Physical properties of Scarpa's fascia.

Preservation of Scarpa's fascia has improved clinical outcomes in abdominoplasty procedures and in other body contour surgeries. However, the physical properties of Scarpa's fascia have not yet been described, and grafts are still underexplored. Fresh surgical specimens from five female patients subjected to classical abdominoplasty were dissected and analyzed. A grid was drawn on the fascia surface, dividing it into equal upper and lower halves; four Scarpa's fascia samples (30 × 10 mm) were collected from each half, 40 mm apart. The thickness was measured with a caliper. A strain/stress universal testing machine was used for mechanical tests. Twenty-five samples were obtained (nine from the upper half, 16 from the lower). The average thickness was 0.56 ± 0.11 mm. The average values for stretch, stress, strain, and Young's Modulus were, respectively, 1.436, 4.198 MPa, 43.6%, and 23.14 MPa. The upper half showed significantly greater thickness and strain values (p = 0.020 and p = 0.048; Student's t-test). The physical and biomechanical properties of Scarpa's fascia can make it a donor area for fascial grafts as an alternative to fascia lata, as it is always available and has minimal donor-site morbidity. Further studies are needed to validate this statement. It seems advantageous to use the lower half of the abdomen instead of the upper part as a donor site.

Use of Infrared Thermography for Abdominoplasty Procedures in Patients with Extensive Subcostal Scars: A Preliminary Analysis.

Subcostal scars may increase the risk of healing complications in abdominoplasty. The authors evaluated the use of thermography as a potential tool for patient selection and surgery planning to avoid complications and improve abdominoplasty outcomes. Two candidates for abdominoplasty procedures who presented with extensive subcostal scars were submitted to an infrared thermography protocol at all phases of the procedure: preoperative, intraoperative, and postoperative at 1 and 6 months. The preoperative thermography for both patients revealed near-normal abdominal wall perfusion. The thermograms captured intraoperatively during flap elevation did not show perfusion deficits on the upper abdominal flap. At 1 month and 6 months postoperative, dynamic thermography for both patients showed normal to near-normal perfusion. The procedures had a complication-free course with a good aesthetic result. Plastic surgeons may be reluctant to perform a full abdominoplasty in patients with a previous subcostal incision. In this preliminary analysis, we raise the potential usefulness of thermography for patients with recent subcostal scars and/or important comorbidities as a strategy for adequate patient and technique selection, avoiding possible complications. Future studies, with an increased number of patients and adequate statistical analysis, may allow us to validate the utility of thermography in these cases and reassure that the presence of previous extensive subcostal scars may not be a contraindication for a full abdominoplasty, especially if they are not recent.

Oral rehabilitation of a saxophone player with orofacial pain: a case report.

This paper presents a clinical case study investigating the pattern of a saxophonist's embouchure as a possible origin of orofacial pain. The rehabilitation addressed the dental occlusion and a fracture in a metal ceramic bridge. To evaluate the undesirable loads on the upper teeth, two piezoresistive sensors were placed between the central incisors and the mouthpiece during the embouchure. A newly fixed metal ceramic prosthesis was placed from teeth 13 to 25, and two implants were placed in the premolar zone corresponding to teeth 14 and 15. After the oral rehabilitation, the embouchure force measurements showed that higher stability was promoted by the newly fixed metal-ceramic prosthesis. The musician executed a more symmetric loading of the central incisors (teeth 11 and 21). The functional demands of the saxophone player and consequent application of excessive pressure can significantly influence and modify the metal-ceramic position on the anterior zone teeth 21/22. The contribution of engineering (i.e., monitoring the applied forces on the musician's dental structures) was therefore crucial for the correct assessment and design of the treatment plan.

Effect of Splinting on Orthodontic Mini-Implant Tipping and Bone Histomorphometric Parameters: An In Vivo Animal Model Study.

