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In removable partial denture fabrication, the patient's interest usually lies in the improvement of his or her esthetic appearance. Unsightly facial clasps have always been a cosmetic problem with traditional options either expensive or technically difficult. This article describes an alternative for anterior retention that maintains excellent esthetics with a simple approach.
STATEMENT OF PROBLEM: Maxillofacial prosthetic materials should simulate the oral tissues as much as possible and therefore have a similar flexibility and resilience. In light of the oral tissues constantly moving, the dynamic deformation properties of maxillofacial materials would seem the most relevant. PURPOSE: In this study, dynamic mechanical thermal analysis was used to evaluate the deformation properties of five silicone rubber materials used to construct facial prostheses. The technique involves the application of a sinusoidally oscillating stress to a material and analyzes how the material elastically or viscoelastically responds to the stress. The dynamic mechanical thermal analysis can operate at a fixed frequency or range of frequencies over a specific temperature range and also isothermally as a function of time. RESULTS: Cosmesil and A-2186 materials were the most resilient materials and Silbione had the greater energy absorption capacity, which was particularly noticeable at the higher frequencies. Silbione also had a lower shear modulus (G'), which indicated it was more flexible than the other materials. CONCLUSION: The dynamic mechanical thermal analysis proved to be a rapid, reliable, and convenient method for the determination of viscoelastic properties of maxillofacial materials.
STATEMENT OF PROBLEM: Flexible die materials have been introduced to facilitate the fabrication of indirect provisional or definitive restorations in 1 appointment. PURPOSE: This study compared the surface detail reproduction of 7 potential flexible die materials when used in combination with 7 elastomeric impression materials. METHODS: Surface detail reproduction of 17 impression material/flexible die material systems was compared with a control system containing an elastomeric impression material and a Type IV dental stone. Test dies of each system were prepared in a random order with the American Dental Association apparatus for testing detail reproduction, compatibility, and dimensional stability. RESULTS: One flexible die system had better surface detail reproduction than the control stone die, other systems had similar or worse reproduction. Surface detail reproduction was adversely affected when a separator was required between the impression and flexible die material. CONCLUSIONS: Impregum F die material with Extrude Light impression material produced better surface detail reproduction than the control dies. Impregum F impressions were incompatible with Blu-Mousse, Impregum F, or Imprint die materials. Polyvinyl siloxane impressions were incompatible with polyvinyl siloxane dies unless a separator was used. When a separator was used, the surface detail reproduction was not as good as the control die system or the Extrude Light impression material/Impregum F die material combination.
STATEMENT OF PROBLEM: Resilient denture liners are widely used for the patients who are not comfortable with correctly made conventional hard-based dentures because of thin and relatively nonresilient mucosa or severe alveolar resorption. There are several materials used for denture liners and the efficacy in their use is influenced by their viscoelastic properties. PURPOSE: This study evaluated the setting behavior and viscoelastic properties of various types of resilient denture liners and the changes in viscoelasticity with the passage of time. MATERIAL AND METHODS: Four types of resilient denture liners were used. Setting behavior of 5 autopolymerizing materials was evaluated with an oscillating rheometer. Stress relaxation tests were conducted to evaluate the viscoelastic properties of 9 materials and changes that occurred over time by means of Maxwell model analogies. RESULTS: Significant differences were found in the setting behavior of the autopolymerizing materials. The acrylic resin and fluoroethylene materials demonstrated viscoelastic properties and the silicone and polyolephin materials were found to be elastic. The acrylic resin materials exhibited the greatest changes in viscoelastic properties over time when compared with silicone, polyolephin, and fluoroethylene materials. CONCLUSIONS: The results suggest that it is important to select denture liner materials according to clinical situations because of the wide ranges of setting behavior, viscoelastic properties, and durability over time.
