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Porcelain-veneered computer-generated partial crowns.

OBJECTIVE: It would be advantageous to be able to use computer-aided design and manufacturing to fabricate a restoration that can be layered with a conventional porcelain veneer in the occlusal region, thus optimizing esthetics, function, and strength. This case study reports the laboratory technique and the clinical performance of 38 partial crowns fabricated with computer technology and veneered with porcelain. METHOD AND MATERIALS: Twenty-one mandibular and 17 maxillary molars in 27 patients were prepared for partial crowns. The occlusal surfaces were lowered (1.5 to 2.0 mm), deep shoulders (1.5 mm) were prepared around the functional cusps, and 1.0-mm-deep shoulders were prepared in the proximal gingival regions. The nonfunctional cusps were prepared with an occlusal shoulder at approximately a right angle with the axial surfaces of the seat. In the computer-aided design procedure, the occlusal table was reduced to 1.4 mm above the preparation surface. The marginal ridge points, the marginal ridge line, the equator line, and the fissure line heights were adjusted accordingly. RESULTS: The lowest occlusal table thickness was 1.1 mm in six partial crowns, 1.2 mm in 26 partial crowns, and 1.3 mm in six partial crowns. The lowest occlusal table thickness of the porcelain veneers varied between 0.4 and 0.6 mm. The total occlusal table thickness thus was 1.5 mm or more. Clinically, no fractures occurred during an observation period varying between 1 and 4 years after placement. CONCLUSION: Computer-aided design and manufacturing technology is also convenient for partial crown preparation design with shoulder finish lines.

Cementation↗

Use of a tooth-colored post for anterior restorations.

The restoration of endodontically treated teeth is still a challenge to the general dentist. Extensive caries or traumatic fracture may result in insufficient coronal tooth structure remaining to support a core. The introduction of fiber post systems in the 1990s has provided dentists with new options for the restoration of the pulpless tooth. This clinical article demonstrates the use of a fiber post and a composite buildup material.

Adult↗

Direct adhesive restoration of anterior teeth: Part 2. Clinical protocol.

Contemporary adhesive restorations allow clinicians to deliver minimally invasive, functional, and aesthetic treatment for compromised dentition in the anterior and posterior regions. Part 1 of this article discussed the state-of-the-art relating to composite restorations, both in situations deemed to be relatively uncomplicated and those that are more complicated. This second part discusses the clinical protocol for the placement of direct composite materials as well as the tooth preparation considerations that must be addressed when providing minimally invasive treatment options.

Clinical Protocols↗

Eighteen-month clinical performance of a self-etching primer in unprepared class V resin restorations.

This study evaluated the clinical performance of unprepared Class V resin composites, placed using a self-etching primer and a single-bottle adhesive, over a period of 18 months. Thirty-eight pairs of restorations of Renew hybrid resin composite (BISCO, Inc) were placed using adhesives from the same manufacturer in caries-free cervical erosion/abfraction lesions. Based on insensitivity to air, the dentin in 76% of these lesions was considered to be sclerotic. The restorations were placed without abrasion of tooth surfaces, except for cleaning with plain pumice. One of each pair was placed using Tyrian, a self-etching primer and the other was placed using One-Step, a single-bottle adhesive placed after acid etching. Both the etchant and self-etching primer were applied for 20 seconds. The restorations were clinically evaluated at baseline, 6, 12 and 18 months, using modified Ryge/USPHS criteria. For both adhesives, very low retention of 50% to 56% of the restorations was observed over 18 months, leading to the conclusion that tooth surfaces must receive some additional treatment prior to restoration with these adhesives. No statistically significant difference (p=0.75) between the two adhesives was observed in overall performance, and dentinal sclerosis and axial depth did not appear to be important factors in the study.

Acid Etching, Dental↗

[New biomaterials and cataract surgery].

