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Fracture strength of different core build-up designs.

PURPOSE: To investigate the resistance to fracture of three crown and core combinations, made with different core build-up systems on human teeth, using a standardized test method. MATERIALS AND METHODS: The anatomic crowns were removed from six groups (n = 8) of endodontically treated, human premolars in conformity with a brass master dye, using the Celay duplicating device. Three of these groups were provided with a core build-up with-out an endodontic post (Ti-Core, Photo-Core and Ketac-Molar); two other groups were provided with a core build-up with an endodontic post (a cast post and core, and a composite with a silica post), and one group was not provided with a core. All groups were then prepared in conformity with a master dye. This preparation ended in axial dentin, 2 mm apical from the core build-up. Thus in the sixth group (premolars without a core build-up), this preparation only affected the 2 mm axial dentin (ferrule), which resulted in a small retention area (2 mm axial dentine) for the crown. Finally, a standard crown was cemented and 24 hrs afterwards loaded until fracture in an Instron testing machine at an angle of 45 degrees. For comparison with the standardized procedures, a seventh group (Photo-core without post) was prepared manually, with dimensions similar to the standardized groups. RESULTS: Within the standardized test set-up no significant difference in strength between the 6 groups could be demonstrated. Only in the case of the hand-made Photo-Core and the cast core was the fracture load significantly different (P= 0.01). In addition, this hand-made group displayed a larger standard deviation than the standardized groups. Taking into consideration the fact that the maximum bite force in the bicuspid region is about 580 N, these tests showed that within the limitations of the standardized test set-up, where the samples had no history of fatiguing, a core build-up without a post is an alternative for the conventional cast core. In this study, the fabrication of the standardized samples proved to be accurate, fast and economical. This method also enables the evaluation of the performance of core and crown design combinations in relationship to the amount of remaining tooth structure by using different master dies and, moreover, to reduce the high standard deviation in this kind of research.

Analysis of Variance↗

Bonding to root caries by a self-etching adhesive system containing MDPB.

PURPOSE: To evaluate the bonding of an experimental antibacterial fluoride-releasing adhesive system (ABF) to normal and carious dentin in human teeth with Class V root caries. METHODS: Mesiodistal sectioning removed the buccal enamel, superficial dentin and much of the carious dentin in 21 extracted human bicuspids with root surface caries. The surfaces of normal coronal and root dentin, and caries-affected and caries-infected dentin were ground with wet 600-grit SiC paper to create a standardized smear layer. Tooth surfaces were treated with the ABF according to manufacturer's instructions, and then covered with excess resin composite. After immersion in 37 degrees C water for 24 hours, the restored teeth were horizontally sectioned into serial slabs that were trimmed into hourglass shapes to isolate the bonded area to the test substrates, and then their bond strengths were measured by the microtensile bond test, and the interfaces examined by SEM and TEM. The bond strengths were statistically compared with ANOVA and Fisher's PLSD (P < 0.05). RESULTS: The bond strengths of ABF to caries-affected and caries-infected dentin were significantly lower than those to normal coronal and root dentin. SEM micrographs revealed that the hybrid layers in caries-affected and caries-infected dentin were more porous compared to the hybrid layer in normal coronal and root dentin. TEM micrographs showed that bacteria that had invaded the dentin were embedded in this adhesive monomer in caries-infected dentin. CLINICAL SIGNIFICANCE: Although the bond strength of ABF adhesive system to root carious dentin is lower than that of normal dentin, the antibacterial and fluoride-releasing properties of ABF may contribute to prevent caries progression and inhibit secondary caries.

Acid Etching, Dental↗

Changes in the soft tissue facial profile following orthodontic extractions: a geometric morphometric study.

