Retrospective clinical study of 842 clasp-retained removable partial dentures with a metal framework: survival, maintenance needs, and biologic findings.

OBJECTIVES: To evaluate clasp-retained removable partial dentures (C-RPDs) with a metal framework for survival, maintenance requirements, and biological implications. METHOD AND MATERIALS: C-RPDs were retrospectively analyzed based on patient records. Treatment failure was defined as fracture of a framework component (metal base or connector) or loss of an abutment tooth. Other outcome variables included factors that might conceivably impact C-RPD survival (maxilla vs. mandible, Kennedy classes, opposing dentitions, treatment by students vs. certified dentists), mobility and caries of abutment teeth (in relation to clasp designs), and maintenance requirements (relining, clasp or resin fractures). Differences were evaluated by appropriate statistical tests at the P ≤ .05 level. RESULTS: A total of 612 patients (339 men, 273 women) 60.0 ± 11.5 years old at delivery were included, covering 842 C-RPDs and a mean observation period of 42.1 ± 33.2 months. Kaplan-Meier C-RPD survival was 76.2% after 5 years and 49.5% after 10 years. Biological complications (i.e. loss of abutment teeth) accounted for the vast majority (95.6%) of C-RPDs failures, and Kaplan-Meier C-RPD survival was significantly better in the mandible (P = .015). Some clasp designs contributed significantly to caries and removal of abutment teeth (both P < .05). No other significant differences were noted. CONCLUSION: Tooth loss both emerges as the main cause of C-RPDs failure and might be amenable to careful selection of clasp designs. Overall, better C-RPD survival should be expected in the mandible. A non-contributory role of Kennedy classes and opposing dentitions is tentatively suggested based on numerically heterogeneous subgroups.

Impact of dental prosthetic treatment and patients' expectations on the seven domains and four-dimensional scale of the Oral Health Impact Profile.

BACKGROUND: Recently, recommendations were given for a new scoring of the Oral Health Impact Profile (OHIP). The original seven domain structure should be replaced by a four-dimensional scale. OBJECTIVES: To investigate the effect of dental prosthetic treatment on the seven domains and the four-dimensional scale of the OHIP-G49/53 questionnaire. METHODS: Seventy four patients were grouped according their pre- and post-treatment situation and the type of treatment they received. Patients completed the OHIP-G49/53 questionnaire before prosthetic treatment (T0), and at 1 week (T1), 3 months (T2) and 6 months (T3) after treatment. Treatment effects on the seven domains and the four dimensions of the OHIP scale were analysed, and the oral health-related quality of life (OHRQoL) was measured. Patients' expectations of their prosthetic treatment were also evaluated. Data were analysed using two-way Mixed ANOVA, regression analysis, and Cronbach's alpha test with a level of significance of α ≤ .017. RESULTS: OHRQoL significantly improved following prosthetic treatment compared with baseline. The largest improvement was found between T0 and T1 evaluations (all p ≤ .001). Unlike the seven-domain scale, the four OHIP dimensions demonstrated further significant improvements across the T1/T2/T3 evaluations (all p ≤ .017). Different pre-treatment findings had different treatment effects on the four OHIP dimensions and seven OHIP domains. Patients' expectations were mainly fulfilled. CONCLUSION: Compared with the seven-domain scale, the four dimensions showed significant follow-up changes, suggesting the four dimensions are suitable for evaluating treatment effects up to 6 months. Clinically meaningful effects of dental prosthetic treatment can be sensitively measured using the four-dimensional OHIP scale.

Modular training model for education of students in restorative and prosthodontic dentistry.

INTRODUCTION: At the moment, no commercial model solution is available for the individualisation of the dentition depending on the clinical case scenario. Furthermore, the realistic training of most restorative and prosthodontic procedures on a single dental study model is not possible. The aim of this study was the creation of a new training model to fill this gap. MATERIALS AND METHODS: Complete upper and lower jaw models were created based on existing scans and radiological data from a patient. All components for 100 complete models and 1128 teeth for the training were produced with a SLA-printer. Overall, 94 voluntary students attending the first and second preclinical course in prosthodontics tested the functionality of the model with three different tooth types against a standard dental study model and real teeth. After the training, the model was rated in a questionnaire. RESULTS: The production of the models and teeth was feasible. The overall rating of the different teeth was worse for type I (Ø 3.6 ± 1.1), significantly better for type II (Ø 2.5 ± 1.0) and type III (Ø 2.4 ± 1.0) than a standard typodont tooth (Ø 2.7 ± 1.1). The new model was rated significantly better overall (Ø 2.6 ± 1.0) than the standard training model (Ø 3.0 ± 1.1). CONCLUSIONS: The aim of this study was fulfilled. A superior training model was created with equivalent and better tooth types. The new teeth were outstanding in terms of cost-efficiency, appearance and feeling during preparation.

