Patterns of morphological integration in the dental arches of individuals with malocclusion.

OBJECTIVES: In humans, there is a large range of variation in the form of the maxillary and mandibular dental arches. This variation can manifest as either prognathism or retrognathism in either or both arches, which can cause malocclusion and lead to abnormal masticatory function. This study aims to identify aspects of variation and morphological integration existing in the dental arches of individuals with different types of malocclusion. METHODS: Coordinate landmark data were collected along the gingival margins of 397 scanned dental casts and then analyzed using geometric morphometric techniques to explore arch form variation and patterns of morphological integration within each malocclusion type. RESULTS: Significant differences were identified between Class II forms (increased projection of upper arch relative to the lower arch) and Class III forms (lower arch projection beyond the upper arch) in symmetrical shape variation, including anteroposterior arch discrepancies and abnormal anterior arch divergence or convergence. Partial least squares analysis demonstrated that Class III dental arches have higher levels of covariance between upper and lower arches (RV = 0.91) compared to the dental arches of Class II (RV = 0.78) and Class I (RV = 0.73). These high levels of covariance, however, are on the lower end of the overall range of possible masticatory blocks, indicating weaker than expected levels of integration. CONCLUSIONS: This study provides evidence for patterns of variation in dental arch shape found in individuals with Class II and Class III malocclusions. Moreover, differences in integration found between malocclusion types have ramifications for how such conditions should be studied and treated. Am. J. Hum. Biol. 28:879-889, 2016. © 2016Wiley Periodicals, Inc.

In vitro evaluation of the marginal integrity of CAD/CAM interim crowns.

STATEMENT OF PROBLEM: The accuracy of interim crowns made with computer-aided design and computer-aided manufacturing (CAD/CAM) systems has not been well investigated. PURPOSE: The purpose of this in vitro study was to evaluate the marginal integrity of interim crowns made by CAD/CAM compared with that of conventional polymethylmethacrylate (PMMA) crowns. MATERIAL AND METHODS: A dentoform mandibular left second premolar was prepared for a ceramic crown and scanned for the fabrication of 60 stereolithical resin dies, half of which were scanned to fabricate 15 Telio CAD-CEREC and 15 Paradigm MZ100-E4D-E4D crowns. Fifteen Caulk and 15 Jet interim crowns were made on the remaining resin dies. All crowns were cemented with Tempgrip under a 17.8-N load, thermocycled for 1000 cycles, placed in 0.5% acid fuschin for 24 hours, and embedded in epoxy resin before sectioning from the mid-buccal to mid-lingual surface. The marginal discrepancy was measured using a traveling microscope, and dye penetration was measured as a percentage of the overall length under the crown. RESULTS: The mean vertical marginal discrepancy of the conventionally made interim crowns was greater than for the CAD/CAM crowns (P=.006), while no difference was found for the horizontal component (P=.276). The mean vertical marginal discrepancy at the facial surface of the Caulk crowns was significantly greater than that of the other 3 types of interim crowns (P<.001). At the facial margin, the mean horizontal component of the Telio crowns was significantly larger than that of the other 3 types, with no difference at the lingual margins (P=.150). The mean percentage dye penetration for the Paradigm MZ100-E4D crowns was significantly greater and for Jet crowns significantly smaller than for the other 3 crowns (P<.001). However, the mean percentage dye penetration was significantly correlated with the vertical and horizontal marginal discrepancies of the Jet interim crowns at the facial surface and with the horizontal marginal discrepancies of the Caulk interim crowns at the lingual surface (P<.01 in each instance). CONCLUSIONS: A significantly smaller vertical marginal discrepancy was found with the interim crowns fabricated by CAD/CAM as compared with PMMA crowns; however, this difference was not observed for the horizontal component. The percentage dye penetration was correlated with vertical and horizontal discrepancies at the facial surface for the Jet interim crowns and with horizontal discrepancies at the lingual surface for the Caulk interim crowns.

Evidence that a neutrophil-keratinocyte crosstalk is an early target of IL-17A inhibition in psoriasis.