OBJECTIVES: The aim of this study is to test the null hypothesis that changes in soft tissue facial profile in children who undergo orthodontic treatment, using either an extraction or non-extraction technique, do not differ. DESIGN: Longitudinal, retrospective. SETTING AND SAMPLE POPULATION: San Juan, PR and Aberdeen, UK. Fifty-eight consecutively treated children using fixed appliances with a mean age of 13.2 (+/- 2.1) years. EXPERIMENTAL VARIABLE: Extraction of the upper and lower, first or second premolars. OUTCOME MEASURES: The mean pre- and post-treatment, extraction and non-extraction configurations were compared using finite-element scaling analysis (FESA), incorporating a thin-plate spline interpolation. RESULTS: Post-treatment the two groups differed statistically in the premaxillary region (p < 0.05) with the non-extraction group being relatively larger in that region by 25%. For the non-extraction group after treatment, localized increases in relative size in the naso-maxillary region size of 25% (p < 0.01) were present. For the extraction group after treatment, a non-significant reduction in relative size of 15% was localized in the putative bicuspid area. CONCLUSION: Soft tissue facial differences in non-extraction and extraction cases prior to treatment may be accentuated following orthodontic treatments that elect non-extraction or extraction protocols. Robust diagnosis and treatment planning, incorporating the judicious use of extractions if appropriate, may yield optimal orthodontic outcomes.

Adolescent↗

[Analysis of distalization of lower canine by light-segmented archwire].

OBJECTIVE: To analyze the practical effect of distalization of lower cuspiud by light-segmented archwire. METHODS: 17 cases were selected. In all cases, two lower first bicuspids were extracted and lower molars were designed as reinforced anchorage. In the first half year, lower cuspids were distalized with light-segmented archwire, and lower incisors were in the physiologic drift stage. Before the treatment, three months and six months after the treatment, cephalograms and study models were recorded respectively. The data were analyzed with SPSS 10.0. RESULTS: The distance of mesiolization of the first lower molar was 1.14 mm in half a year. The distance of distalization of the lower cuspid was 5.02 mm in half a year. No significant difference was found in LM-MP and SN-MP angle. LI-NB angle was decreased by 9.57 degrees. Crowding of lower incisors was transferred from -2.55 mm to 1.08 mm. CONCLUSION: During distalization of lower cuspid by light-segmented archwire, anchorage tooth was stable, lower cuspids were distalized effectively, and lower incisors drifted towards the ideal position automatically.

Bicuspid↗

[Changes of orthodontic tooth in different healing extraction sites].

OBJECTIVE: To compare the canines root resorption and alveolar bone height when they were moved into different healing extraction sites. METHODS: Twenty patients with overjet were treated by extracting the maxillary first premolars. By random determination, distalization of different lateral upper canines started after 1 week and 12 weeks. Every 4 weeks use a force of approximately 100 g to distalize the canines. The experiment was ended when bilateral canines have contacted with the second maxillary bicuspids completely. Periapical radiography of the canine in the end of the distalization was made. RESULTS: External apical root resorption and alveolar bone height of the canines have no significant difference between the different healing extraction sites. CONCLUSION: Tooth extraction site healing has not much effect on the canine external apical root resorption and alveolar bone height, when it was distalization. In practice, tooth movement into extraction sites can start early.

Adolescent↗

[Stress analyses and comparison of the Kennedy III dentition defect restored with removable partial denture].

PURPOSE: To investigate the stress distribution of the abutment and oral mucosa in Kennedy III, restored with removable partial dentures, either unilateral or bilateral designed. METHODS: Five FEA models were established for the partial edentulous and RPDs, which were divided into group A and group B. According to the denture design, bilateral (B) or unilateral (A) designed. The 3-D finite element analyses were proceeded and calculated with the help of the software ANSYS. Paired t test was used for statistical analysis using SAS 6.2 software package. RESULTS: The maximum stress appeared near the cervical mesial area of the first bicuspid and the second molar. There was no significant difference between the two groups in the stress distribution of the abutment and oral mucosa (P>0.05). CONCLUSION: In regard to the stress of the abutments, unilateral designs have no excess stress formed when RPD was used to restore Kennedy III dentition defect.

Bicuspid↗

[Mechanical resistance of endodontically treated upper first premolar crowns].

This work shows the results of mechanical strength tests effected over first superior bicuspids before endodontically treated. The Authors show the strength differences, in connection to the access-cavity, between endodontically treated and non-treated teeth. Finally it was found that the demolition of only one marginal ridge reduces the tooth strength to withstand the occlusal forces.

Adolescent↗

[Extremely delayed mineralisation of a first premolar in conjunction with submerged deciduous molars--a case report].