Impact of two different patient decision aids in prosthodontic consultations: a prospective randomized controlled study.

OBJECTIVES: Different approaches to prosthodontic consultation, all involving a strong focus on shared decision-making, were analyzed from the perspective of patients by inter-group comparisons. No patient decision aid (PDA) was used in the control group, a paper-based PDA in test group 1, and a software-based PDA in test group 2. MATERIALS AND METHODS: Seventy-five patients were prospectively randomized to the control group or a test group. All patients then rated the consultation on a questionnaire, six key items of which were analyzed, along with the time spent on each consultation. RESULTS: Overall satisfaction was highest in test group 2, with a significant difference from the control group (p = 0.015). Test group 2 showed the most favorable ratings for all six questionnaire items, which invariably was significant compared to the control group (p = 0.032). Test group 1 significantly differed from test group 2 based on two items (consultation was adequately intelligible: p = 0.011; consultation was adequately comprehensive: p = 0.034) but not from the control group based on any item (p = 0.070). CONCLUSIONS: Within the limitations of this study, the use of a software-based PDA, in particular, can be recommended based on patient satisfaction and was associated with the shortest sessions for consultation. CLINICAL RELEVANCE: Patients are routinely faced with a wealth of information in dental offices and may be overwhelmed especially by prosthetic treatment options and decision requirements. Our findings shed some light on the nature of aids that may truly be helpful in the process of shared decision-making. TRIAL REGISTRATION: ClinicalTrials.gov.Identifier: ISRCTN11472465.

Comprehensive Geriatric Assessment and Quality of Life Aspects in Patients with Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC).

To define frailty in older cancer patients, the aim of this study was to assess the geriatric status and quality of life (QoL) aspects in patients suffering from recurrent/metastatic head and neck squamous cell carcinoma (r/m HNSCC) under palliative treatment. A comprehensive geriatric assessment (CGA) was performed on 21 r/m HNSCC patients at two defined assessments, and the QoL aspects and the impact of descriptive data were evaluated. The Kolmogorov-Smirnov test, Spearman's rho correlation, and two-way mixed ANOVA were used for statistical analysis. All patients were found to be "frail". Pain, fatigue, and the burden of illness were the highest-rated symptoms. Oral function and orofacial appearance were highly impaired. A significant impact of descriptive data on the CGA and QoL results was found (all p ≤ 0.05). Thus, the CGA results revealed high frailty, severe comorbidities, and high impairments in QoL aspects. The CGA and QoL results were negatively affected by the primary HNSCC treatment approach, the need for prosthetic treatment, and worse oral functional capacity. Therefore, frailty in r/m HNSCC patients seems to be multidimensional. The evaluation of the CGA and QoL aspects in r/m HNSCC patients can be recommended to detect special needs, organize aftercare, and improve the support for frail and vulnerable cancer patients to create a multidisciplinary treatment approach.

Comparison of inferior gluteal artery perforator flaps versus vertical rectus abdominis musculocutaneous flaps in the reconstruction of perineal wounds.