This study aimed to address the stability of orthodontic mini-implants submitted to an immediate orthodontic functional load, in splinted or unsplinted conditions, further characterizing the histomorphometric parameters of the neighboring bone tissue, in an in vivo experimental model. Mini-implants (1.4 × 6.0 mm) were placed in the proximal tibia of New Zealand White rabbits and immediately loaded with a 150 g force. Tissue healing was characterized within 8 weeks. Microtomography was used to assess the mini-implants' tipping and bone histomorphometric indexes. Loaded implants were evaluated in splinted and unsplinted conditions, with data being compared to that of unloaded mini-implants with the Kruskal-Wallis nonparametric test, followed by Dunn's multiple comparison tests. The splinting of mini-implants submitted to immediate orthodontic loading significantly reduced the tipping to levels similar to those of unloaded mini-implants. Immediate loading further increased the histomorphometric indexes associated with bone formation at the peri-implant region, in both splinted and unsplinted conditions, with no significant differences between the tension and compression regions. Accordingly, within this experimental setting, splinting was found to lessen tipping and mini-implants' displacement, without affecting the increased bone formation at the peri-implant region, induced by a functional orthodontic load.

Classic Versus Scarpa-sparing abdominoplasty: An infrared thermographic comparative analysis.

BACKGROUND: Scarpa fascia preservation during abdominoplasty has been shown to have several clinical advantages. The mechanisms behind its efficiency have been the subject of several studies. Three theories have been proposed, relating to mechanical factors, lymphatic preservation, and improved vascularization. This study aimed to further investigate the possible vascular impact of Scarpa fascia preservation by using a thermographic analysis. METHODS: A single-center prospective study was conducted, involving 12 female patients randomly and equally assigned to one of two surgical procedures: classic (Group A) and Scarpa-sparing abdominoplasty (Group B). Dynamic thermography was applied before and after surgery (one and six months), and two regions of interest (ROIs) were considered. The latter had the same location on every sample, and corresponded to areas where different surgical planes had been used. Static thermography was applied intraoperatively, and four ROIs were considered, located over Scarpa and over the deep fascia. The respective thermal data were analyzed. RESULTS: The general characteristics of both groups were identical. Preoperative thermography demonstrated no differences between groups. Intraoperative higher thermal gradients between lateral and medial ROIs were observed in Group B (P = 0.037, right side). Dynamic thermography at one month demonstrated a trend for better thermal recovery and better thermal symmetry (P = 0.035, 1-min mark) in Group B. No other differences were found. CONCLUSION: Dynamic thermography presented a better response when Scarpa fascia was preserved: stronger, faster, and more symmetric. Based on these results, improved vascularization may have a role in explaining the clinical efficiency of a Scarpa-sparing abdominoplasty.

Comparison between different fracture toughness techniques in zirconia dental ceramics.

Vickers indentation (IF) and single-edge-V-notched beam (SEVNB), to measure the fracture toughness (KIC ) of zirconia-based dental ceramics and mathematical models were proposed to establish a correlation between both. Zirconia (ZrO2 ) stabilized with 3 mol. % of Y2 O3 (3Y-TZP) and 5 mol% of Y2 O3 (5Y-PSZ) were compacted (n = 42) and sintered for 2 h at different temperatures (1475°C, 1500°C, 1550°C, or 1600°C). After sintering, they were characterized by relative density using the ASTM C373-88 standard, X-ray diffraction (XRD) and scanning electron microscopy (SEM). The average grain size was measured according to the ASTM E1382-97 standard. The fracture toughness (KIC ) was determined using two methods: Vickers indentation fracture toughness (KIC-IF ): method based on mathematical modeling that considers the parameters used for the Vickers hardness test and Fracture toughness by the single-edge-V-notch-beam (KIC-SEVNB ): method proposed by ISO 23146:08. The main phases of the 3Y-TZP and 5Y-PSZ ceramics were ZrO2 -tetragonal and ZrO2 -cubic, respectively. The 3Y-TZP specimens showed equiaxed grains with average grain sizes ranging from 0.55 to 0.79 µm. The grain sizes of 5Y-PSZ of specimens sintered at 1475°C and 1600°C were 0.62 and 2.32 µm, respectively. For all ceramics the crack size ratio was c/a < 2.5, suggesting a Palmqvist-type crack system. The fracture toughness measured by the Vickers indentation method (KIC-IF ) and by the SEVNB method (KIC-SEVNB ) was the same when the experimental data were fit to a mathematical model.