STATEMENT OF PROBLEM: After 0 years of intermittent reports in the literature, the use of fiber reinforcement is just now experiencing rapid expansion in dentistry. PURPOSE: This article describes the development and use of a continuous, unidirectional fiber reinforced composite as a framework for the fabrication of fixed prostheses. METHODS: By using various matrix materials and fibers, a number of fiber-reinforced composite formulations were evaluated with the goal of creating a system with optimized mechanical properties and handling characteristics. Fiber-reinforced composite based on a light polymerized BIS-GMA matrix has been used clinically to make 2-phase prostheses comprised of an internal glass fiber-reinforced composite substructure covered by a particulate composite. The clinical and laboratory procedures required for the fabrication and use of reinforced composite fixed prostheses are described for laboratory-fabricated complete or partial coverage fixed prosthesis and chairside prosthesis. RESULTS: Although additional clinical experience is needed, fiber-reinforced composite materials can be used to make metal-free prostheses with excellent esthetic qualities.
STATEMENT OF PROBLEM: Titanium and its alloys are more commonly used in prosthodontics and welding has become the most common modality for their joining. Studies on the welding of titanium and its alloys have not quantified this value, though its importance has been suggested. PURPOSE: This study compared the strength and properties of the joint achieved at various butt joint gaps by the arc-welding of cast Ti-6Al-4V alloy tensile bars in an argon atmosphere. MATERIAL AND METHODS: Forty of 50 specimens were sectioned and welded at four gaps. All specimens underwent tensile testing to determine ultimate tensile strength and percentage elongation, then oxygen analysis and scanning electron microscopy. RESULTS: As no more than 3 samples in any group of 10 actually fractured in the weld itself, a secondary analysis that involved fracture location was initiated. There were no differences in ultimate tensile strength or percentage elongation between specimens with weld gaps of 0.25, 0.50, 0.75, and 1.00 mm and the as-cast specimens. There were no differences in ultimate tensile strength between specimens fracturing in the weld and those fracturing in the gauge in welded specimens; however, as-cast specimens demonstrated a higher ultimate tensile strength than welded specimens that fractured in the weld. Specimens that fractured in the weld site demonstrated less ductility than those that fractured in the gauge in both welded and as-cast specimens, as confirmed by scanning electron microscopy examination. The weld wire showed an oxygen scavenging effect from the as-cast parent alloy. CONCLUSIONS: The effects of the joint gap were not significant, whereas the characteristics of the joint itself were, which displayed slightly lower strength and significantly lower ductility (and thus decreased toughness). The arc-welding of cast titanium alloy in argon atmosphere appears to be a reliable and efficient prosthodontic laboratory modality producing predictable results, although titanium casting and joining procedures must be closely controlled to minimize heat effects and oxygen contamination.
STATEMENT OF PROBLEM: Major connectors of removable partial dentures must distribute forces bilaterally without damaging the supporting tissues. PURPOSE: This study investigated which design and cross-sectional shape of major connectors most favorably influence rigidity and flexibility. METHODS AND MATERIAL: Five designs for maxillary removable partial denture major connectors and 5 lingual bar major connectors of different cross-sectional forms were cast in chrome cobalt alloy on a master cast. Points M and P, which represented the position of the first premolar and second molar teeth, were positioned 20 mm apart on the casting. Vertical and horizontal forces were applied to each point while the opposite side was gripped in an Instron testing machine. A force-deflection curve was obtained for each loading point. Mean stiffness values were obtained for loading in compression and torsion. RESULTS: Values for torsional loading simulating vertical forces were lower when compared with values obtained for compression loading that simulated horizontal occlusal forces. Differences in stiffness were greater in mandibular major connectors loaded at M and P. The half pear-shaped cross section was the stiffest. CONCLUSIONS: In the maxillary arch, the most rigid major connector was the anteroposterior palatal bar combination placed on different horizontal and vertical planes. The most flexible was the U-shaped design. In the mandibular arch, the most important factor in achieving rigidity was the cross-sectional shape of the major connector. The half pear-shaped cross section proved to be the most rigid.