In 1949, Harold Ridley implanted the first intraocular lens, after cataract surgery, he had chosen as the best available material Polymethyl Metacrylate noticing during the war in the injured eyes of the R.A.F. Pilots that the material was perfectly tolerated inside the eye as a foreign body. It took 10 years for intraocular lenses to take off, due to the necessary improvement of both surgery and manufacturing, since then all the intraocular lenses are made of the same material and perfectly tolerated. However the material is hard and not foldable. The improvement of Phakoemulsification have made small incision (3.2 mm) surgery possible, however there is a need for new foldable implants that can be inserted into the eye through a small incision, so rather new bio material are now being used. A variety of silicone foldable lenses have been proposed, their advantages are: easy foldability, solidity and injectability through an injector. Their disadvantages are, as compared to the 40 years standing solid PMMA lenses; less biocompatibility changes in color and apparition of crystal precipitates. Also reports on induced polyarthritis, lupus and paraneoplasic syndromes with other silicone prosthesis, these complications appear after 5 or 6 years. Although new silicone lenses are being brought on the market, there is some hesitation in implanting these lenses on patients less than 80 years of age. Polyhema lenses appeared in 1985, with 38% water content. The material is perfectly biocompatible even more than PMMA, however their initial design was not adequate until 1992. Their advantages are perfect biocompatibility over the years, autoclavability. Their only disadvantage a certain fragility during folding. Our 7 years experience with silicone and hydrogel has shown that 20% of the first silicone lenses had to be exchanged between 3 to 4 years after surgery and 0% of the polyhema. Posterior capsule opacification at 1 year was twice more frequent with silicone than with PMMA or hydrogels and that mild chronic uveitis occurs 3 times frequently with silicone lenses.

Biocompatible Materials↗

[Aortic and mitral valve aneurysms complicated with infective endocarditis: a case report].

A rare case of aortic and mitral valve aneurysms complicated with infective endocarditis was accurately diagnosed by transesophageal echocardiography. A 57-year-old man with severe aortic regurgitation due to infective endocarditis was admitted to our hospital. Transthoracic echocardiography showed an aortic valve aneurysm on the right coronary cusp and perforations on the other cusps. Transesophageal echocardiography demonstrated a small aneurysm on the anterior leaflet of the mitral valve which was not clearly visualized by transthoracic echocardiography. Color Doppler echocardiography revealed severe aortic regurgitation and mild mitral regurgitation without perforation of the mitral valve aneurysm. Aortic valve replacement and mitral valvuloplasty of the anterior mitral leaflet were performed. The right coronary cusp of the aortic valve showed marked thinning with infiltration of inflammatory cells. The postoperative clinical course was uneventful.

Aortic Valve↗

Morphologic characterization of polyvinyl sponge (Ivalon) breast prosthesis.

BACKGROUND: Although almost all breast implants are made of silicon, some implants, especially the ones used in early augmentation mammoplasty, were made of other materials, one of which is polyvinyl alcohol (commercially known as the Ivalon sponge). The morphology of this type of breast implant and its associated tissue reactions have not been characterized in detail. MATERIALS AND METHODS: A pair of polyvinyl breast prostheses implanted 40 years ago in a 66-year-old woman were removed together with their capsules to correct progressive disfiguration. The implants and capsules were radiographed. Sections from these specimens were subjected to routine histologic studies and special stains, including periodic acid-Schiff and Masson's trichrome stains. RESULTS: The breast implants were composed of crystals with a pathognomonic morphology. By hematoxylin-eosin stain, these crystals were polygonal, colorless, and refractile, but nonbirefringent, and they had a characteristic bubbling internal structure. The crystals displayed a deep-blue color with Masson's trichrome stain and were strongly periodic acid-Schiff-positive, with or without diastase digestion. These crystals appeared isolated or interconnecting and were separated from one another by spaces filled with tissue fluid. The capsules were composed of the same kind of crystals, but they were heavily calcified and associated with dense fibrosis and occasional multinucleated giant cells. CONCLUSIONS: This case serves to emphasize that breast prostheses made of materials other than silicon may be rarely encountered in the surgical pathology laboratory. Although polyvinyl breast implants were abandoned, injection of polyvinyl into various tissues for therapeutic purposes is sometimes indicated. The morphologic features of polyvinyl as detailed in this study should enable prompt and accurate recognition of this material, whether it is in breast implants or other types of tissue.

Aged↗

Postoperative lower extremity bypass surveillance: beyond ankle arm blood pressures.