The response of psoriasis to antibodies targeting the interleukin (IL)-23/IL-17A pathway suggests a prominent role of T-helper type-17 (Th17) cells in this disease. We examined the clinical and immunological response patterns of 100 subjects with moderate-to-severe psoriasis receiving 3 different intravenous dosing regimens of the anti-IL-17A antibody secukinumab (1 × 3 mg/kg or 1 × 10 mg/kg on Day 1, or 3 × 10 mg/kg on Days 1, 15 and 29) or placebo in a phase 2 trial. Baseline biopsies revealed typical features of active psoriasis, including epidermal accumulation of neutrophils and formation of microabscesses in >60% of cases. Neutrophils were the numerically largest fraction of infiltrating cells containing IL-17 and may store the cytokine preformed, as IL-17A mRNA was not detectable in neutrophils isolated from active plaques. Significant clinical responses to secukinumab were observed 2 weeks after a single infusion, associated with extensive clearance of cutaneous neutrophils parallel to the normalization of keratinocyte abnormalities and reduction of IL-17-inducible neutrophil chemoattractants (e.g. CXCL1, CXCL8); effects on numbers of T cells and CD11c-positive dendritic cells were more delayed. Histological and immunological improvements were generally dose dependent and not observed in the placebo group. In the lowest-dose group, a recurrence of neutrophils was seen in some subjects at Week 12; these subjects relapsed faster than those without microabscesses. Our findings are indicative of a neutrophil-keratinocyte axis in psoriasis that may involve neutrophil-derived IL-17 and is an early target of IL-17A-directed therapies such as secukinumab.

Internal fit of pressed and computer-aided design/computer-aided manufacturing ceramic crowns made from digital and conventional impressions.

STATEMENT OF PROBLEM: No studies have evaluated the internal adaptation of pressed and milled ceramic crowns made from digital impressions. PURPOSE: The purpose of this in vitro study was to evaluate the internal fit of pressed and milled ceramic crowns made from digital and conventional impressions. MATERIAL AND METHODS: Thirty polyvinyl siloxane (PVS) impressions and 30 Lava COS impressions made of a prepared dentoform tooth (master die) were fabricated. Thirty crowns were pressed in lithium disilicate (IPS e.max Press), and 30 crowns were milled from lithium disilicate blocks (IPS e.max CAD) (15/impression technique) with the E4D scanner and milling engine. The master die and the intaglio of the crowns were digitized with a 3-dimensional laser coordinate measurement machine. The digital master die and intaglio of each crown were merged. The distance between the die and the intaglio surface of the crown was measured at 3 standardized points. One-way ANOVA was used for statistical analysis (α=.05). RESULTS: One-way ANOVA revealed that the internal gap obtained from the Lava/press group (0.211 mm, ±SD 0.041) was significantly greater than that obtained from the other groups (P<.001), while no significant differences were found among PVS/press (0.111 mm ±SD 0.047), PVS/CAD/CAM (0.116 mm ±SD 0.02), and Lava/CAD/CAM (0.145 mm ±SD 0.024). CONCLUSIONS: The combination of the digital impression and pressed crown produced the least accurate internal fit.

Ceramic materials for porcelain veneers: part II. Effect of material, shade, and thickness on translucency.

STATEMENT OF PROBLEM: Information regarding the differences in translucency among new ceramic systems is lacking. PURPOSE: The purpose of this study was to compare the relative translucency of the different types of ceramic systems indicated for porcelain veneers and to evaluate the effect of shade and thickness on translucency. MATERIAL AND METHODS: Disk specimens 13 mm in diameter and 0.7-mm thick were fabricated for the following 9 materials (n=5): VITA VM9, IPS Empress Esthetic, VITA PM9, Vitablocks Mark II, Kavo Everest G-Blank, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as the positive control and Lava as the negative control. The disks were fabricated with the shade that corresponds to A1. For IPS e.maxPress, additional disks were made with different shades (BL2, BL4, A1, B1, O1, O2, V1, V2, V3), thickness (0.3 mm), and translucencies (high translucency, low translucency). Color coordinates (CIE L∗ a∗ b∗) were measured with a tristimulus colorimeter. The translucency parameter was calculated from the color difference of the material on a black versus a white background. One-way ANOVA, the post hoc Tukey honestly significant difference, and the Ryan-Einot-Gabriel-Welsch multiple range tests were used to analyze the data (α=.05). RESULTS: Statistically significant differences in the translucency parameter were found among porcelains (P<.001) according to the following rank: VM9>PM9, Empress Esthetic>Empress CAD>Mark II, Everest, e.max CAD>e.max Press>Lava. Significant differences also were noted when different shades and thickness were compared (P<.001). CONCLUSIONS: Different ceramic systems designed for porcelain veneers present varying degrees of translucency. The thickness and shade of lithium disilicate ceramic affect its translucency. Shade affects translucency parameter less than thickness.