STATEMENT OF PROBLEM: Dental luting cements fail by microcrack formation and bacterial ingress or by gross failure and crown dislodgment. Both of these failure modes are related to mechanical properties and deformation. PURPOSE: This study evaluated those mechanical properties of cements. METHODS AND MATERIAL. Elastic modulus for 8 representative cements (zinc phosphate, polycarboxylate, glass ionomer, encapsulated glass ionomer, resin-modified glass ionomer, resin composite, and adhesive resin composite) was measured by using a nondestructive technique and evaluated for cement type and storage time (1 hour, 1 day, 1 week, 1 month, 1 year) by 2-way ANOVA (P <.05). Compressive properties (proportional limit, resilience, and toughness), ultimate strengths (compressive, diametral tensile, and flexural), and flexural toughness were determined and evaluated by 2-way ANOVA for 2 crosshead testing rates (5 and 0.5 mm/min) and cement type (P <.05). RESULTS: Cements varied with respect to elastic moduli, compressive proportional limit, compressive resilience, compressive strength, compressive toughness, diametral tensile strength, flexural strength, and flexural toughness. Storage time affected the elastic moduli of different materials in different ways. Elastic moduli of polycarboxylate and glass ionomer cements increased over time, whereas the other materials changed little after the first day. Crosshead rate only significantly affected compressive proportional limit and resilience. CONCLUSIONS: Luting cements differed considerably with respect to mechanical properties.
STATEMENT OF PROBLEM: Fiber-reinforced plastics for dental applications have been under development for some time. A major difficulty in using reinforcing fibers with multiphase acrylic resins, such as powderliquid resins, has been improper impregnation of fibers with the resin. PURPOSE: The aim of this study was to describe and test a novel system to use polymer-preimpregnated reinforcing fibers with commonly used multiphase acrylic resins. MATERIAL AND METHODS: Continuous unidirectional and woven preimpregnated glass fiber reinforcements (Stick and Stick Net) were used to reinforce heat-curing denture base and autopolymerizing denture base polymers. A temporary fixed partial denture polymer was also reinforced with Stick reinforcement material. Five test specimens were fabricated for unreinforced control groups and for Stick- and Stick Net-reinforced groups. A 3-point loading test was used to measure transverse strength and flexural modulus of the materials and ultimate strain at fracture was calculated. Cross-sections of test specimens were examined with a SEM to evaluate degree of impregnation of fibers with polymer matrix. Quantity of fibers in test specimens was determined by combustion analysis. RESULTS: Transverse strength of heat-curing denture base polymer was 76 MPa, Stick reinforcement increased it to 341 MPa, and flexural modulus increased from 2550 to 19086 MPa. Stick Net reinforcement increased transverse strength of heat-curing denture base polymer to 99 MPa and flexural modulus to 3530 MPa. Transverse strength of autopolymerizing denture base polymer was 71 MPa; Stick increased it to 466 MPa; and flexural modulus increased from 2418 to 16749 MPa. Stick Net increased the transverse strength of autopolymerizing denture base polymer to 96 MPa and flexural modulus to 3573 MPa. Transverse strength of temporary fixed partial denture polymer increased from 58 to 241 MPa and flexural modulus from 1711 to 7227 MPa. ANOVA showed that reinforcement type and polymer brand affected transverse strength and modulus (P <.001). Stick Net reinforcement increased the strain at fracture, whereas Stick reinforcement decreased the strain values. SEM examination revealed well-impregnated glass fibers with polymer matrix. Quantity of glass fibers varied from 6 to 28 vol-%, the lowest being with Stick Net reinforcement and the highest with Stick reinforcement. CONCLUSIONS: Novel glass fiber reinforcements may considerably enhance flexural properties of multiphase dental polymers, which is due to proper impregnation of fibers with polymer matrix. By using Stick or Stick Net reinforcement, the strain at fracture of the material can be modified.