Surveillance is essential to the postoperative follow-up of lower extremity bypass grafts. Early, intermediate, and late thrombosis place the patient's limb at risk, so detection of problems before the graft fails is critical. Because contrast angiography is not routinely performed for surveillance, most vascular surgeons rely on history, physical examination, and noninvasive vascular studies (NVS) to assess perfusion to the lower extremity after bypass grafting. These NVS include ankle/brachial waveforms, blood pressures, and indexes before and after exercise. The purpose of this study is to report our findings with duplex color-flow ultrasonography (DCU) to examine lower extremity bypass grafts. According to our protocol, we monitor lower extremity grafts with ankle/brachial Doppler pressures, analogue waveforms, and lower extremity exercise when possible. These NVS are performed by nurses in the vascular laboratory before the patient is discharged from the hospital, at least twice during the first year, and then annually. DCU is also performed at least two times during the first year and then annually. If the study results are abnormal or if the patient has symptoms, testing is usually repeated. When abnormalities persist contrast angiography may be warranted. We have detected anatomic and hemodynamic changes in lower extremity bypasses by use of our protocol. By adding DCU to ankle/brachial blood pressures, we have identified aneurysmal dilation, diffuse atherosclerosis, focal narrowing, arteriovenous fistulas caused by unligated venous branches, retained venous valves, and disease progression proximal or distal to the graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗

1997 Judson C. Hickey Scientific Writing Awards. Lip prosthesis retained with resin-bonded retentive elements as an option for the restoration of labial defects: a clinical report.

Surgical resection of the lips is a relatively uncommon procedure, and it usually presents surgical and prosthodontic rehabilitation challenges. The goals of prosthetic treatment include regaining favorable speech and restoration of esthetics. This clinical report described a method for fabricating a lip prosthesis that uses resin-bonded retentive elements bonded to the patient's teeth for retention. Clinical and laboratory procedures of the prosthetic treatment were described, and the advantages and disadvantages were reviewed.

Acrylic Resins↗

Correlation of ultrastructural alterations in cavernous tissue with the clinical diagnosis vasculogenic impotence.

Cavernous tissues of 27 impotent and 4 potent men were evaluated in order to determine the ultrastructural changes in patients with vasculogenic impotence. Tissue samples were obtained during penile prosthesis insertions and surgical repairs of penile fractures in impotent and potent patients, respectively. For the clinical evaluation (pharmacologic color Doppler ultrasound, dynamic pharmacocavernosometry and nocturnal penile tumescence monitoring) patients were divided into three groups: slight/moderate arterial dysfunction (n = 5), severe arterial dysfunction (n = 9) and purely cavernous erectile dysfunction (n = 9). No significant ultrastructural alteration was noticed in the group with moderate arterial dysfunction; decrease and deterioration of smooth muscle cells was the prominent finding in the severe arterial and venogenic dysfunction groups. Preliminary examination of cavernous tissue may be a part of routine evaluations in the approach to the management of erectile dysfunction.

Adult↗

Transcatheter closure of perimembranous ventricular septal defects with the Amplatzer asymmetric ventricular septal defect occluder: preliminary experience in children.

OBJECTIVE: To close perimembranous ventricular septal defects (PMVSDs) in children with the new Amplatzer asymmetric ventricular septal defect occluder (AAVSDO). PATIENTS AND DESIGN: 10 children, aged 1.5-12 years, with PMVSDs underwent transcatheter closure with the AAVSDO. The device consists of two low profile disks made of Nitinol wire mesh with a 1.5 mm connecting waist. The left disk is 5 mm towards the apex and only 0.5 mm towards the aortic valve. The right disk is 4 mm larger than the waist. The prosthesis diameter was chosen to be 1-2 mm larger than the largest diameter of the defect (determined by transoesophageal echocardiography and angled angiocardiography). A 7-8 French gauge sheath was used to deliver the AAVSDO. RESULTS: The PMVSD diameter ranged from 2-8 mm. The device diameter ranged from 4-8 mm. After deployment of the prosthesis there was no residual shunt in 9 of 10 patients (90%). In one patient there was a trivial residual shunt that disappeared at the three month follow up. Three patients developed transient complete left bundle branch block. No other complications were observed. CONCLUSIONS: The AAVSDO appears to be a promising device for transcatheter closure of PMVSDs in children. Further studies are required to document its efficacy, safety, and long term results in a larger patient population.