BACKGROUND: Achieving a healed perineal wound following chemoradiotherapy and abdominoperineal resection (APR) is challenging for surgeons and patients. Prior studies have shown trunk-based flaps, including vertical rectus abdominis myocutaneous (VRAM) flaps, are superior to both primary closure and thigh-based flaps; however, there has been no direct comparison with gluteal fasciocutaneous flaps. This study evaluates postoperative complications after various methods of perineal flap closure of APR and pelvic exenteration defects. METHODS: Retrospective review of patients who underwent APR or pelvic exenteration from April 2008 through September 2020 was analyzed for postoperative complications. Flap closure techniques, including VRAM, unilateral (IGAP), and bilateral (BIGAP) inferior gluteal artery perforator fasciocutaneous flaps, were compared. RESULTS: Of 116 patients included, the majority underwent fasciocutaneous (BIGAP/IGAP) flap reconstruction (n = 69, 59.6%), followed by VRAM (n = 47, 40.5%). There were no significant differences between group patient demographics, comorbidities, body mass index, or cancer stage. There were no significant differences between BIGAP/IGAP and VRAM groups in minor complications (57% versus 49%, p = 0.426) or major complications (45% versus 36%, p = 0.351), including major/minor perineal wounds. CONCLUSIONS: Prior studies have shown flap closure is preferable to primary closure after APR and neoadjuvant radiation but lack consensus on which flap offers superior postoperative morbidity. This study comparing outcomes of perineal flap closure showed no significant difference in postoperative complications. Fasciocutaneous flaps are a viable choice for the reconstruction of these challenging defects.

A Cost and Metric Comparison of Disposable Negative-Pressure Wound Therapy Systems.

BACKGROUND: Disposable NPWT (dNPWT), a form of negative-pressure wound therapy, has been shown to be both outcome- and cost-effective for small to medium-sized wounds or closed incisions compared to traditional NPWT systems. When choosing a dNPWT system, multiple factors should be evaluated, including the wound size, wound type, estimated exudate production, and required days of therapy. If the device is not optimized for use in a particular patient, a much higher overall cost can be expected. METHODS: A web-based search, manufacturer website review and communication, and list price-based cost analysis was performed for currently available dNPWT systems. These systems differ with respect to cost, degree of negative pressure, canister size, number of dressings included, and recommended days of therapy. RESULTS: The results showed that 3M™ KCI devices (3M™ KCI, St. Paul, MN) cost about 6x more per day than non-KCI devices, and the V.A.C.® Via and Prevena™ Plus Customizable Incision Management System (both 3M KCI) cost over $180 per day of use. The no-canister Pico 14™ (Smith+Nephew, Watford, UK) is the most cost-effective dNPWT option, with an overall cost of $25.00 per day, but is limited to low exudate-producing wounds, such as closed incisions. At $25.67 per day, the UNO 15 (Genadyne Biotechnologies, Hicksville, NY) is the most cost-effective dNPWT option that still includes a replaceable canister system. CONCLUSION: We present a cost and metric comparison of currently available dNPWT systems. Despite significant differences in the cost of treatment with each dNPWT device, there has been limited research on their relative efficacies.

Oral-Health-Related Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw: A Prospective Clinical Study.

Medication-related osteonecrosis of the jaw (MRONJ) represents an adverse side effect of antiresorptive and antiangiogenic medications. It is associated with impaired quality of life, oral health, and oral function and can be classified into various stages. The purpose of this prospective clinical study is to evaluate the impact of stages I and II MRONJ on oral-health-related quality of life (OHRQoL) and related parameters. Patients' OHRQoL, satisfaction with life, oral discomfort, and oral health were assessed using the German version of the Oral Health Impact Profile (OHIP-G49), visual analog scales (VAS), and Satisfaction with Life Scale (SWLS) at baseline (T0), 10 days (T1), and 3 months after treatment (T2) in 36 patients. Data were analyzed using Kolmogorov-Smirnov test, two-way mixed ANOVAs, and follow-up Mann-Whitney U tests. The impact of treatment effects on the original seven OHIP domain structures and the recently introduced four-dimensional OHIP structure were evaluated using linear regression analysis. Thirty-six patients received surgical MRONJ treatment. Before treatment, patients' perceived OHRQoL, oral discomfort, oral health, and satisfaction with life were negatively affected by MRONJ. Surgical treatment significantly improved OHRQoL and related parameters (all p ≤ 0.012). This improvement was greater in patients with higher impairment at T0. OHRQoL and oral restrictions were still impaired after treatment in patients who needed prosthetic treatment. The four-dimensional structure revealed valuable information beyond the standard seven OHIP domains. Increased awareness of MRONJ risks and an interdisciplinary treatment approach for MRONJ patients are needed.

Impact of different layers within a blank on mechanical properties of multi-layered zirconia ceramics before and after thermal aging.