3D and 2D marginal fit of pressed and CAD/CAM lithium disilicate crowns made from digital and conventional impressions.

PURPOSE: This in vitro study evaluated the 3D and 2D marginal fit of pressed and computer-aided-designed/computer-aided-manufactured (CAD/CAM) all-ceramic crowns made from digital and conventional impressions. MATERIALS AND METHODS: A dentoform tooth (#30) was prepared for an all-ceramic crown (master die). Thirty type IV definitive casts were made from 30 polyvinyl siloxane (PVS) impressions. Thirty resin models were produced from thirty Lava Chairside Oral Scanner impressions. Thirty crowns were pressed in lithium disilicate (IPS e.max Press; 15/impression technique). Thirty crowns were milled from lithium disilicate blocks (IPS e.max CAD; 15/impression technique) using the E4D scanner and milling engine. The master die and the intaglio of the crowns were digitized using a 3D laser coordinate measurement machine with accuracy of ±0.00898 mm. For each specimen a separate data set was created for the Qualify 2012 software. The digital master die and the digital intaglio of each crown were merged using best-fitting alignment. An area above the margin with 0.75 mm occlusal-gingival width circumferentially was defined. The 3D marginal fit of each specimen was an average of all 3D gap values on that area. For the 2D measurements, the marginal gap was measured at two standardized points (on the margin and at 0.75 mm above the margin), from standardized facial-lingual and mesial-distal digitized sections. One-way ANOVA with post hoc Tukey's honestly significant difference and two-way ANOVA tests were used, separately, for statistical analysis of the 3D and 2D marginal data (alpha = 0.05). RESULTS: One-way ANOVA revealed that both 3D and 2D mean marginal gap for group A: PVS impression/IPS e.max Press (0.048 mm ± 0.009 and 0.040 mm ± 0.009) were significantly smaller than those obtained from the other three groups (p < 0.0001), while no significant differences were found among groups B: PVS impression/IPS e.max CAD (0.088 mm ± 0.024 and 0.076 mm ± 0.023), C: digital impression/IPS e.max Press (0.089 mm ± 0.020 and 0.075 mm ± 0.015) and D: digital impression/IPS e.max CAD (0.084 mm ± 0.021 and 0.074 mm ± 0.026). The results of two-way ANOVA revealed a significant interaction between impression techniques and crown fabrication methods for both 3D and 2D measurements. CONCLUSIONS: The combination of PVS impression method and press fabrication technique produced the most accurate 3D and 2D marginal fits.

Fracture toughness of yttria-stabilized zirconia sintered in conventional and microwave ovens.