Direct intraoral fabrication of multiple post-coping restorations for an overdenture in the same arch can be a time-consuming chairside clinical procedure. In addition, accurate intraoral fabrication of resin patterns with intracrevicular margins is not always possible as a result of limited access. This article presents a direct-indirect method that uses an elastic cast for fabrication of multiple post-coping restorations with intracrevicular margins. Custom post patterns are fabricated directly in the root canal with autopolymerizing resin (Duralay). An impression is made of the remaining tooth structure, which also includes the post patterns, and a flexible cast is poured chairside. The cast is available within 6 to 8 minutes of impression making and can be trimmed similar to a stone die. The procedure also provides flexibility that allows separation of the cast from the impression without fracture of the custom post pattern or cast. The fabrication of the post-coping restoration can be completed in the laboratory, or if necessary, completed chairside and verified intraorally, before dismissing the patient.
OBJECTIVES: Outlet strut fracture remains a concern for 30,000 patients living with a Björk-Shiley convexo-concave heart valve (Shiley, Inc, Irvine, Calif, a subsidiary of Pfizer, Inc). Previous studies (Netherlands and United Kingdom) investigating valve manufacturing aspects identified multiple performance of the hook deflection test as a risk factor for 60 degrees valves. The present study validated this finding using new data with a greater number of valves implanted worldwide. Risks of outlet strut fracture associated with other manufacturing aspects were also investigated. METHODS: A matched case-control study design was used including 416 outlet strut fracture cases and 803 controls. RESULTS: Analyses similar to that of the Dutch and United Kingdom studies produced odds ratios of 3.4 (95% confidence interval [CI]: 1.1-10.3) and 2.8 (95% CI: 1.1-7.3), respectively, for multiple hook deflection tests. Load deflection test, which replaced the hook deflection test, showed a statistically significant association with outlet strut fracture: odds ratio of 5.0 (95% CI: 2.1-11.8) and 6.2 (95% CI: 2.2-18.0) for single and multiple load deflection tests, respectively. An analysis where hook deflection tests were separated from load deflection tests showed significantly elevated odds ratios with performance of any type of flexibility test, and the highest odds ratio was observed with a combined performance of load and hook deflection tests. CONCLUSIONS: Multiple hook deflection tests can now be considered for inclusion in the risk model used for guidelines on explant surgery to improve prediction of outlet strut fracture and provide patient reassurance. Load deflection tests and combined performance of hook and load deflection tests were found to be significant risk factors. No outlet strut fractures were reported for valves manufactured after March 1984 when the load deflection test was still in place. Examining manufacturing documents for these valves may identify new risk factors that could be responsible for the outlet strut fractures risk that remains unexplained to date.
Our goal was to identify the most appropriate material for right ventricle-pulmonary artery conduits in growing animals. We used 100 lambs that were 3 to 4 weeks old (mean weight 11.7 kg). Follow-up was up to 24 months. Group I received plain tubular conduits: (1) Dacron knitted fabric, (2) collagen-coated knitted fabric, (3) Milliknit and Microknit material, (4) woven Dacron fabric, (5) three-dimensional Dacron fabric (crossweave 500 and 800), or (6) polytetrafluoroethylene. Group II received either a (1) woven Dacron fabric conduit with a built-in tissue valve or (2) polytetrafluoroethylene graft with a built-in St. Jude Medical valve. We did angiograms and catheterizations every 3 to 6 months and killed the lambs at 6, 12, 18, or 24 months. Tubular Dacron fabric woven or knitted grafts, regardless of matrix, pore size, thickness, or coating, caused formation of a thick acellular pseudointima buildup, which led to progressive obstruction starting as early as 3 months. Polytetrafluoroethylene grafts in groups I and II showed the formation of thin inner and outer capsules (0.5 mm) and none developed obstruction despite wall calcification. Conduits of woven Dacron fabric with a built-in tissue valve degenerated rapidly, leading to calcification thrombosis and obstruction within 3 months; no lamb survived 12 months. Polytetrafluoroethylene conduits with a St. Jude Medical valve in lambs receiving anticoagulants remained free of obstruction and continued to function well. It appears that synthetic conduits of polytetrafluoroethylene perform well in either of the situations here tested and may be the best choice at present.