OBJECTIVES: To compare the mechanical properties of different layers of multi-layered zirconia materials. METHODS: 720 cylindric test plates were fabricated from four defined layers of three multi-layered zirconia ceramics (IPS e.max ZirCAD Prime, Optimill Multilayer 3D; Ceramill zolid fx multilayer) and divided into two equal groups. One group underwent thermal cycling (5-55 °C, 10 000 cycles; "TC") and one did not ("no TC"), before density, flexural strength, Weibull modulus, and Vickers hardness were evaluated. EDX analysis was conducted using an additional cylinder of each material. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests. Statistical analysis was performed with Bonferroni correction (α < 0.001). RESULTS: After aging, ZirCAD layer 4 showed the overall highest density (6.04 ± 0.02 g/cm3), which was significantly higher than density of layer 4 of Optimill (6.02 ± 0.06 g/cm3) and Ceramill (5.80 ± 1.08 g/cm3) (both p < 0.001). Flexural strength of ZirCAD and Optimill increased consecutively after thermal aging. ZirCAD layer 4 had the overall highest flexural strength before and after artificial aging. After thermal cycling, the Weibull modulus ranged between 4.32 (ZirCAD layer 1) and 13.58 (Ceramill layer 4). ZirCAD had the overall highest Vickers hardness: in layer 1 (1579.18 ± 47.14 HV) before aging, and in layer 2 (1607.1 ± 149.71 HV) after aging. Flexural strength and Vickers hardness differed significantly between the four ZirCAD layers (p < 0.001). Thermal ageing had no significant impact on mechanical properties (p > 0.001). SIGNIFICANCE: Mechanical properties were affected by plate position within the blank. When nesting a restoration within a multi-layered zirconia blank, the mechanical properties required should be considered.

Impact of Missing Teeth on Oral-Health-Related Quality of Life: A Prospective Bicenter Clinical Trial.

PURPOSE: To investigate the effect of missing teeth on patients' oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: A total of 151 patients participated in this prospective bicenter clinical study (mean age: 64.7 ± 10.5 years; 71 women). Four subgroups were defined based on the number of missing teeth. OHRQoL was assessed using the German version of the Oral Health Impact Profile-49/53 (OHIP-G49/53) and visual analog scale (VAS) questionnaires. The effect of missing teeth on OHIP (total and by dimension) and VAS scores before and after prosthetic treatment was investigated at baseline (T0), 1 week (T1), and 3 months (T2) after prosthetic treatment. Scores were analyzed using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests. Correlations were assessed using Spearman rho correlation. The level of significance was set at P = .05. RESULTS: Initial OHIP and VAS scores were highest for patients with 11 to 28 missing teeth. Scores improved among all groups between T0 and T1/T2. After prosthetic rehabilitation (T1), improvements in total OHIP scores were greatest for patients with no missing teeth or with 11 to 28 missing teeth. Patients with no missing teeth or with 1 to 4 missing teeth before treatment had the lowest posttreatment OHIP scores. Total OHIP scores among the groups were in the same value range (P > .185). No direct correlation was found between the VAS and total OHIP scores. CONCLUSION: OHIP and VAS scores for OHRQoL were associated with the number of missing teeth. Prosthetic treatment resulted in improved OHRQoL and oral function among all groups. The use of a VAS yielded additional detailed information.

Validation of the German-language version of the Liverpool Oral Rehabilitation Questionnaire version 3 and evaluation of oral-health-related quality of life among patients with squamous cell carcinoma of the head and neck.

The aim of this study was to translate the Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3) into German and validate this version in order to assess oral-health-related quality of life (OHRQoL) among head and neck cancer patients. This study was conducted at a German university clinic among patients who had completed therapy for squamous cell carcinoma of the head and neck (HNSCC). The original English-language LORQv3 was translated into German according to the forward-backward approach. Validity and reliability were evaluated using further questionnaires related to OHRQoL and psychological impairments. Subgroups were built with reference to oral rehabilitation status and type of cancer therapy. Furthermore, OHRQoL was evaluated. Test-retest reliability was assessed by weighted kappa with a 10-14 day interval. Data were analysed by using Spearman's correlation and the following tests: Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney U and Cronbach's alpha. The level of significance was set at α = 0.05. Analysis of the LORQv3 evaluations revealed excellent Cronbach's alpha and high test-retest reliability. Construct validity were supported by the data. LORQv3 summary score and domains were significantly affected by status of oral rehabilitation (p = 0.003, p = 0.008, p = 0.024) and treatment approach (p < 0.001, p = 0.025, p = 0.035). The German version of the LORQv3 showed high reliability and validity and an impaired OHRQoL of HNSCC patients. It can therefore be recommended for the assessment of OHRQoL.

