Clinical Outcomes of Lithium Disilicate Single Crowns after a Mean Duration of 3 Years - A Retrospective Study.

PURPOSE: To investigate the clinical performance and clinical survival rate of lithium disilicate-based core ceramic (IPS e.max Press) utilised in single crowns and to the accompanying periodontal health status. MATERIALS AND METHODS: A total of 47 patients with 88 IPS e.max Press single crowns were examined at the Faculty of Dentistry, University of Malaya, using modified United States Public Health Service evaluation criteria (USPHS). These 88 crowned teeth included 19 vital and 69 nonvital teeth that were restored with different post and core materials. The periodontal status was compared using the plaque index (PI), gingival recession (GR), modified papillary bleeding index (MPBI) and probing pocket depth (PPD) between the crowned teeth and contralateral control (sound) teeth. RESULTS: About 96.6% of the crowns exhibited satisfactory clinical performance. The mean survival rate at three years was 97.7%, and 100% at two years with a low incidence of fractures. There were no staitistically significant differences in the mean gingival recession (p = 0.182) and mean plaque scores (p = 0.102) between crowned and control teeth. The crowned teeth had higher mean MPBI (p = 0.000) and PPD (p = 0.051) compared to the contralateral sound teeth. Periodontal response in relation to subgingival crown margins, was statistically significantly lower regarding pocket depths (p = 0.01) and bleeding on probing (p = 0.00). CONCLUSION: IPS e.max Press crowns exhibited satisfactory clinical performance with high survival rate. No dentinal sensitivity was recorded. Plaque retention and gingival recession were similar to contralateral control teeth. Poor periodontal health was related to the subgingival crown margins.

Clinical Outcomes and Predictors of Satisfaction in Patients with Improved Lithium Disilicate All-Ceramic Crowns.

OBJECTIVES: The aim of this study was to determine the clinical outcomes and predictors of satisfaction in patients with lithium disilicate (LD) ceramic crowns. SUBJECTS AND METHODS: Clinical outcomes were assessed in 47 patients with 88 LD crowns using modified United States Public Health Service (USPHS) evaluation criteria and survival rates. The questionnaire for predictors included 3 aspects: (a) sociodemographic characteristics, (b) oral health habits (tooth brushing frequency, flossing frequency, and dental visits), and (c) satisfaction of the restorations (aesthetics, function, fit, cleansability, and chewing ability of the crowns, and overall satisfaction). Frequency distributions were computed using univariate and multivariate analysis. The Student t test and analysis of variance (ANOVA) were used to compare means across variables. Correlation analysis was done to assess the association between continuous variables. RESULTS: The age of crowns was 34.7 ± 9.7 months. The survival rate was 96.6% at 35.9 ± 9.2 months. There was a significant association between successful crown function and oral hygiene measures: tooth brushing (p˂ 0.001), dental visits (p = 0.006), and flossing (p = 0.009). A strong negative correlation was observed between aesthetic satisfaction (r = -0.717, p˂ 0.001) and chewing ability (r = -0.639, p˂ 0.001) with crown age. The linear regression model was significant for all predictors (p < 0.05) except overall satisfaction (p > 0.05). CONCLUSION: The LD crowns had long survival rates of 96.6% up to 35.9 ± 9.2 months and provided satisfactory clinical performance (low risk of failure). Oral hygiene habits such as brushing, flossing, and regular dental visits influenced patient satisfaction with LD crowns.

Low-melting-point polymeric nanoshells for thermal-triggered drug release under hyperthermia condition.