STATEMENT OF PROBLEM: The fabrication of zirconium dioxide (ZrO2) dental prosthetic substructures requires an extended sintering process (8 to 10 hours) in a conventional oven. Microwave sintering is a shorter process (2 hours) than conventional sintering. PURPOSE: The purpose of this study was to compare the fracture toughness of 3 mol % Y2O3-stabilized ZrO2 sintered in a conventional or microwave oven. MATERIAL AND METHODS: Partially sintered ZrO2 specimens from 3 manufacturers, KaVo, Lava 3M, and Crystal HS were milled (KaVo Everest engine) and randomly divided into 2 groups: conventional sintering and microwave sintering (n=16 per group). The specimens were sintered according to the manufacturers' recommendations and stored in artificial saliva for 10 days. Fracture toughness was determined by using a 4-point bend test, and load to fracture was recorded. Mean fracture toughness for each material was calculated. A 2-way ANOVA followed by the Tukey HDS post hoc test was used to assess the significance of sintering and material effects on fracture toughness, including an interaction between the 2 factors (α=.05). RESULTS: The 2-way ANOVA suggested a significant main effect for ZrO2 manufacturer (P<.001). The post hoc Tukey HSD test indicated that mean fracture toughness for the KaVo ZrO2 (5.85 MPa·m(1/2) ±1.29) was significantly higher than for Lava 3M (5.19 MPa·m(1/2) ±0.47) and Crystal HS (4.94 MPa·m(1/2) ±0.66) (P<.05) and no significant difference was observed between Lava 3M and Crystal HS (P>.05). The main effect of the sintering process (Conventional [5.30 MPa·m(1/2) ±1.00] or Microwave [5.36 MPa·m(1/2) ±0.92]) was not significant (P=.76), and there was no interaction between sintering and ZrO2 manufacturer (P=.91). CONCLUSIONS: Based on the results of this study, no statistically significant difference was observed in the fracture toughness of ZrO2 sintered in microwave or conventional ovens.

Ceramic materials for porcelain veneers. Part I: Correlation between translucency parameters and contrast ratio.

STATEMENT OF PROBLEM: Different parameters are used in the literature to describe translucency, making it difficult for clinicians to find clear information on ceramic translucency and compare studies. PURPOSE: The purpose of this study was to assess the correlation between the contrast ratio (CR) and translucency parameter (TP) when the translucency of different types of ceramic systems is compared. MATERIAL AND METHODS: Disks 13 mm in diameter and 0.7 mm thick were fabricated for the following materials (n=5): VITA VM9, VITA PM9, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as positive control, while Lava Zirconia served as negative control. The luminous reflectance (Y) and color coordinates (CIE L* a* b*) of the specimens were measured with a tristimulus colorimeter. The CR (CR=Yb/Yw) was calculated from the reflectance of the light of the material on a black backing (Yb) to the reflectance on a white backing (Yw). The TP (TP=[(Lb*Lw*)(2+)(ab*-aw*)(2+)(bb*-bw*)(2) ](1/2)) was calculated from the color difference of the material on a black versus a white background. One-way ANOVA based on ranked data and the Pearson and Spearman rank correlation tests were used to analyze the data (α=.05). RESULTS: A significant correlation between CR and TP was found when all specimens were included (P<.001). The coefficient of -0.99 indicated a strong decreasing relationship between the 2 variables. CONCLUSIONS: Either CR or TP can be used to evaluate the relative translucency of ceramic systems.

Biomechanical study of SonicWeld Rx pin in cortical bone graft layering technique.

PURPOSE: The purpose of this in vitro study was to determine the biomechanical values of the SonicWeld Rx pin system in comparison with titanium screws for use in onlay cortical bone grafting. MATERIALS AND METHODS: In this study, 2.1-mm SonicWeld Rx pins and 1.5-mm titanium screws, measuring 7 mm in length, were used. Sawbone blocks were positioned to simulate an onlay bone graft, and the pins and screws were used to replicate bicortical fixation. Four groups were designated for vertical load application, and failure of the fixation was determined when stability was compromised. Study groups consisted of fixation material types and number of fixation appliances. A Bose Electroforce 3300 system was used to deliver the force and to obtain data. RESULTS: Comparison of SonicWeld Rx 1-pin fixation with titanium 1-screw fixation showed similar peak resistance loads. Average peak loading resistance for SonicWeld Rx 1-pin fixation was 65.54 N and that for titanium 1-screw fixation was 59.37 N, with no significant difference (P = .9698). Average peak strength of SonicWeld Rx 2-pin and titanium 2-screw fixations was 110.24 and 97.3 N, respectively, with no significant difference (P = .1041). CONCLUSION: Based on the measured biomechanical values, SonicWeld Rx fixation can withstand similar peak load forces compared with that of titanium screw fixation. The SonicWeld Rx fixation can be an alternative method of fixation for onlay bone grafting in dentoalveolar ridge augmentation.