Effect of the surface finish on the mechanical properties and cellular adhesion in (Ce,Y)-TZP/Al2O3 ceramic composites for denture implants.

Ceramic composites based on (Ce, Y)-TZP/Al2O3 system have great potential for applications as dental implants due to their unusually great balance between good mechanical properties and resistance to hydrothermal degradation. Surface roughness plays an important role in controlling these properties, but few studies have investigated the relationship between cytocompatibility and surface roughness, at levels considered moderate and low, comparable to titanium implants. In this work, bending strength, hydrothermal degradation and biological evaluation of a ceramic composite based on (Ce,Y)-TZP/Al2O3 system were investigated as a function of surface roughness. Compacted samples were sintered at 1500 °C - 2h and then submitted to different surface treatments: Group 1 composed of samples with smooth surfaces, Group 2 and Group 3 composed of rough surfaces (grinded with 15 µm or 45 µm diamond sandpaper, respectively. Samples were characterized by X-ray diffraction, scanning electron microscopy, contact angle and optical profilometry and then subjected to hydrothermal degradation tests in autoclave (134 °C - 2 bar) using artificial saliva. The Piston-on-three-balls (P-3B) testing was used to determine flexural strength. To assess indirect cytotoxicity, samples were immersed in the culture medium for NIH-3T3 cells for 72 h. Furthermore, cell adhesion and proliferation were investigated using MG63 cells (human osteosarcoma) after 3, 7, 14, and 21 days of culture. Cytotoxicity, adhesion, and cell proliferation were examined by the Methyl Tetrazolium salt (MTS) and Alizarin Red, using a confocal laser microscope. The results indicated that the materials have high resistance to degradation. Furthermore, the (Ce,Y)-TZP/Al2O3 composites are not cytotoxic. The flexural strength of the composites was 913 ± 103 MPa in samples presenting original (smooth) surface, however, a reduction in the order of 17% was observed in samples containing rough surfaces. The rougher samples show the best cellular adhesion and proliferation, leading to the formation of a mineralized matrix after 21 days. These results clearly suggest that the new (Ce,Y)-TZP/Al2O3 brand is strong and highly biocompatible and warrants further study.

The Challenge of Dental Education After COVID-19 Pandemic - Present and Future Innovation Study Design.

The present work suggests research and innovation on the topic of dental education after the COVID-19 pandemic, is highly justified and could lead to a step change in dental practice. The challenge for the future in dentistry education should be revised with the COVID-19 and the possibility for future pandemics, since in most countries dental students stopped attending the dental faculties as there was a general lockdown of the population. The dental teaching has an important curriculum in the clinic where patients attend general dentistry practice. However, with SARS-CoV-2 virus, people may be reluctant having a dental treatment were airborne transmission can occur in some dental procedures. In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are extremely important. Therefore, dental education has to adapt the curriculum to embrace new technology devices, instrumentations systems, haptic systems, simulation based training, 3D printer machines, to permit validation and calibration of the technical skills of dental students.

Use of Acid for Oxide Layer Removal of Overcast UCLA Abutments: Influence on Fit and Roughness.

PURPOSE: The objective of this study was to evaluate the influence of the oxide layer removal procedure using acid on the roughness and internal fit of overcast universal castable long abutments (UCLAs) for a taper connection. MATERIALS AND METHODS: For this, maxillary first premolars were waxed on the plastic sleeve of 15 UCLAs with a premachined interface. The specimens were overcast using the NiCr alloy, and the frameworks were randomly distributed to undergo one of two different oxide layer removal methods: blasting with 100-µm particles of aluminum oxide at 0.60-MPa pressure or bathing for 5 hours in 0.5% hydrofluoric acid. The surface roughness was evaluated by a light interferometer at the subcritical contour of each abutment. Next, the frameworks were attached to the respective analogs for internal fit evaluation. The central cross section of each assembly was exposed, and three regions were visualized by scanning electron microscopy (SEM): taper interface, axial wall, and index region. The premachined base was used as the control. The groups were compared using analysis of variance (ANOVA) and Tukey post hoc test (α = .05). RESULTS: The results showed that acid bathing produced intermediary roughness between premachined and blasted surfaces (P < .05). SEM images showed a sealed interface at the taper region of all groups, despite some irregularities after alumina blasting. Increased discrepancies at the axial wall and index region were found after the alumina blasting procedure (P < .05). CONCLUSION: It was concluded that acid bathing should be used, instead of blasting to remove the oxide layer, to produce a better fit and smoother surface on UCLAs.