This case report presents a patient with extremely delayed mineralisation of a first upper right premolar and simultaneously congenitally missing second premolars. While the germs of the first premolars are usually detectable on dental X-ray films at the age of three or four years, the demonstrated patient was older than 13 years when the first premolar became visible. As the right first bicuspid actively erupted normal root growth took place, and once the tooth is in its normal position its anatomy can be considered normal. With the eruption of the permanent tooth the periodontal situation improved considerably in the region where depression of its predecessor had taken place. As a practical clinical consequence one should take into consideration that mineralisation of a first premolar can be extremely delayed in cases with congenitally missing second premolar teeth.

Adult↗

Microleakage and cusp fracture resistance of heat-treated composite resin inlays.

The purpose of this study was to examine the microleakage and cusp fracture resistance of heat-treated composite resin inlays. One hundred and twenty extracted human bicuspid teeth were prepared with MOD Class II preparations and divided into 12 experimental groups. Ten extracted human teeth were kept sound as positive controls and 10 of the prepared teeth were left unrestored as negative controls for the cusp fracture resistance experiment. The remaining prepared teeth were grouped and restored with the following restorations: bulk or incremental placement, light-cured inlays, heat-treated inlays "cemented" with enamel bonding agent, enamel bonding agent/glass ionomer "sandwich", or a dentinal bonding agent. Heat-treated inlays showed significantly (P less than 0.05) less microleakage than all other groups. The cusp fracture resistance of the heat-treated inlays was in the same magnitude as that of the traditionally placed composite resin restoration. All restorations were significantly (P less than 0.05) lower in cusp fracture resistance than sound non-carious teeth.

Adhesives↗

In vitro evaluation of fluorescein for testing the permeability of white spots on tooth enamel.

This investigation demonstrates the reliability of fluorescein for detecting the permeability of incipient dental caries (white spots). Artificial white spots were created on the buccal surface of 12 human bicuspids by viscous lactic acid (pH 4). Permeability of these lesions was assessed and reassessed before and after 24 and 48 hr of acid challenge using two disclosants: sodium iodide and sodium fluorescein. Estimates obtained from both disclosants showed that the microvoid volume approximately doubled as the decalcification time doubled. The two disclosants exhibited good intraclass reliability and their scores were correlated (r = 0.69 to r = 0.91). However, only fluorescein disclosed the extent of porous white spot lesions. Thus, fluorescein should be considered when the objective is to detect the location and permeability of incipient lesions.

Bicuspid↗

[Long-term evaluation of the periodontal status in extraction treatment].

In this article the periodontal status of the 30 patients which were treated with Edgewise mechanics, by extraction of four first bicuspids is evaluated approximately 5 years later the active treatment. Comparison of the pocket depths between the teeth moved into extraction areas and the other teeth, is made. And also the pocket depths of the parallel and non-parallel teeth in the extraction area are compared. It is found that orthodontic treatment had no adverse effect on periodontal status in long term. But non-parallel teeth in the extraction area showed much higher values of pocket depth when compared to parallel teeth.

Bicuspid↗

[Amalgams. Traditional and modern].

The amalgam continues to be the most widely used material for durable restoration of decayed bicuspids and molars. After a discussion of this material's relative drawbacks, the author describes the restoration possibilities now offered by the advanced high-copper alloys available today. The latest developments involve both "conservative" preparations and extensive pre-prosthetic occlusal restorations.

Bicuspid↗

[The decision to extract in orthodontics].

Serial extractions of premolars are submitted, in the present state of the contemporary orthodontics, in opposition to the non-extraction treatments (maxillary expansion, molar distancing...). The choice depends on many parameters including the severity and the nature of the malocclusion, the age and the morphological type of the patient and also the "orthodontic philosophy" relating to the techniques used by each orthodontist. The indications and contraindications of these teeth removals are explained showing the benefits and the disadvantages in different cases. "Orthodontics extractions" of other teeth (2nd bicuspid, 1st and 2nd molar, incisor) are also discussed.

Bicuspid↗

Cast titanium dental implants for the posterior mandible.

The purpose of this paper is to present the results of the evaluation of five patients who received titanium dental implant replicas of extracted molars and pre-molars, placed in the posterior mandible. The replicas were placed in the sockets where the molars and bicuspids had been extracted. The implant replicas were fabricated in two parts, an abutment portion and a root portion connected by a titanium screw. The root portion was made of cast titanium. The abutment portion was made of a high noble metal to which porcelain could be fused, so that the crown restoration could be made directly on the abutment. The patient's ages ranged from 27 to 63 years. Four were male and one was female. The implants were placed three to six weeks after extraction. All implants integrated. The longest follow-up with the implant in function was five years.