Balloon Occlusion↗

Isolated right atrial tamponade after open heart surgery: role of echocardiography in diagnosis and management.

Ten patients with isolated right atrial tamponade complicating open heart surgery were identified over a 3.5-year period at three institutions. Clinical manifestations varied but were typically those of decreased perfusion with elevated central venous pressure. Hemodynamically these patients had systemic hypotension and tachycardia with elevated central venous pressure but without elevation of pulmonary artery or pulmonary artery wedge pressures. The correct diagnosis in each case was established by echocardiography; 7 via the transthoracic and 3 via the transesophageal approach. The typical echocardiographic feature was an extrinsic extracardiac mass compressing the atrium. Doppler findings included high flow velocities through the right atria, and color flow demonstrated narrow color jets through compressed, slit-like right atria. Surgical exploration confirmed these findings in each case. We conclude that the combination of clinical awareness and appropriate hemodynamic evaluation can alert the physician to the possibility of isolated right atrial hematoma causing decreased perfusion and/or shock following open heart surgery. Echocardiography using either the transthoracic or transesophageal approach can establish the diagnosis and lead to timely surgical intervention.

Aged↗

Prospective study on Trilucent soybean oil-filled breast prosthesis.

BACKGROUND: The use of Trilucent breast implants dates back to 1995. These implants were produced in an attempt to overcome the perceived shortcomings of other implants filled with saline and silicone gel. The filler material, which was derived from soybean oil, was said to be biodegradable and biocompatible. When this prosthesis was subsequently found to be prone to rapid aging and rupture of the silicone shell, the company that manufactured this implant decided to withdraw it from the market and offered to remove or replace all Trilucent prostheses. METHODS: The authors present a clinical study of the Trilucent implant in which 36 patients received a total of 63 implants and 33 patients had 58 implants removed. The authors also examined the implant shell of the removed prostheses to investigate the possible cause of silicone implant aging and rupture. RESULTS: Each of the implants removed was carefully inspected visually, and samples of the implant shell were analyzed by scanning electron microscopy. All the implants removed had a very bizarre appearance; they were variegated in color, with shades of yellow and brown, and were studded with whitish yellow nodules whose number grew in proportion to the time the prosthesis was implanted. Scanning electron microscopic analysis of the implant shell revealed a heterogeneous inner surface of the implant together with fissures and globoid deposits on the cut surface. CONCLUSIONS: The authors' findings on Trilucent implants are similar to those reported in previously published studies for other types of breast implants for the first 2 years after implantation, after which a progressive, rapid deterioration was observed.

Adult↗

[Recent progress in adjunctive methods during surgery of aortic dissection].

Aortic dissection is severe disease, but recently surgery of aortic dissection is reported in good results. In order to improve results, three adjunctive methods have been progressed recently; intraoperative color Doppler retrograde cerebral perfusion and deep hypothermia. Intraoperative color Doppler reveals dynamic hemodynamics and structural information in aortic dissection in real time which leads to proper surgical treatment to obtain maximum effects with minimum invasiveness. To carry out thrombus obliteration in false lumen by informations of intraoperative color Doppler leads to a healing in aortic dissection. Retrograde cerebral perfusion during surgery of aortic dissection permitted simple procedure and good surgical results with reduced neurological complications. Deep hypothermia for protection of spinal cord and other organs also yielded good operative results and reduced rate of paraplegia.

Aortic Dissection↗

Retention of Candida albicans on acrylic resin and silicone of different surface topography.