Tooth Position in Wind Instrument Players: Dentofacial Cephalometric Analysis.

BACKGROUND: Specific dentofacial characteristics in wind instrumentalists should be taken in consideration when analyzing physiological and anatomical issues regarding the musician's embouchure, posture, and biomechanics during musical performance. OBJECTIVES: To compare tooth cephalometric characteristics between wind instrument players and string players (overjet, overbite, lower facial height, facial convexity, lower incisor inclination, and interincisal angle). METHODS: In total, 48 wind instrumentalists (67%) and 24 string instrumentalists (33%). These musicians performed lateral tele-radiography and the correspondent linear and angular measurements of the dentofacial cephalometric analysis. Statistical comparison of wind and string instrumentalists was made by using an independent t-test. RESULTS: Small variations on the analyzed parameters were found between the wind and string instrument groups. Based on the cephalometric analysis the variable interincisal angle was statistically significant (p < 0.05), when comparing the wind and string instrument group. CONCLUSIONS: Knowledge of the overjet and overbite value permits a substantial analysis on the tooth position of wind instrument players, where both of these parameters are increased and greater than the norm value. The cephalometry was an added value on the interpretation of possible factors that lead to the position of the central incisors of wind instruments. Till some extent in this group of musicians the applied forces during the embouchure mechanism on the anterior teeth and the existing perioral forces promote an equilibrium on the vector of forces. This study findings demonstrate that when evaluating the two samples, wind and string instruments there are different dentofacial configurations, however the only statistically significant differences that were found are related to the interincisal angle (p < 0.05).

Mechanical properties of ceramic composites based on ZrO2 co-stabilized by Y2O3-CeO2 reinforced with Al2O3 platelets for dental implants.

OBJECTIVES: The objective of this work was the development and characterization of a ceramic composite based on (Ce,Y)-TZP/Al2O3 aiming an application on dental implants, comparing it with conventional monolithic 3Y-TZP ceramics, currently used for the same type of application. METHODS: Ceramic samples, 3Y-TZP (n = 40) and (Ce,Y)-TZP/Al2O3 (n = 40), were sintered at 1500 °C - 2h and characterized by relative density, X-Ray diffraction (XRD) and microstructure. Then, the samples of both materials were divided into two groups: 1) samples with original (as sintered) surfaces; 2) samples with conditioned, polished, surfaces. All samples were submitted to hydrothermal degradation tests, on an autoclave (134 °C - 2 bar), for 10 h in artificial saliva. The degraded samples were characterized by XRD and the polished group were also characterized by their elastic moduli, Vickers hardness and fracture toughness (Vickers indentation method). Both groups were also submitted to a flexural strength test, 3B-P testing, for which the data were interpreted using Weibull statistics. RESULTS: All sintered specimens presented nearly full densification. After the hydrothermal degradation tests, 3Y-TZP samples presented 16.4% of monoclinic (m)-ZrO2 phase while the composite samples withheld 100% of tetragonal (t)-ZrO2 phase. Both materials presented equiaxial ZrO2 grains with an average size of 0.48 ± 0.17 µm and 0.75 ± 0.22 µm, respectively, for the monolithic and composite ceramics. In the composites, is observed the presence of well distributed Al2O3 grains on the ZrO2 matrix, in two distinct morphologies: equiaxial grains and platelets. The composites (Ce,Y)-TZP/Al2O3 presented average values of elastic moduli, Vickers hardness and fracture toughness of 228.3 ± 6.5 GPa, 1427 ± 46 HV e 11.3 ± 0.4 MPa m1/2, respectively. An inversely proportional relationship is observed between the roughness and the bending strength, since the 3Y-TZP samples presented a average strength of 860.7 ± 81 MPa (as-sintered) and 965.4 ± 93 MPa (polished) while the (Ce,Y)-TZP/Al2O3 composites presented average strength of 810.6 ± 147 MPa (as-sintered) and 952.6 ± 88 MPa (polished). CONCLUSIONS: The composites (Ce,Y)-TZP/Al2O3 showed high resistance to degradation in saliva and adequate properties for use as dental implants. Values of flexural strength (>950 MPa) and Weibull modulus (m > 10) were similar to the conventional 3Y-TZP ceramics. Moreover, its hardness, elastic modulus and fracture toughness were higher than those obtained for 3Y-TZP. The expressive values of KIC obtained for (Ce,Y)-TZP/Al2O3 composites are results of association of different toughening mechanisms acting simultaneously in the material.