Ball versus Locator® Attachments: A Retrospective Study on Prosthetic Maintenance and Effect on Oral-Health-Related Quality of Life.

Locator® and ball attachments are well-established systems to attach overdentures to two inter-foraminal implants. This study aimed to evaluate differences between the two systems regarding prosthetic maintenance and patients' oral-health-related quality of life (OHRQoL). Dental records of patients with a mandibular implant-retained overdenture were retrospectively analyzed. Prosthetic maintenance measures involving the denture suprastructure and attachment matrix and patrix were analyzed. Furthermore, the Oral Health Impact Profile-G14 (OHIP-G14) was used to evaluate OHRQoL. Results were analyzed by means of Kaplan-Meier analysis and Student's t- and log-rank tests. The records of 122 patients were evaluated. Kaplan-Meier survival analysis revealed a significant difference between ball attachments (Group B; n patients = 47) and Locator® attachments (Group L; n patients = 75) regarding the occurrence of denture fractures (p < 0.001) and events affecting the matrix (p = 0.028) and patrix (p = 0.030). Group L had a significantly lower total OHIP-G14 score than Group B (p = 0.002). The most common maintenance events were matrix-related and denture relining for both attachment systems. Group B required more maintenance measures than Group L. Moreover, patients in Group L had better OHRQoL than patients in Group B.

Influence of different agents on the preload force of implant abutment screws.

STATEMENT OF PROBLEM: Screw loosening is a common problem in implant dentistry; however, information is sparse on the influence of different fluids on the screw threads. PURPOSE: The purpose of this in vitro study was to investigate the influence of 4 different fluids and agents (saliva, blood, chlorhexidine [CHX] gel, and special sealing silicone) on the preload force of abutment screws. MATERIALS AND METHODS: The test specimens (N=50) consisted of a thread sleeve resembling the implant, an abutment analog, and an abutment screw. The tightening of the screw with a torque wrench was performed in 5 steps (15 Ncm, 20 Ncm, 25 Ncm, 30 Ncm, and 35 Ncm). Each agent was applied in the lumen of the thread sleeve of 10 specimens. Ten dry thread sleeves served as the control. Comparisons between 2 independent groups were performed with the t test or Wilcoxon-Mann-Whitney test, as appropriate. The Bonferroni correction was used for multiple comparisons (α=.05). RESULTS: Preload forces increased linearly with the applied tightening torque for dry implant lumina, as well as for saliva, blood, silicone, and CHX gel in the implant lumina or thread sleeves. In general, none of the tested agents resulted in significantly higher preload forces compared with the dry control. CONCLUSIONS: The agents investigated did not have any lubricant action on implant abutment screws.

Implications of Allee effects for fisheries management in a changing climate: evidence from Atlantic cod.

There are concerns that increasing anthropogenic stressors can cause catastrophic transitions in ecosystems. Such shifts have large social, economic, and ecological consequences and therefore have important management implications. A potential mechanism behind these regime shifts is the Allee effect, which describes the decline in realized per capita growth rate at small population density. With an age-structured population model for Atlantic cod, Gadus morhua, we illustrate how interactions between human-induced stressors, such as fishing and climate change, can worsen the impact of an Allee effect on populations by promoting hysteresis. Therefore, the risk of population collapse and recovery failure is exacerbated and the success of preventing and reverting collapse depends on the climate regime. We find that, in presence of the Allee effect, a fishing moratorium is only sufficient for recovery when sea surface temperature rise remains within 2°C and fishing is restricted within 10 yrs. If sea surface temperature rises beyond 2°C, even immediate banning of fishing is not sufficient to guarantee recovery. If fishing is not fully banned and a residual fishing pressure remains, the probability of recovery is further decreased, also in the absence of an Allee effect. The results underscore the decisive role of Allee effects for the management of depleted populations in an increasingly human-dominated world. Once the population collapses and its growth rate is suppressed, rebuilding measures will be squandered and collapse will very likely be irreversible. We therefore emphasize the need for proactive management involving precautionary, adaptive measures and reference points. Our studies shows that climate change has the potential to strengthen Allee effects, which could increasingly challenge fisheries management.