Human perception of dental porcelain translucency correlated to spectrophotometric measurements.

PURPOSE: This study evaluated the relationship between instrumental measurements and subjective visual assessment of differences in dental porcelain translucency. MATERIALS AND METHODS: Unshaded feldspathic porcelain was used with controlled amounts of tin oxide to create two groups of 12-mm diameter disks with incremental changes in opacity. Contrast ratio (CR = Yb/Yw) was determined with a spectrophotometer, and used as a measure of porcelain translucency (Group A = 0.20 to 0.40; Group B = 0.6-0.8). Within each group, there were 14 specimens with 11 CRs. Three observer groups (first year dental students, residents, faculty with >10 years of shade matching experience) were recruited to assess the translucency between porcelain disks under two lighting conditions (reflected light, transmitted light). Each subject's ability to distinguish between specimens of differing translucency was determined. Descriptive statistics and three-way ANOVA followed by a post-hoc Tukey-Kramer test were used to evaluate the translucency perception threshold (TPT) of subjects (alpha= 0.05). RESULTS: The overall mean TPT (DeltaC) was 0.07, while 50% of the subjects could perceive a 0.06 CR difference between porcelain specimens. Three-way ANOVA revealed a significant difference in translucency perception among the observer groups (p < 0.0001), whereas the main effects for porcelain opacity (p= 0.3038) and lighting condition (p= 0.0645) were not significant, and no significant interactions were found. Post-hoc Tukey-Kramer test indicated that the mean TPT observed in the faculty group (DeltaC = 0.04) was significantly lower than those observed in student (DeltaC = 0.09) and resident groups (DeltaC = 0.08), while there was no significant difference between students and residents. CONCLUSIONS: The overall mean TPT of all subjects was 0.07, and 50% of the study population perceived a 0.06 CR difference in translucency. Increased shade matching experience (> or =10 years) significantly improved the ability to perceive differences in translucency; however, neither the viewing condition nor porcelain opacity affected the perceived translucency threshold.

Short-contact clobetasol propionate shampoo 0.05% improves quality of life in patients with scalp psoriasis.

Scalp psoriasis has a considerable impact on the quality of life (QOL) of patients, and most patients are dissatisfied with available treatments. Clobetasol propionate shampoo 0.05% has been shown to be effective and safe for moderate to severe scalp psoriasis. We evaluated the effect of clobetasol propionate shampoo on QOL and the degree of participant satisfaction with the product. Participants received once-daily treatment for up to 4 weeks. Their QOL and degree of satisfaction were evaluated by questionnaires. The mean (standard deviation) Dermatology Life Quality Index (DLQI) score decreased significantly from 7.0 (4.9) at baseline to 3.2 (3.2) at week 4 (P<.001). Participants who considered the disease as having a small effect or no effect on their QOL increased from 45.6% at baseline to 81.7% at week 4. Most participants were satisfied with the cosmetic acceptability and the efficacy and safety aspects of the product, considered it better than prior treatments, and would use it again in the future. Therefore, we conclude that treatment with clobetasol propionate shampoo improved the QOL of participants and resulted in high satisfaction.

Long-term efficacy of up to 15 months' efalizumab therapy in patients with moderate-to-severe chronic plaque psoriasis.

The efficacy and safety of efalizumab in the treatment of moderate-to-severe chronic psoriasis has been established in studies of up to 3 years' duration. This study aims to describe the efficacy of up to 15 months' treatment with efalizumab and the convenience of therapy in patients with moderate-to-severe chronic plaque psoriasis. Patients who had completed a 3-month, double-blind, randomized, placebo-controlled, Phase IIIb trial entered a 12-month extension study and received efalizumab, 1 mg/kg/week administered subcutaneously, for up to 12 months. Of 450 patients originally randomly assigned to receive efalizumab, 40.9% achieved a reduction of > or = 75% in the Psoriasis Area and Severity Index score after 15 months of treatment. Improvements were also observed on the frequency and severity subscales of the Psoriasis Symptom Assessment. The majority of patients reported that efalizumab treatment was more or much more convenient than other psoriasis treatments. Efalizumab, 1 mg/kg/week, provides long-term efficacy and good convenience with up to 15 months of continuous treatment.