Shaved Cartilage Gel Versus Diced Cartilage on Final Dorsal Camouflage: Prospective Study of 200 Patients.

Importance: Diced cartilage (DC) is a reported technique that has been used for dorsal camouflage after reduction rhinoplasty. Nevertheless, there are certain issues regarding its use on nasal dorsum, especially its variable resorption rate and risk of graft distortion or migration, especially in thin-skinned patients. Recently, regenerative medicine protocols have been used to overcome drawbacks of methods based on DC. Thus, cartilage embedded in platelet-rich fibrin (PRF) has been described as a promising and reliable alternative to existing procedures. Objective: To compare long-term aesthetic outcomes of two different techniques for dorsal camouflage: DC versus shaved cartilage plus platelet-rich fibrin (SC+PRF)-shaved cartilage gel. Design, Setting, and Participants: This is a prospective, interventional, and longitudinal study at an academic tertiary medical center. Participants were 200 consecutive patients undergoing primary reduction rhinoplasty by spare roof technique (SRT) or component dorsal reduction (CDR). Materials and Methods: The inclusion criteria were primary rhinoplasty, in Caucasian patients with dorsal hump, and camouflage of the dorsum by DC or SC+PRF. Exclusion criteria were ≤18 years of age, revision rhinoplasty and reconstructive rhinoplasty for neoplasic or severe traumatic nasal deformities. The "Utrecht Questionnaire for outcome assessment in aesthetic rhinoplasty" was used. Patients answered it before and after surgery (3 and 12 months after). Results: The study population included 200 patients divided into two groups considering the type of dorsal camouflage: DC (n = 132) and shaved cartilage gel (n = 68). The mean age at the time of surgery was 35.44 years (standard deviation ±9.78) and the study population included 130 females (65.0%) and 70 males (35.0%). Regarding aesthetic outcomes, analyses of postoperative means showed a significant improvement, in both groups, over time. However, self-assessment, based on the visual analogue scale (VAS), at 12 months postsurgery, was higher for patients with SC+PRF than with DC (p = 0.004). Twelve months after surgery, patients with thin skin had better aesthetic outcome with SC+PRF than with DC (p = 0.001). For both reduction rhinoplasty techniques, aesthetic outcomes, based on the VAS at 12 months after surgery, were significantly better for patients with SC+PRF (SRT: p = 0.016; CDR: p = 0.004). For both rhinoplasty approaches, either open or closed, aesthetic outcomes, based on the VAS at 12 months after surgery, were significantly better for patients with SC+PRF (closed approach: p = 0.046; open approach: p = 0.017). Conclusions: SC+PRF provides better long-term aesthetic outcomes, not only for thin-skinned patients, but also for patients who had undergone rhinoplasty by a structured or preservation technique, or by an open or closed approach, for dorsal hump reduction.

Spare Roof Technique Versus Component Dorsal Hump Reduction: A Randomized Prospective Study in 250 Primary Rhinoplasties, Aesthetic and Functional Outcomes.