The flexural strength of CAD/CAM polymer crowns and the effect of artificial ageing on the fracture resistance of CAD/CAM polymer and ceramic single crowns.

OBJECTIVES: The purpose of this study was to investigate the fracture resistance, flexural strength and Weibull modulus of an innovative CAD/CAM polymer and to compare its fracture resistance with that of glass ceramics. MATERIALS AND METHODS: A total of 32 (n = 16 IPS e.max CAD (LIDI); n = 16 LuxaCam Composite (LUXA)) first mandibular molar crowns were fabricated and cemented onto metal dies by use of luting composite. Half of the specimens were loaded until fracture without prior artificial ageing. The other half were subjected to thermal (5°/55 °C) and mechanical (1,200,000 cycles, 80 N) cycling before fracture loading. Scanning electron microscopy was used to analyse fracture behaviour. A three-point bending test of the flexural strength of LUXA was performed according to ISO 6872:2008. Data were analysed by means of the Kolmogorov-Smirnov test, Mann-Whitney U-test (p < 0.05) and Weibull statistical analysis. RESULTS: Initial fracture resistance of LIDI was significantly higher than that of LUXA. However, the initial fracture resistance of LIDI decreased significantly after artificial ageing. After ageing, fracture resistance was 1050.29 ± 325.08 N for LUXA and 1250.09 ± 32.53 N for LIDI. Three-point bending test yielded a mean flexural strength value for LUXA of 145.28 ± 18.21 MPa and a Weibull modulus of m = 9.51. CONCLUSIONS: Polymer-based material tested in this study had a lower fracture resistance than that of the glass-ceramic material. Fracture resistance and flexural strength of LuxaCam Composite are sufficient for use in the first molar region. CLINICAL RELEVANCE: The mechanical properties of this innovative polymer-based material indicate it can be used in the first molar region as a suitable alternative to glass ceramics. Further clinical studies are required to confirm this. The study presents an innovative material as an alternative to glassceramic for the clinical use in dentistry. The materials investigated were differently affected by artificial aging. Clinical use for patients with bruxism may be considered.

Conical zirconia telescoping into electroformed gold: A retrospective study of prostheses supported by teeth and/or implants.

BACKGROUND: Telescopic prostheses are an evidence-based treatment modality, and conical zirconia crowns and electro-formed gold copings have been used for dentures supported by teeth and/or implants. PURPOSE: We aimed to evaluate the survival rates of zirconia-based tooth/implant restorations. MATERIALS AND METHODS: A total of 126 telescopic overdentures, all retained by conical zirconia crowns and electro-formed gold copings, were retrospectively evaluated and failures analyzed for abutment configurations. Survival rates and modifying factors were evaluated by Kaplan-Meier analysis, log-rank testing, and Cox regression analysis. RESULTS: We evaluated observation periods of up to 11.5 years (mean: 45.25 ± 25.11 months). Five-year prosthesis survival was 96.9 ± 2.2% (95% CI: 92.6-100). Six dentures had been lost, and these failures were significantly associated with specific abutment configurations. CONCLUSIONS: Within the limitations of this retrospective study, the concept of conical zirconia telescoping into electro-formed gold provides a viable alternative to other telescopic designs used for removable dental prostheses. The concept is well suited especially for tooth/implant-supported prosthetic rehabilitation.

IPS e.max for All-Ceramic Restorations: Clinical Survival and Success Rates of Full-Coverage Crowns and Fixed Partial Dentures.

The IPS e.max system by Ivoclar Vivadent, offering a variety of products and indications, is widely used for all-ceramic restorations. We analyzed the clinical track record of these products in daily clinical practice, associating their restorative survival rate with various parameters to define recommendations for long-term stability. A total of 1058 full-coverage crowns and fixed partial dentures (FPDs) were evaluated retrospectively over up to 66.48 (37.05 ± 18.4) months. All were made of IPS e.max Press, IPS e.max CAD, IPS e.max Ceram or IPS e.max ZirPress and had been delivered by a private dental practice within three years. Uses not recommended by the manufacturer were also deliberately included. The five-year cumulative survival was 94.22% (i.e., 94.69% or 90.58% for glass-ceramic crowns or FDPs and 100% or 90.06% for zirconia-based crowns or FDPs). Significantly superior outcomes emerged for conventional vs. adhesive cementation and for vital vs. non-vital abutment teeth, but not for recommended vs. non-recommended uses. Caution is required in restoring non-vital teeth, but the spectrum of recommended uses should generally be reconsidered and expanded, given our finding of high survival and success rates for IPS e.max ceramics, even for uses not currently recommended by the manufacturer.