PURPOSE: The aim of this paper was to synthesise core-shell nanostructures comprised of mesoporous silica core and a low melting-point polyethylene glycol (PEG) nanoshell with a sharp gel-liquid phase transition for rapid drug release at hyperthermia temperature range. MATERIALS AND METHODS: The phase transition behaviours of PEGs with molecular weights of 1000, 1500, and 2000 Da were analysed using differential scanning calorimetry (DSC) to determine the optimal formulation with phase transition in the hyperthermia range. The 'graft-to' method was employed to synthesise core-shell nanostructures using the selected PEG formulation. The drug loading and release behaviours of these nanocarriers were examined by ultra-violet visible spectroscopy (UV-Vis) using doxorubicin as a model drug. Magnetic resonance-guided focused ultrasound (MRgFUS) was also applied as a typical thermal modality to evaluate the rate of drug release from the core-shell nanostructures. RESULTS: The PEG molecular weight of 1500 Da presented the optimal phase transition temperature for thermal-triggered release under hyperthermia conditions. Drug release measurements at different temperatures using UV-Vis methods showed a 20.2 ± 4.3% leakage in aqueous solution at 37 °C after 30 min, while this value was significantly increased to 68.2 ± 3.7% at 50 °C. A 45.5 ± 3.1% drug release was also obtained after sonication of the drug-loaded nanoparticles for 5 × 20 s using MRgFUS. CONCLUSION: Although the ratio of drug leakage at physiological temperatures was relatively high, the sharp transition temperature, high loading efficiency, and fast drug release at hyperthermia temperature range could make these core-shell nanoparticles prominent for enhancing the efficacy of various hyperthermia modalities in the treatment of cancer tumours.

A new mechanism of thermal sensitivity for rapid drug release and low systemic toxicity in hyperthermia and thermal ablation temperature ranges.

PURPOSE: The aim of this paper was to introduce a new mechanism of thermal sensitivity in nanocarriers that results in a relatively low drug release at physiological temperature and rapid release of the encapsulated drug at hyperthermia and thermal ablation temperature range (40-60 °C). MATERIALS AND METHODS: The nanocarriers were synthesised by coating mesoporous silica nanoparticles with a thin layer of polyacrylamide. The low gelation temperature of the protective shell provides preferred routes for drug diffusion when the nanocarriers are heated within the hyperthermia temperature range. In order to determine the gelation point of polyacrylamide shell, differential scanning calorimetry was used. Various chemical, morphological, thermal, as well as drug loading capacities of these nanocarriers were characterised and their drug release behaviour was examined using magnetic resonance -guided focused ultrasound (MRgFUS). RESULTS: Drug release measurements at different temperatures using doxorubicin showed 11.5 ± 2.4% leakage in aqueous solution at 37 °C after 30 min, while this value was significantly increased to 67.6 ± 2.5% at 60 °C. A 39.2 ± 2.2% release of doxorubicin was also obtained due to the sonication of drug-loaded nanoparticles for 5 × 20 s using MRgFUS. CONCLUSION: The nanocarriers developed do not exhibit a sharp transition temperature. However, a relatively high loading efficiency as well as rapid drug release at thermal ablation temperature range makes these nanostructures promising candidates for application as adjuvants to various thermal modalities such as radiofrequency and high intensity focused ultrasound.

Triggering Mechanisms of Thermosensitive Nanoparticles Under Hyperthermia Condition.

Nanoparticle-based hyperthermia is an effective therapeutic approach that allows time- and site-specific treatment with minimized off-site effects. The recent advances in materials science have led to design a diversity of thermosensitive nanostructures that exhibit different mechanisms of thermal response to the external stimuli. This article aims to provide an extensive review of the various triggering mechanisms in the nanostructures used as adjuvants to hyperthermia modalities. Understanding the differences between various mechanisms of thermal response in these nanostructures could help researchers in the selection of appropriate materials for each experimental and clinical condition as well as to address the current shortcomings of these mechanisms with improved material design.

Clinical pairing revisited: a study at the University of Malaya, Malaysia.

This study is part of ongoing educational research conducted by the Department of Conservative Dentistry, University of Malaya, Malaysia, to evaluate the perception of clinical pairing. A thirteen-question survey was distributed to 148 dental students after they had experienced four-handed dentistry. The objectives were to identify the advantages, disadvantages, and the acceptance of the implementation of clinical pairing from the students' point of view. The responses from the open-ended questions were categorized into six main themes (areas of interest): quality-related (Q), patient-related (PT), partner-related (P), lecturer-related (T), infection control (IC), and learning environment (L). Data analysis was done using SPSS version 18. Results indicated that the students perceived they possessed enough knowledge regarding clinical pairing. However, it was found that they still preferred to work independently as compared to working in pairs. The benefits of clinical pairing may not be viewed in the same vein by both dental students and teachers. The quality-related theme was perceived by students as the main advantage of clinical pairing, whilst the partner-related theme was perceived otherwise. The study also revealed that students may have some preconceived notions about pairing that may have impaired their acceptance. As a consequence, some reluctance was seen in their responses.