BACKGROUND: Most Caucasian aesthetic rhinoplasty patients complain about having a noticeable hump in profile view. Taking the integrity of the middle vault into consideration, there are 2 ways to dehump a nose: the structured technique and the preservation technique. OBJECTIVES: The aim of this study was to compare the aesthetic and functional outcomes of 2 reduction rhinoplasty techniques. METHODS: We performed a prospective, randomized, interventional, and longitudinal study on 250 patients randomly divided into 2 groups: the component dorsal hump reduction group (CDRg) (n = 125) and the spare roof technique group (SRTg) (n = 125). We utilized the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty. Patients answered the questionnaire before the surgery, and at 3 and 12 months after surgery. In addition, we utilized a visual analog scale (VAS) to score nasal patency for each side. RESULTS: Analyses of the preoperative and postoperative aesthetic VAS scores showed a significant improvement in both groups, from 3.66 to 7.00 (at 3 months) to 7.35 (at 12 months) in the CDRg, and from 3.81 to 8.14 (at 3 months) to 8.45 (at 12 months) in the SRTg. Analyses of postoperative means of aesthetic VAS scores showed a significant improvement in both groups over time. However, aesthetic improvement was higher in the SRTg than in the CDRg at both 3 (P < 0.001) and 12 months (P < 0.001) postsurgery. Analyses of the mean functional VAS scores showed a significant improvement with both techniques, with a better result for the SRTg. CONCLUSIONS: The SRT is a reliable technique that can help deliver consistently better aesthetic and functional results than CDR for reduction rhinoplasty in Caucasian patients with a dorsal hump.

99mTc-antitumor necrosis factor-alpha scintigraphy for the detection of inflammatory activity in rheumatoid arthritis.

OBJECTIVE: Tumor necrosis factor-alpha (TNF-α) is an important inflammatory cytokine. 99mTc-anti-TNF-α antibody scintigraphy has proven to be a viable alternative to MRI in specific cases. The objective of this study was to evaluate the performance of scintigraphy with 99mTc-anti-TNF-α in the identification of inflammatory foci in individuals diagnosed with rheumatoid arthritis using MRI as the gold standard. METHODS: This cross-sectional, descriptive and analytical-qualitative clinical study compared the performance of 99mTc-anti-TNF-α scintigraphy with that of MRI with intravenous administration of gadolinium (used as the gold standard) and a clinical examination (Disease Activity Score 28) in 220 joints of 20 patients with a diagnosis of rheumatoid arthritis and one healthy control. RESULTS: The concordance of scintigraphy with MRI in individuals with a diagnosis of rheumatoid arthritis was 79%. The accuracy, sensitivity and specificity of scintigraphy for distinguishing between inflammatory and noninflammatory sites were 92, 89, and 93%, respectively. No adverse reactions to the examinations were reported. CONCLUSIONS: Scintigraphy with 99mTc-anti-TNF-α was well-tolerated and had a good ability to distinguish between inflammatory and noninflammatory lesions in patients with rheumatoid arthritis.

Orofacial Trauma on the Anterior Zone of a Trumpet's Player Maxilla: Concept of the Oral Rehabilitation-A Case Report.

BACKGROUND: The occurrence of an orofacial trauma can originate health, social, economic and professional problems. A 13-year boy suffered the avulsion of tooth 11 and 21, lost at the scenario. METHODS: Three intraoral appliances were manufactured: A Hawley appliance with a central expansion screw and two central incisors (1), trumpet edentulous anterior tooth appliance (2) and a customized splint (3) were designed as part of the rehabilitation procedure. Objectively assessing the sound quality of the trumpet player with these new devices in terms of its spectral, temporal, and spectro-temporal audio properties. A linear frequency response microphone was adopted for precision measurement of pitch, loudness, and timbre descriptors. RESULTS: Pitch deviations may result from the different intra-oral appliances due to the alteration of the mouth cavity, respectively, the area occupied and modification/interaction with the anatomy. This investigation supports the findings that the intra-oral appliance which occupies less volume is the best solution in terms of sound quality. CONCLUSIONS: Young wind instrumentalists should have dental impressions of their teeth made, so their dentist has the most reliable anatomy of the natural teeth in case of an orofacial trauma. Likewise, the registration of their sound quality should be done regularly to have standard parameters for comparison.