An in vitro comparison of vertical marginal gaps of CAD/CAM titanium and conventional cast restorations.

PURPOSE: To determine if there was a significant difference between the vertical marginal openings of cast restorations, computer-aided design, and computer-aided machining restorations. MATERIALS AND METHODS: Ten working dies were created from a single master die and used to fabricate ten restorations in each of the following groups: computer-aided design/computer-assisted machining (CAD/CAM), WAX/CAM, and WAX/CAST. The CAD/CAM titanium restorations were fabricated using the scanning and crown design modules of the KaVo Everest system. The WAX/CAM titanium restorations were fabricated using the double scan technique with the KaVo Everest system. The WAX/CAST high noble copings were fabricated using the conventional lost wax casting technique. The restorations were seated on the master die, and high-resolution digital photographs were made of the marginal area on all four sides. The vertical marginal opening was then measured using a calibrated digital software program. One-way ANOVA and Tukey's post hoc tests were used to determine the presence of statistically significant differences. RESULTS: The vertical margin openings were CAD/CAM: 79.43 +/- 25.46 microm; WAX/CAM: 73.12 +/- 24.15 microm; WAX/CAST: 23.91 +/- 9.80 microm. There was a statistically significant difference between the WAX/CAST group and the remaining groups. CONCLUSIONS: There was no difference between the vertical marginal gaps of the CAD/CAM and WAX/CAM. The WAX/CAST technique resulted in smaller vertical marginal gaps than either CAD/CAM or WAX/CAM.

The safety and efficacy of four different fixed combination regimens of adapalene 0.1%/benzoyl peroxide 2.5% gel for the treatment of acne vulgaris: results from a randomised controlled study.

BACKGROUND: Combined use of a retinoid and antimicrobial is recommended for acne, however, local tolerability issues may compromise patient adherence and treatment outcome. OBJECTIVES: This multicentre, single-blinded controlled study was designed to determine whether modified adapalene/benzoyl peroxide (A/BPO, Epiduo®, Galderma, France) regimens improve local tolerability during the first four weeks of treatment without impairing efficacy at Week 12. MATERIALS & METHODS: In total, 120 subjects with mild-to-moderate acne received, during the first four weeks, A/BPO daily overnight (A/BPO-EN), A/BPO daily for three hours (A/BPO-3h), A/BPO daily overnight and a provided moisturizer lotion (A/BPO-moisturizer), or A/BPO every other night (A/BPO-EoN). Local tolerance assessments included signs and symptoms, global worst score (GWS), and total sum score (TSS). Efficacy was assessed based on lesion counts, investigator global assessment (IGA), and total lesion count reduction. Adherence, subject satisfaction, and overall safety were also assessed. RESULTS: The mean TSS was significantly reduced at Week 1 with A/BPO-EoN vs. A/BPO-EN (p<0.05), and A/BPO-EoN led to the lowest GWS and a decrease in severity of stinging/burning and erythema (p<0.05). The A/BPO-moisturizer regimen prevented dryness and scaling compared with the A/BPO-EN regimen. The median decrease in lesions from baseline was similar in all groups: up to 67% for total, 72% for inflammatory, and 70% for non-inflammatory lesion counts. Adherence, IGA, patient satisfaction, and overall safety were excellent. CONCLUSIONS: Modulating treatment regimens during the first four weeks improved local tolerability without impacting overall efficacy outcome after 12 weeks and may improve treatment adherence during the first weeks of therapy.

Critical Thinking Theory to Practice: Using the Expert's Thought Process as Guide for Learning and Assessment.

Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.

Effect of incorrect primer application on dentin permeability.