PURPOSE: We test the hypothesis that holmium:YAG lithotripsy efficiency varies with optical fiber size and energy settings (energy density). MATERIALS AND METHODS: The 272, 365, 550 and 940 microm. optical fibers delivered 1 kJ. total holmium:YAG energy to calcium oxalate monohydrate calculi at energy output/pulse of 0.2 to 1.5 J. Stone mass loss was measured for each fiber energy setting. Stone crater width was characterized for single energy pulses. Fiber energy outputs were compared before and after lithotripsy. RESULTS: Stone mass loss correlated inversely with optical fiber diameter (p <0.05). Stone loss correlated with energy/pulse for the 365, 550 and 940 microm. fibers (p <0.001). The 272 and 365 microm. fibers yielded equivalent stone loss at 0.2 and 0.5 J. per pulse. At energies of 1.0 J. per pulse or greater the 272 microm. optical fiber was prone to damage, and yielded reduced energy output and stone loss compared to the 365 microm. fiber (p <0.01). Stone crater width for single pulse energies correlated with energy settings for all fibers (p <0.001). CONCLUSIONS: Lithotripsy efficiency with the holmium:YAG laser depends on pulse energy output and diameter of the optical delivery fiber, implying that lithotripsy efficiency correlates with energy density. The 365 microm. fiber is indicated for most lithotripsy applications. The 272 microm. fiber is susceptible to damage and inefficient energy transmission at energies of 1.0 J. per pulse or greater. The 272 microm. fiber is indicated at energies of less than 1.0 J. per pulse for small caliber ureteroscopes or when maximal flexible ureteroscope deflection is required.
STATEMENT OF PROBLEM: Fiber-reinforcement has been used to overcome the mechanical limitations of denture base polymers. One major difficulty in the use of fiber reinforcement has been the addition of fibers during conventional processing methods. PURPOSE: This study evaluated the effect of various lengths and concentrations of chopped E-glass fiber-reinforcement on the transverse strength, modulus of elasticity, and impact strength of injection and compression-molded polymethyl methacrylate based denture base polymer. MATERIALS AND METHODS: Test specimens (n=10) of 4-, 6-, and 8-mm fiber length and 1%, 3%, and 5% weight fiber concentrations were prepared with either an injection or a compression-molded processing method. Denture base polymer specimens without any fiber reinforcement were used as control for both processing methods. Transverse strength test specimens (65 x 10 x 2.5 mm) were stored in water bath at 37 degrees C for 2 weeks. The transverse strength (MPa) and modulus of elasticity (GPa) was measured with the 3-point bending test. Impact strength (kJ/m(2)) test specimens (60 x 7.5 x 4 mm) were tested with the Charpy-type pendulum impact test setup. The data were analyzed with multifactorial analysis of variance and Tukey post hoc tests (alpha=.05). RESULTS: Injection-molded fiber-reinforced groups showed significantly higher transversal strength, elastic modulus, and impact strength compared with compression-molded groups (P <.001). In the injection-molded groups, fiber concentration increased all mechanical properties tested (P <.05), but fiber length only increased transverse strength and modulus of elasticity (P <.05). In the compression molded groups, fiber concentration affected modulus of elasticity and impact strength significantly (P <.05), but fiber length did not show any significant effect on the mechanical properties tested (P >.05). CONCLUSION: The transverse strength, elastic modulus and impact strength of injection-molded denture base polymer increased significantly with the use of chopped E-glass fibers, whereas the effect was not significant with the compression-molded polymer.