Adult↗

Cardiobacterium hominis endocarditis manifesting as bacterial meningitis.

Cardiobacterium hominis is a rare cause of endocarditis, and infection caused by this organism has not been described outside the vascular system. A patient with a congenital bicuspid aortic valve was initially seen with C hominis bacterial meningitis. Septic emboli from an underlying endocarditis were probably the source of the infection.

Adult↗

Are screening echocardiograms warranted for neonates with meningomyelocele?

OBJECTIVE: To evaluate the incidence and types of congenital heart defects associated with meningomyelocele. DESIGN: All neonates who underwent meningomyelocele repair and had a perioperative echocardiogram from July 1990 to October 1998 were studied. Medical records were reviewed for age, weight, clinical cardiac examination results, meningomyelocele location, and associated noncardiac defects. Heart defects were identified from reviewing echocardiographic reports and videotapes. RESULTS: At meningomyelocele surgery, the 105 patients (53 female; 52 male) ranged in age from 1 to 20 days and in weight from 0.6 to 4.1 kg. Congenital heart disease was detected in 39 patients (37%). A secundum atrial septal defect was the most common defect (24%). A ventricular septal defect was found in 10 patients, 2 patients had anomalous pulmonary venous return, and 1 each had tetralogy of Fallot, bicuspid aortic valve, coarctation, and hypoplastic left heart syndrome. A patent ductus arteriosus and patent foramen ovale were not considered abnormal in these neonates. The cardiac examination was abnormal in only 5 of the 39 patients with heart defects (sensitivity = 13%). The presence of associated noncardiac defects (in addition to meningomyelocele) and location of the meningomyelocele (cervicothoracic vs lumbar) did not affect the incidence of heart disease. Of the patients with heart defects, girls were more frequently affected (25 of 39 vs 14 of 39, P<.05). CONCLUSIONS: Congenital heart defects are common in neonates, especially girls, with meningomyelocele and are unrelated to meningomyelocele location or associated noncardiac defects. Because the clinical examination is insensitive for detecting heart defects in this group, screening echocardiograms are warranted. This information has important implications for ventriculoatrial shunting, urinary tract instrumentation (antibiotic prophylaxis), and neurosurgical procedures (venous air embolism).

Abnormalities, Multiple↗

Selected therapy for ascending aortic aneurysms.

Since 1971, ten patients, 26 to 62 years of age, have undergone repair of ascending aortic aneurysms with concomitant aortic insufficiency. Three patients had Marfan's syndrome, five patients had cystic medial necrosis, one had leutic aortitis, and one had atherosclerotic involvement of the aorta. There was one operative death. Follow-up exceeds seven years. Because of the tendency for progressive annular and sinus dilation in Marfan's syndrome, composite graft and valve conduits with reimplantation of the coronary arteries is the procedure of choice. In selected patients with annulaortic ectasia, good valve tissue and no sinus dilation, bicuspidization of the valve, and replacement of the ascending aorta is indicated. The operation is generally less formidable than composite graft replacement, maintains normal coronary anatomy, and alleviates the long-term risks of anticoagulation.

Adult↗

Developmental analysis of cardiovascular system of 45,X fetuses with cystic hygroma.

There have been few pathological investigations of 45,X embryos and fetuses from a developmental point of view. Since most 45,X embryos and fetuses are lost prenatally, it is important to investigate them morphologically in order to elucidate the pathogenesis of the abnormalities. In this study, 13 45,X fetuses with cervical cystic hygroma were examined between 12 and 23 weeks of pregnancy. Every case had a hypoplastic thymus. The aortic valve was bicuspid in 11 cases and unicuspid in 2 cases. The aortic arch showed tubular hypoplasia between the left carotid artery and the left subclavian artery in 12 cases and type B interruption in one case. Smooth muscle cells and elastic fibers were reduced in number in the hypoplastic aortic arch. These results suggest hypoplastic development of the fourth branchial arch. Combined abnormalities between the aortic arch and aortic valve are not infrequently observed in DiGeorge anomaly. A similar developmental mechanism apparently underlies the pathogenesis of 45,X embryos. Possible genes causing the abnormalities are discussed.

Aorta, Thoracic↗