Effect of hydrothermal aging on the properties of zirconia with different levels of translucency.

OBJECTIVES: The aim of this study was to evaluate the effect of hydrothermal aging on the mechanical properties and translucency of dental zirconia with different levels of translucency. METHODS: Three different types of dental yttria-stabilized zirconia were used: 3Y-TZP (ZrO2 - 3 mol.% Y2O3) of medium opacity (designated Z3OP), 3Y-TZP of medium translucency (Z3MT), and 5Y-PSZ (ZrO2 - 5 mol.% Y2O3) of high translucency (Z5HT). A total of 120 specimens were sintered (n = 40 specimens/group). The control group (sintered→polished→heat-treated) and the aged group (sintered→polished→heat-treated→hydrothermally degraded at 134 °C, 2 bar, 5h) were characterized by relative density, quantitative phase analysis by X-ray diffraction using the Rietveld method, microstructural analysis by scanning electron microscopy, surface roughness and translucency. All groups were submitted to a biaxial flexural strength test. Data analysis using Kruskal-Wallis, Nemenyi (p-value = 0.05), and Weibull statistics were used. RESULTS: All sintered specimens presented full densification. After aging, an increase of the m-ZrO2 phase content was observed for the Z3OP group. On the other hand, Z3MT and Z5HT did not show any m-ZrO2 phase, indicating resistance to the hydrothermal degradation. Smaller grains were observed in the Z3MT group in relation to Z3OP group and the Z5HT group presented a bimodal grain distribution, where the largest grains were associated to cubic ZrO2. Z3OP exhibited a slight increase in roughness as a function of degradation, while the roughness remained statistically stable in the other groups. Translucency was little influenced by degradation, but considerably affected by increasing thickness. The Z5HT samples were the group with the highest translucency among the control groups. Z3OP exhibited the highest flexural strength, while being the most susceptible to hydrothermal degradation. The lowest values were presented by Z5HT in all groups, due to the high concentration of c-ZrO2 grains. CONCLUSION: Hydrothermal aging is less critical to the flexural strength of zirconia-based materials than the materials' composition and microstructure. Z5HT zirconia showed the highest translucency, however the measured difference is not visually perceptible. Z5HT was considered the most resistant to hydrothermal degradation.

Craniofacial morphology of wind and string instrument players: a cephalometric study.

BACKGROUND: Playing an instrument may promote a parafunctional behavior within the cranio-cervical-mandibular-complex with unknown repercussions. The aim of this study was to find any association between the dental inter-arch relationship and the practice of a wind or string instrument. METHODS: A sample of 77 musicians, divided in two groups of wind (n = 50) and string instrumentalists (n = 27), had a lateral cephalogram taken to compare six cephalometric parameters following the Rickett's analysis (maxilla position, mandible position, facial type, skeletal class, upper incisor and lower incisor inclination). The Fisher test was performed to compare, with a 95% statistical confidence, if both groups have similar frequency distributions for each cephalometric parameter. RESULTS: No statistical differences were found for the maxilla position, mandible position, facial type, skeletal class and upper incisor inclination. Statistical differences were found for the lower incisor inclination (p = 0.011). CONCLUSIONS: Playing a wind instrument showed to have little orthopaedic influence at the craniofacial morphology, on contrary it may influence the lower incisor inclination with its osseous base.

Adhesive dentistry sensory stimulus technique as a neuromechanism for the treatment of orofacial pain associated to temporomandibular disorders: Case study.