STATEMENT OF PROBLEM: The adhesion of microorganisms to a denture surface is a prerequisite for colonization. PURPOSE: This study compared the retention of Candida albicans on smooth and rough acrylic resin and silicone surfaces after a washing procedure to determine the effect of surface roughness on prosthesis infection and hygiene. MATERIAL AND METHODS: Standardized cell suspensions of C. albicans were incubated with smooth and rough acrylic resin and silicone surfaces for 1 hour at 24 degrees C. After washing, cells that had been retained on the surface were stained with acridine orange and examined with incident beam fluorescent microscopy. RESULTS: There was no significant difference in cell numbers on either of the smooth surfaces. Significantly higher numbers of cells (p > 0.0005) were observed on roughened surfaces (silicone > acrylic resin) than on smooth surfaces. The fitting surface of the maxillary denture was not polished. CONCLUSIONS: Silicones used in prostheses were processed against dental stone. The resultant surface roughness may facilitate microbial retention and infection and should therefore be kept to a minimum.

Acridine Orange↗

Percutaneous aortic valve replacement: an experimental study. I. Studies on implantation.

OBJECTIVE: The purpose of this preliminary study was to devise a new surgical procedure for minimally invasive aortic valve implantation with a transluminal technique. METHODS: The new collapsible heart valve was prepared by mounting a porcine aortic valve, taken from a freshly slaughtered pig, into a self-expandable nitinol stent by means of a suture technique. The outer diameter of the valved stent ranged from 15 to 23 mm, and the length ranged from 21 to 28 mm. Before implantation in vivo, these valved stents were tested in an in vitro circulatory system. Only in vitro-tested valved stents with a pressure gradient of less than 7 mm Hg and regurgitation of I degrees or less were used for transluminal aortic valve implantation in vivo. Six of these valved stents were implanted in the descending aorta and 8 in the ascending aorta of anesthetized pigs. The catheter delivery system (22F) was extraperitoneally inserted through the left iliac artery or the infrarenal aorta. Measurements for transvalvular gradient, valvular opening and closure, blood-flow characteristics, regurgitation, and macroscopic analysis were performed at baseline and after the observation period (164 +/- 48 minutes). RESULTS: This preliminary study contained 14 animals. One animal died of ventricular fibrillation. Technical failure occurred in 2 pigs as a result of stent twisting. At the end of the observation period, the 11 successfully implanted valved stents demonstrated low transvalvular gradients (mean end-systolic Deltarho(max) of 5.4 +/- 3.3 mm Hg for the descending aorta group, 5.4 +/- 1.2 mm Hg for the supracoronary group, and 5.4 +/- 1.1 mm Hg for the subcoronary group), which did not differ from their in vitro gradients. Two-dimensional echocardiography demonstrated complete valvular closure and opening in 5 of 5 cases. Angiography indicated only a physiologic jet of regurgitation (0 degrees ) in 8 animals and mild (I degrees ) regurgitation in 3 animals. Color Doppler ultrasonography indicated no regurgitation in 5 of 5 cases and minor paravalvular leakage in 1 case. CONCLUSION: Aortic valved stents can be successfully implanted without thoracotomy by using a transluminal catheter technique. Long-term function of the valves remains to be established.

Animals↗

Shrinkage temperature versus protein extraction as a measure of stabilization of photooxidized tissue.

A rise in thermal denaturation temperature has been utilized as an indication of stabilization of collagen-containing materials such as pericardial tissue and porcine heart-valve leaflets following treatment with glutaraldehyde, Denacol, or other chemical agents. In contrast, stabilization of bovine pericardial tissue by dye-mediated photooxidation does not result in a significant rise in shrinkage temperature comparable with these treated materials. It was therefore hypothesized that a rise in shrinkage temperature is not a necessary indication for tissue stabilization. A sensitive protein extraction assay has been developed which can be used to monitor the stabilization of pericardial tissue by a variety of treatment methods, including photooxidation. A reduction in extractable protein, as analyzed by polyacrylamide gel electrophoresis, is noted for pericardial tissue treated with photooxidation, glutaraldehyde, or Denacol. Loss of extractable protein, as a function of treatment time, correlates well with a significant rise in shrinkage temperature for pericardium treated with glutaraldehyde or Denacol but not with photooxidation. This difference is attributed to the stabilization processes of glutaraldehyde and Denacol, which involve extensive crosslinking and polymer formation within and in addition to the native pericardial matrix, leading to a rise in matrix complexity and thermal stability. In contrast, photooxidation is a catalytic process involving modification and crosslink formation within existing matrix components, resulting in a material with little added matrix complexity.

Animals↗