Bonding of universal adhesive system to enamel surrounding real-life carious cavities

Abstract: This study aimed to evaluate the bond strength of a universal adhesive system to enamel surrounding real-life carious cavities. Twenty-eight permanent molars (n = 7) with carious lesions in dentin were subjected to selective carious tissue removal to firm dentin and had their crowns sectioned longitudinally. A universal adhesive system (Single Bond Universal [SBU] used in either etch-and-rinse and self-etch strategies) was compared with an etch-and-rinse Adper Single Bond 2 (ASB) and a self-etch Clearfil SE Bond (CSE) adhesive systems (control systems). Adhesives were applied on the enamel, assumed demineralized, surrounding the cavity margins and on sound enamel (control substrate). Composite cylinders were built (0.72 mm2) and microshear bond strength (µSBS) test was performed after 24 h of water storage. The µSBS values (MPa) were analyzed using two-way ANOVA and Tukey's post hoc tests (α = 0.05). Bond strength values obtained in demineralized enamel surrounding carious cavity margins were significantly lower than that obtained in sound enamel (distant from carious cavity margins) (p = 0.035). The bonding strategy of the SBU did not influenced the bond strength values, which were higher than that obtained with ASB. CSE showed similar µSBS values to ASB and SBU in the self-etch mode. In conclusion, the bond strength to enamel assumed demineralized is lower than to sound enamel. The enamel surrounding carious cavities jeopardize the bonding of universal adhesive system. The bond strength of universal adhesive is similar, regardless to bonding strategy.

Twenty-four-month clinical performance of different universal adhesives in etch-and-rinse, selective etching and self-etch application modes in NCCL - a randomized controlled clinical trial

Abstract Objective The aim of this randomized, controlled, prospective clinical trial was to evaluate the performances of two different universal adhesives and one etch-rinse adhesive for restoration of non-carious cervical lesions (NCCLs). Material and Methods Twenty patients with at least seven NCCLs were enrolled. Lesions were divided into seven groups according to adhesive systems and application modes: GSE: GLUMA Universal-self-etch, GSL: GLUMA Universal-selective etching, GER: GLUMA Universal-etch-and-rinse, ASE: All-Bond Universal-self-etch, ASL: All-Bond Universal-selective etching, AER: All-Bond Universal-etch-and-rinse, SBE (Control): Single Bond2-etch-and-rinse. A total of 155 NCCLs were restored with a nano hybrid composite (Tetric N-Ceram). Restorations were scored with regard to retention, marginal discoloration, marginal adaptation, recurrent caries and post-operative sensitivity using modified United States Public Health Service (USPHS) criteria after one week, 6, 12 and 24 months. Statistical evaluations were performed using Chi-square tests (p=0.05). Results The recall rate was 81.9% after the 24-month follow-up. The cumulative retention rates for self-etch groups (GSE: 72.2%, ASE:75%) were significantly lower than other experimental groups (GSL: 93.7%, GER: 100%, ASL: 94.1%, AER: 100%, SBE: 100%) at the 24-month follow-up (p<0.05). Regarding marginal adaptation and marginal discoloration, GSE and ASE groups demonstrated more bravo scores after 6 and 12-month observations but differences were not significant (p>0.05). Only one restoration from ASL group demonstrated post-operative sensitivity at 6 and 12-month observations. No secondary caries was observed on the restorations at any recall. At the end of 24-month observations, no significant differences were detected among groups regarding any of the criteria assessed, except retention. Conclusion GLUMA Universal and All-Bond Universal showed better results in etch-and-rinse and selective etching mode compared to the self-etch mode regarding retention. Etch-and-rinse and selective etching application modes of the current universal adhesives tended to provide better clinical outcomes considering the criteria evaluated at the end of 24-month evaluation.

A randomized, prospective clinical study evaluating effectiveness of a bulk-fill composite resin, a conventional composite resin and a reinforced glass ionomer in Class II cavities: one-year results

Abstract Bulk-fill restorative materials such as bulk-fill composite resins and high viscous glass ionomer cements have become very popular materials in operative dentistry because their application is easy and time-saving. Objectives: The aim of this clinical study was to evaluate the clinical performance of a highly viscous reinforced glass ionomer material, a bulk-fill composite resin and a micro hybrid composite resin in Class II restorations. Methodology: In total, 109 Class II restorations were performed in 54 patients using three different restorative materials: Charisma Smart Composite (CSC); Filtek Bulk Fill Posterior Restorative (FBF); Equia Forte Fil (EF). Single Bond Universal adhesive (3M ESPE, Germany) was used with composite resin restorations. The restorations were evaluated using modified USPHS criteria in terms of retention, color match, marginal discoloration, anatomic form, contact point, marginal adaptation, secondary caries, postoperative sensitivity and surface texture. The data were analyzed using Chi-Square, Fischer's and McNemar's tests. Results: At the end of one year, 103 restorations were followed up. No changes were observed during the first 6 months. At the end of one year, there were small changes in composite restorations (FBF and CSC) but no statistically significant difference was observed between the clinical performances of these materials for all criteria (p>0.05). However, there was a statistically significant difference between EF, FBF and CSC groups in all parameters except marginal discoloration, secondary caries and postoperative sensitivity in one-year evaluation (p<0.05). Conclusion: Bulk-fill composite resins and conventional composite resins showed more successful clinical performance than highly viscous reinforced glass ionomers in Class II cavities.