PURPOSE: The authors intend, by presenting a case study, emphasize the neuromodulation process of orofacial pain induced by the stimulation of the sensory and motor stimulation of the trigeminal nerve, which can play an important role on pain modulation. MATERIALS AND METHODS: A 25 year-old woman presenting orofacial pain was referred to the stomatology service at the Centro Hospitalar do Porto. After collecting the patient's anamnesis, the thermographic camera FLIR i7 was used to record the thermal status of the orofacial structures, before the adhesive dentistry sensory stimulus protocol, after 45 minutes, and after one week. RESULTS: This study suggests the relation of adhesive dentistry sensory stimulus technique in the neuromodulation of orofacial pain and its association with the temporomandibular disorders . As the tongue senses the stimulus of the resin composite placed on the palatal surface of the 1st premolar, 2nd premolar and 1st molar of the maxilla, this can promote and induce an effect regarding a peripheral nerve neuromodulation resulting in a blockage of the nociceptive trigeminal pathway from temporomandibular disorders. CONCLUSION: Orofacial pain is a common complaint among the patients that come to a dentistry appointment, which may have different diagnosis and treatments. A positive effect on the patient's symptomatology was confirmed clinically on subsequent dental appointments and monitored by infrared thermography.

Infrared thermography of the crânio-cervico-mandibular complex in wind and string instrumentalists.

PURPOSE: Musculoskeletal disorders can be common in wind and string instrumentalists. The musical gesture technique associated to musical performance can promote an asymmetrical isometric contraction with the hyperactivity of specific muscular groups and the overload of articular surfaces which can cause discomfort or pain. The aim of this investigation was to assess specific anatomical regions of interest within the cranio-cervico-mandibular complex in order to determine and evaluate the presence of muscular hyperactivity associated to musical performance. METHODS: An infrared imaging camera, FLIR®, was used to record the regions of interest in wind (n = 48) and string instrumentalists (n = 29). Bilateral temperature differences were considered as thermal asymmetries with a conventional threshold of 0.3 ºC to distinguish pathological from healthy states. The regions of interest (ROI) were the anterior triangle of the neck, the sternocleidomastoid and trapezius muscles regarding the postural and stabilizing muscles of the head and neck. On the orofacial region, the anatomical sites were the anterior temporal muscle, the masseter muscle and the temporomandibular joint. A Pearson chi-square test was performed to compare the assessed areas. RESULTS: Between 30-37% of all participants showed ROI in an asymmetric pattern. The most affected sites were the temporal muscle and the TMJ for both groups. The anterior triangle of the neck showed statistical differences (p = 0.044) between string and wind instrumentalists, while the temporal (p = 0.034) and trapezius muscle (p = 0.028) when comparing large and small mouthpieces of brass instruments. Although female participants showed a higher prevalence of asymmetrical patterns regarding the ROI, no statistical differences were found between genders. CONCLUSIONS: Infrared thermography exhibited significant differences between wind and string instruments within the CCMC. Regarding the issue of occupational health in performing arts, it is an advantage being able to quantify asymmetrical patterns sites of the CCMC to understand the underlying physiological responses to repetitive movements, overloading and muscular hyperactivity that occur during musical performance.

Spare Roof Technique: A New Technique for Hump Removal-The Step-by-Step Guide.

Humpectomy is one of the most common steps in reduction rhinoplasty among Caucasian patients. The most widespread procedures to address hump removal are both the "en bloc humpectomy" (with reconstruction of the middle third with spreader grafts) and the "split hump technique" (with confection of spreader flaps). The spare roof technique, for rhinoplasty reduction, has been developed over the past 4 years. In this technique, the upper lateral cartilages are completely preserved-even the hidden part under the caudal aspect of the nasal bones. It consists of five main steps: step 1, the upper lateral cartilages are released from the dorsal aspect of the nasal septum; step 2, a 1-mm strip of the dorsal septum is taken in each movement as required; step 3, ostectomy of the caudal aspect of nasal bones, keeping the upper lateral cartilages intact and releasing the "lateral" (left and right) pyriform aperture ligament; step 4, classic medial and lateral osteotomies (closing the open bony roof); and step 5, suturing the upper lateral cartilages to the dorsal septum and thus avoiding the natural spring effect. The outcomes of the first 100 patients have been validated by a prospective, interventional, and longitudinal study performed on patients undergoing primary rhinoplasty by means of the spare roof technique. This study confirms that the spare roof technique significantly improved patient quality of life regarding nose function and appearance. It is a reliable technique that can help deliver consistently good results in Caucasian and Mediterranean patients with a dorsal hump seeking rhinoplasty.