PURPOSE: To evaluate in vitro the effect of clinical primer application errors on human dentin permeability. The null hypothesis is that there is no difference in dentin permeability reduction with the use of a total-etch three-step (TE3) dentin adhesive system among the treatment groups. MATERIALS AND METHODS: Seventy extracted noncarious human third molars were sectioned to obtain 0.7-mm-thick midcoronal dentin disks. The specimens were randomly assigned to 5 groups and treated with a total-etch three-step (TE3) ethanol/water-based dentin adhesive system, Optibond FL (Kerr; Orange, CA, USA), according to manufacturer's instructions using 4 simulated application errors: short application of primer by immediate drying; no primer application; no drying of primer; aggressive drying of primer. Permeability of dentin was measured as fluid filtration at baseline and after adhesive polymerization. Kruskal-Wallis and Tukey's post-hoc comparisons were used to evaluate permeability reduction differences among groups (alpha = 0.05). RESULTS: The null hypothesis was rejected (p < 0.0001). The data provided strong evidence that the distribution of percentage permeability reduction differed among the 5 treatment groups (p < 0.0001). All possible pairwise comparisons of the groups were statistically significant. The highest mean percentage of permeability reduction was observed in the group where manufacturer's instructions were followed (99.4+/-1.0), followed by the aggressive drying primer group (86.7+/-11.1), the shortened primer application group (73.01+/-12.0), the no-drying primer group (48.44 +/-19.9), and, finally, the no-primer group (22.33+/-7.7). CONCLUSION: The incorrect primer application allowed significant dentin permeability. Strict adherence to recommended clinical application of dentinal adhesives is fundamental to achieve good dentin tubule sealing.

Impact of Digital Tooth Preparation Evaluation Technology on Preclinical Dental Students' Technical and Self-Evaluation Skills.

The aim of this study was to evaluate the effect of digital tooth preparation imaging and evaluation technology on dental students' technical abilities, self-evaluation skills, and the assessment of their simulated clinical work. A total of 80 second-year students at one U.S. dental school were assigned to one of three groups: control (n=40), E4D Compare (n=20), and Sirona prepCheck (n=20). Students in the control group were taught by traditional teaching methodologies, and the technology-assisted groups received both traditional training and supplementary feedback from the corresponding digital system. Three outcomes were measured: faculty technical score, self-evaluation score, and E4D Compare scores at 0.30 mm tolerance. Correlations were determined between the groups' scores from visual assessment and self-evaluation and between the visual assessment and digital scores. The results showed that the visual assessment and self-evaluation scores did not differ among groups (p>0.05). Overall, correlations between visual and digital assessment scores were modest though statistically significant (5% level of significance). These results suggest that the use of digital tooth preparation evaluation technology did not impact the students' prosthodontic technical and self-evaluation skills. Visual scores given by faculty and digital assessment scores correlated moderately in only two instances.

An integrated analysis of thirteen trials summarizing the long-term safety of alefacept in psoriasis patients who have received up to nine courses of therapy.