The purpose of this study was to determine the effects of 6 months of moderate aerobic exercise on age-dysregulated measures of T lymphocyte and natural killer (NK) cell number and function. Previously sedentary elderly (age = 65 +/- 0.8 years) subjects were randomly assigned to supervised 3 time/week exercise intervention group (EXC, n = 14) or flexibility/toning control group (FT-CON, n = 15). Fasting resting blood samples were drawn prior to and after the 6 month intervention. The EXC group exhibited a significant (P < 0.05) 20% increase in VO2 max, whereas the FT-CON group had a smaller non-significant (P = 0.07) increase (9%). Immune results revealed that, in general, changes in immune function in response to 6 months of exercise training at an average intensity of 52% heart rate reserve (HRR) were similar when compared to FT-CON who exercised at approximately 21% HRR. There were no intervention-induced changes in total white blood cell, neutrophil, lymphocyte, monocyte, eosinophil, or basophil blood counts. Furthermore, the percentage and number of CD3+, CD4+ and CD8+ T cells in the blood remained unchanged. There was a tendency for the percentage and number of CD4+ and CD8+ näive cells (CD45RA+) to increase and for CD4+ memory cells (CD45RO+) to decrease post-intervention, especially in FT-CON. Both groups exhibited a small intervention-induced increase in the T-cell proliferative response to mitogenic stimulation: the percentage change of which was higher in the EXC group at several doses of Con A. Unstimulated NK cell cytolysis versus K562 cells tended to increase (P < 0.1) in the EXC group with little change in FT-CON. We conclude that 6 months of supervised exercise training can lead to nominal increases in some measures of immune function, while not affecting others, in previously sedentary elderly.
OBJECTIVES: New designs have improved the ability of flexible ureteroscopes to assess the upper urinary tract. However, limitations of tip deflection may interfere with diagnosis and treatment of lower pole renal pathologic features and smaller working channels may impair irrigant flow. Our purpose was to compare the new flexible ureteroscopes with prior models to determine whether engineering advances have overcome these problems. METHODS: Two newly released flexible ureteroscopes, the ACMI DUR-8 Elite and the Storz 11278AU, were compared with four other ureteroscopes, the ACMI DUR-8, Storz 11274AAU, Olympus URF-P3, and Wolf 9F. Active tip deflection, irrigation flow rates, and intraluminal pressures with and without various endoscopic tools were assessed. The specifications, purchase prices, and repair costs were obtained from the individual manufacturers. Also, the field of view and screen image size of each scope were compared. RESULTS: The ACMI DUR-8 Elite and Storz 11278AU had improved tip deflection of 79 degrees and 144 degrees, respectively, from previous ureteroscopes. Although the tip deflections of all ureteroscopes were compromised by the insertion of endoscopic tools, new ureteroscopes were less affected. With a 3F basket within the working channel, the ACMI DUR-8 Elite and the Storz 11278AU had a loss of downward deflection of only 0.7% and 2.8% compared with a loss of 9.6% and 5.0% for their older models, respectively. However, the flow rate of these new instruments was decreased. CONCLUSIONS: The new flexible ureteroscopes have significantly better active tip deflection than previous models, both with and without endoscopic instrumentation inserted. However, improved flexibility comes at the expense of a decreased flow rate.
Routine urothelial biopsies of the lower urinary tract are obtained using the cold cup biopsy technique. This procedure is most often performed in the surgical suite and requires rigid endoscopic access and the use of biopsy forceps and Bugbee electrodes to obtain tissue for histologic examination. A new single-step biopsy forceps has been used through the flexible cystoscope. Using a 16 F actively deflectable, flexible cystoscope and the 5.4 F Therma Jaw Hot Urologic Forceps, bladder biopsies were obtained in 27 patients for a variety of indications. This biopsy forceps allows simultaneous tissue sampling and electrocoagulation of the biopsy site, thus eliminating the need for exchange of instruments through the flexible cystoscope. Tissue samples are somewhat protected from thermal changes during coagulation through the use of a Faraday cage. Biopsies were frequently obtained in an outpatient setting, requiring only local topical anesthesia (2% lidocaine jelly). Carcinoma in situ, transitional cell carcinoma, acute and chronic inflammation, and normal bladder mucosa were differentiated histologically. Using this technique, lower urinary tract urothelial mapping can be performed safely in the office with minimal patient discomfort.
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