Quality assurance for care of melanoma patients based on guideline-derived quality indicators and certification.

BACKGROUND AND OBJECTIVES: In 2013 the first German S-3 guidelines on the diagnosis, treatment, and follow-up of melanoma were published in the framework of the German Guideline Program on Oncology. Quality indicators were developed at the same time as the guideline development process in order to implement the guideline recommendations. PATIENTS AND METHODS: A multidisciplinary, interprofessional working group developed quality indicators following a standardized process. RESULTS: Twelve quality indicators directly linked to guideline recommendations were generated and agreed on by consensus. They were integrated into the catalogue of requirements for dermato-oncological centers certified by the German Cancer Society. CONCLUSIONS: The close cooperation between the guideline group and commission for certification allowed the guideline contents to be implemented in the form of quality indicators in everyday clinical practice. Adherence to the guidelines is required and continuously evaluated as part of certification.

Emotion recognition in body dysmorphic disorder: application of the Reading the Mind in the Eyes Task.

Body dysmorphic disorder (BDD) is characterized by perceived appearance-related defects, often tied to aspects of the face or head (e.g., acne). Deficits in decoding emotional expressions have been examined in several psychological disorders including BDD. Previous research indicates that BDD is associated with impaired facial emotion recognition, particularly in situations that involve the BDD sufferer him/herself. The purpose of this study was to further evaluate the ability to read other people's emotions among 31 individuals with BDD, and 31 mentally healthy controls. We applied the Reading the Mind in the Eyes task, in which participants are presented with a series of pairs of eyes, one at a time, and are asked to identify the emotion that describes the stimulus best. The groups did not differ with respect to decoding other people's emotions by looking into their eyes. Findings are discussed in light of previous research examining emotion recognition in BDD.

Interactions of Pb and Cd mixtures in the presence or absence of natural organic matter with the fish gill.

Metal gill binding and toxicity can be modeled using the concentration addition model, in which the toxic unit (TU) concept is used to determine if constituent metals are acting in a strictly additive, less than, or greater than additive fashion. To test this hypothesis, rainbow trout (Oncorhynchus mykiss) were exposed to a matrix of Pb plus Cd mixtures (nominal concentrations=0.75, 1.5, 2.25, 3.0 µmol L(-1)), in the presence or absence of mainly terrigenous (allochthonous; 10 mg CL(-1)) natural organic matter (NOM), and metal-gill binding, and toxicity was quantified. Based on its greater affinity for metal-gill binding sites, Cd-gill binding was expected to exceed Pb-gill binding during metal mixture exposure, but this only occurred at the lowest metal concentrations (0.75 µmol L(-1)); at higher concentrations Pb-gill binding was greater than Cd-gill binding. These unexpected observations were because Pb and Cd likely bind to different populations of high affinity, low capacity binding sites on the gill, which was borne out in subsequent attempts to mathematically model metal-gill interactions during metal-mixture exposure. The presence of an additional low affinity, high capacity population of Pb-gill binding sites also contributed to higher Pb-gill accumulation. Metal-gill interactions were complicated by NOM, which exacerbated toxicity during Cd-only exposure despite lowering Cd-gill accumulation. NOM also promoted Cd-gill binding in the presence of low-moderate concentrations of Pb (0.75 and 1.50 µmol L(-1)). We suggest that direct interactions of Cd-NOM complexes with the gill, and increases in Cd bioavailability due to Pb outcompeting Cd for NOM-metal binding sites due to its greater affinity for such ligands, accounted for greater Cd-gill binding and toxicity. We conclude that interactions of Pb and Cd with the gill cannot be predicted using the concentration addition model, and that NOM is not universally protective against metal-gill binding and toxicity when fish are exposed to metal mixtures.