental X-ray Training and Teaching Replica (DXTTR). For each radiographic series, a radiology faculty member determined the total number of error points based on performance criteria. The Wilcoxon Rank Sum Test was used to determine significance between the two groups, p = .05. After exposing the FMS, students in the second group completed a questionnaire to assess their preference for using the CAI CD. The Sign Rank Test was used to determine preference, p = .05. No significant difference in error points were found to exist between the two groups. Dental students who reviewed the CAI preferred using it and would recommend it to others before exposing their FMS.

Attitude↗

Effect of multiple application of a dentin adhesive on contraction gap width of a resin-based composite.

PURPOSE: To test the efficacy of the multiple application of a total-etch dentin adhesive was investigated by measuring (1) the contraction gap width of a light-activated resin-based composite in a cylindrical dentin cavity and (2) the early tensile bond strength to a flat dentin surface with the Single Bond Dental Adhesive System. MATERIALS AND METHODS: Contraction gap width was measured in a cylindrical dentin cavity (3 mm x 1.5 mm) treated with a single coat or double coats of the Single Bond adhesive and restored with Silux Plus or Z-100. As control, the cavity was treated with an experimental dentin bonding system consisting of EDTA, 35% GM and Clearfil Photo Bond. Early tensile bond strengths of Silux Plus or Z-100 were measured on the flat dentin surface treated with the three bonding procedures as in the contraction gap study within 10 min. after final cure. RESULTS: The contraction gap of Silux Plus and Z-100 was prevented with the double coats of the Single Bond adhesive, whereas the contraction gap of Z-100 was not prevented with the single coat of the Single Bond and the experimental system. When the film thickness of the Single Bond system was less than 2 microm, the gap could not be prevented. The tensile bond strengths of Silux Plus and Z-100 to flat dentin mediated with the three bonding procedures were not significantly different (P>0.05).

Acid Etching, Dental↗

Microleakage of four simplified adhesive systems under thermal and mechanical stresses.

PURPOSE: To evaluate microleakage at the dentin margins of Class II resin-based composite restorations using four simplified adhesive systems: Etch & Prime 3.0, Prime & Bond NT, Clearfil Liner Bond 2V and Clearfil SE Bond, upon thermal and mechanical stresses. MATERIALS AND METHODS: Forty slot preparations (5mm x 3mm x 1.5mm) were cut in sound human molars with gingival margins below the cement/enamel junction. All adhesive systems were applied strictly according to manufacturers' instructions. Cavities were restored using Clearfil AP-X composite resin. After finishing and polishing, teeth were submitted to thermal (x700, 5-55 degrees C, 60-second dwell time) and consecutively mechanical cycling (100,000 cycle; 8 Kgf load). Specimens were coated with nail polish, immersed in silver nitrate for 2 hours and sectioned longitudinally with a diamond disc. The extent of leakage was ranked using a 0-4 scale. RESULTS: Statistical analysis was performed using Kruskal-Wallis test. Minimal leakage occurred with Clearfil SE Bond. There was a statistically significant difference (P<0.01) between this system and Clearfil Liner Bond 2V, although the latter also showed low values of dye penetration. No statistically significant difference was found between Etch & Prime 3.0 and Prime & Bond NT. Both showed statistically greater leakage than the two other systems (P<0.01).

Composite Resins↗

Modulation of mastication during experimental loosening of complete dentures.

PURPOSE: Suction is achieved when complete dentures are first fitted, but it fades during the months following insertion, when it is increasingly complemented by muscular denture control. The aim of this study was therefore to investigate the extent to which patterns of mastication are altered by experimental failure of physical retention. MATERIALS AND METHODS: Seven edentulous volunteers had maxillary replica dentures made, with fine tubes incorporated so that alternating positive and negative air pressure could be generated under the fitting surface. Mandibular movements, EMG, and pressure under the denture base were recorded during unilateral chewing. RESULTS: The change of physical retention passed undetected by all subjects; they continued chewing apparently undisturbed. However, during air injection, the mandibular excursions were slightly slower (nonsignificant) and demonstrated a reduced variance (P < or = .05). The muscle activity showed significantly longer bursts (P < or = .05), and peak activity occurred later in the cycle (nonsignificant). CONCLUSION: Sudden failure of denture retention seems to initiate an immediate and effective modulation of centrally generated muscular activity patterns.

Aged↗

A 6- and 12-month follow-up of appliance therapy in TMD patients: a follow-up of a controlled trial.

PURPOSE: This study compared the long-term effects of treatment with a stabilization appliance and treatment with a control appliance in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: In a controlled trial, 60 TMD patients with temporomandibular joint (TMJ) pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. At the 10-week follow-up, the 60 patients were assigned to one of three groups according to their demand for treatment. Group T, the treatment group, comprised 30 patients treated with a stabilization appliance; group C, the control group, comprised nine patients treated with a control appliance; and group M, the mixed treatment group, comprised 21 patients treated with first a control appliance and then a stabilization appliance. Signs and symptoms were evaluated in all three groups at 6- and 12-month follow-ups. RESULTS: At the 6- and 12-month follow-ups, a significant reduction in TMJ pain as measured on a visual analogue scale was found in all three groups, and a significant decrease in signs and symptoms was found in groups T and M. CONCLUSION: After 6 and 12 months of use, the stabilization appliance was found to still be effective in the alleviation of signs and symptoms in patients with TMD. Many patients in group C changed to a stabilization appliance at the 1 0-week follow-up, which significantly reduced the number of patients in this group. Most patients reported positive change in overall subjective symptoms in this trial. The stabilization appliance can therefore be recommended for patients with TMD.

Adult↗