BACKGROUND: Information on longer-term safety and tolerability is needed to confidently prescribe alefacept therapy for chronic plaque psoriasis beyond 1 or 2 courses. OBJECTIVE: The aim of this work was to further examine the safety profile of alefacept by integrating data from clinical trials involving patients with chronic plaque psoriasis who received up to 9 courses of therapy over a 5-year period. METHODS: Data from 13 clinical trials conducted in patients with plaque psoriasis were integrated because they had similar inclusion/exclusion criteria and assessments. Patients who enrolled in the analyzed trials were aged > or =15 years with chronic plaque psoriasis for > or =12 months that involved > or =10% of body surface area, and CD4+ T lymphocyte counts above the lower limit of normal (>404 cells/microL). The incidences of adverse events (AEs), serious AEs, discontinuations for AEs, infections, serious infections, malignancies, and anti-alefacept antibodies were summarized for each course of alefacept. The incidence of infections was stratified according to CD4+ T lymphocyte counts (<250 cells/microL vs > or =250 cells/microL). RESULTS: Data from 13 clinical trials of alefacept were integrated and summarized (multicenter, randomized, double-blind studies, n = 6; multicenter, open-label studies, n = 5; other, n = 2). The analyzed population (n = 1869) included 1291 (69.1%) men and 578 (30.9%) women, between the ages of 15 and 84 years (mean, 44.8 years), of whom 1648 (88.2%) were white. Weights ranged from 40 kg to 206 kg (mean, 90.0 kg). A total of 1369 of these patients had been included in a previous analysis. Among the most commonly reported AEs in each treatment course were headache (0%-14.2%), nasopharyngitis (7.7%-25.0%), influenza (0%-8.1%), upper respiratory tract infection (0%-12.5%), and pruritus (0%-7.5%). The rates of discontinuations due to AEs (0%-4.8%), serious AEs (0%-4.8%), serious infections (0%-0.9%), or malignancies (0%-4.8%) did not appear to increase with repeated exposure. Fewer than 1 % of patients in each course developed a serious infection. No opportunistic infections or infection-related deaths were reported. The incidence of infections appeared to be unrelated to CD4+ T lymphocyte counts. Fewer than 2.5% of patients tested positive for anti-alefacept antibodies during any course of therapy. CONCLUSIONS: This integrated analysis of data from 13 trials with 1869 patients supports the safety and tolerability of alefacept for longer-term treatment of psoriasis.

Effect of Computer-Assisted Learning on Students' Dental Anatomy Waxing Performance.

The aim of this study was to evaluate the impact of computer-assisted learning on first-year dental students' waxing abilities and self-evaluation skills. Additionally, this study sought to determine how well digital evaluation software performed compared to faculty grading with respect to students' technical scores on a practical competency examination. First-year students at one U.S. dental school were assigned to one of three groups: control (n=40), E4D Compare (n=20), and Sirona prepCheck (n=19). Students in the control group were taught by traditional teaching methodologies, and the technology-assisted groups received both traditional training and supplementary feedback from the corresponding digital system. Five outcomes were measured: visual assessment score, self-evaluation score, and digital assessment scores at 0.25 mm, 0.30 mm, and 0.35 mm tolerance. The scores from visual assessment and self-evaluation were examined for differences among groups using the Kruskal-Wallis test. Correlation between the visual assessment and digital scores was measured using Pearson and Spearman rank correlation coefficients. At completion of the course, students were asked to complete a survey on the use of these digital technologies. All 79 students in the first-year class participated in the study, for a 100% response rate. The results showed that the visual assessment and self-evaluation scores did not differ among groups (p>0.05). Overall correlations between visual and digital assessment scores were modest though statistically significant (5% level of significance). Analysis of survey responses completed by students in the technology groups showed that profiles for the two groups were similar and not favorable towards digital technology. The study concluded that technology-assisted training did not affect these students' waxing performance or self-evaluation skills and that visual scores given by faculty and digital assessment scores correlated moderately.

Randomised, controlled trial of the efficacy and safety of adapalene gel 0.1% and tretinoin cream 0.05% in patients with acne vulgaris.

BACKGROUND: Previous clinical trials have shown that adapalene gel produces less irritation than tretinoin gels and tretinoin 0.025% cream. Short term results have shown that adapalene is less irritating than tretinoin gels and creams. This study is the first to compare the 0.1% formulation of adapalene gel with the 0.05% strength of tretinoin cream in a formal clinical trial. OBJECTIVE: To investigate the efficacy and tolerability of adapalene gel 0.1% compared with tretinoin cream 0.05% in patients with mild-to-moderate acne vulgaris. METHODS: Ten-week, multicentre, randomised, investigator-masked, active-controlled, parallel group study in 409 patients with acne vulgaris. RESULTS: Adapalene gel 0.1% demonstrated equivalent efficacy in reduction of acne lesion counts and global improvement of acne severity over 10 weeks' treatment and was significantly better tolerated than tretinoin cream 0.05% in terms of erythema, dryness, desquamation and stinging/burning. CONCLUSION: Adapalene gel 0.1% showed equivalent efficacy and was significantly better tolerated than tretinoin cream 0.05% in patients with mild-to-moderate acne vulgaris.