Longevity of metal-ceramic crowns cemented with self-adhesive resin cement: a prospective clinical study

Abstract Resin cements are often used for single crown cementation due to their physical properties. Self-adhesive resin cements gained widespread due to their simplified technique compared to regular resin cement. However, there is lacking clinical evidence about the long-term behavior of this material. The aim of this prospective clinical trial was to assess the survival rates of metal-ceramic crowns cemented with self-adhesive resin cement up to six years. One hundred and twenty-nine subjects received 152 metal-ceramic crowns. The cementation procedures were standardized and performed by previously trained operators. The crowns were assessed as to primary outcome (debonding) and FDI criteria. Statistical analysis was performed using Kaplan-Meier statistics and descriptive analysis. Three failures occurred (debonding), resulting in a 97.6% survival rate. FDI criteria assessment resulted in scores 1 and 2 (acceptable clinical evaluation) for all surviving crowns. The use of self-adhesive resin cement is a feasible alternative for metal-ceramic crowns cementation, achieving high and adequate survival rates.

Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher’s exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

Longitudinal Evaluation of Bond Strength to Enamel of Dental Adhesive Systems Associated with Nd:YAG Laser.

OBJECTIVES: This study evaluated the durability of bond strength to enamel using total-etch (Single Bond/SB) and self-etch (Clearfil SE Bond/CSEB) adhesives associated with neodymium:yttrium-aluminu-garnet (Nd:YAG) laser irradiation through the uncured adhesives. METHODS: Bovine incisors were worn to expose an area of enamel and were divided into four groups: group 1 (control) SB + polymerization; group 2 (control) CSEB + polymerization; group 3 (laser) - SB + Nd:YAG laser (174.16 J/cm(2)) + polymerization; and group 4 (laser) CSEB + Nd:YAG (174.16 J/cm(2)) + polymerization. Blocks of composite were fabricated and stored for 24 hours or 12 months, sectioned into beams, and submitted to microtensile tests. Results were analyzed by three-way analysis of variance (ANOVA) (adhesive, technique, and storage time) and Tukey tests. RESULTS: ANOVA revealed significant differences for adhesive × technique and technique × storage time (p<0.05). The mean values (MPa) for interaction adhesive × technique (standard deviation) were as follows: SB/control = 35.78 (6.04)a; SB/laser = 26.40 (7.25)b, CSEB/control = 26.32 (5.71)b, CSEB/laser = 23.90 (7.49)b. For interaction technique × storage time the mean values were as follows: control/24 hours = 32.58 (6.49)a; control/12 months = 29.52 (8.38)a; laser/24 hours = 29.37 (5.71)a; laser/12 months = 20.92 (6.5)b. Groups with the same letters showed no statistically significant differences. CONCLUSION: Scanning electron microscope analysis showed evident areas of micromorphological alterations in lased samples after 12 months of water storage. Nd:YAG laser irradiation of enamel through unpolymerized total-etch adhesive significantly reduced bond strength compared with the control. Bond strength decreased when enamel samples irradiated with Nd:YAG laser through unpolymerized adhesives were stored in water for 12 months.

Osteointegration of a bisphenol-a-glycidyl-dimethacrylate composite and its use in anterior skull base defects: an experimental study in an experimental design model of cerebrospinal fluid leak.

OBJECT: Promising clinical results were reported in watertight closure of anterior skull base defects (ASBDs) with bisphenol-a-glycidyl-dimethacrylate (bis-GMA)-based materials to prevent the cerebrospinal fluid leaks. However, interrelation of these materials with surrounding bones in histologic level, referred to as the osteointegration, has not been reported in the anterior skull base. In addition, an illustrative case with an ASBD that was repaired using a bis-GMA composite has been presented. METHODS: Twenty New Zealand rabbits were divided into 4 groups: control and sham groups consisted of 2 and 6 rabbits, respectively. The "skull base defect" group (n = 6) underwent a unifrontal craniectomy and an iatrogenic ASBD followed by creating a dural defect to obtain a cerebrospinal fluid leak. Similar bony and dural defects were acquired in the "repair with bis-GMA based allograft" group (n = 6), but the bony defect was closed with bis-GMA-based allograft. RESULTS: All animals in the "skull base defect" group died in 3 weeks after surgery. There were no animal losses in the "repair with bis-GMA based allograft" group at the sixth month. Histologic evaluation revealed complete osteointegration of bis-GMA composite with surrounding bones. CONCLUSIONS: bis-GMA based allograft achieved a watertight repair of the ASBD. Histologic findings of this study showed that bis-GMA composite is a reliable material to be used in the closure of anterior skull base bony defects.

A 12-month clinical evaluation of pit-and-fissure sealants placed with and without etch-and-rinse and self-etch adhesive systems in newly-erupted teeth

OBJECTIVES: The objective of this one-year clinical study was to investigate the effect of two adhesive systems (Adper Single Bond, a two-step etch-and-rinse and Clearfil SE Bond, a two-step self-etch system) on pit-and-fissure sealant retention in newly-erupted teeth. This study compared the success of the sealants in mesial and distopalatal grooves with and without these two adhesive systems. MATERIAL AND METHODS: In a clinical trial, 35 children aged 6-8 years undergoing sealant placement were recruited. This one-year clinical study scored 70 mesial and 70 distopalatal sealants of newly-erupted permanent maxillary first molar, with a split-mouth design. All children received sealant alone in one permanent maxillary molar tooth. Children were randomized into two groups. One group received Self-etch (Se) bond plus sealant and the other group received Single Bond plus sealant in another permanent maxillary molar tooth. Clinical evaluation at 3, 6 and 12 months was performed and the retention was studied in terms of the success and failure. RESULTS: The success rate of sealant in the distopalatal groove, using SeB at 3, 6 and 12 months was 93.3% (95% CI: 68.0, 99.8), 73.3% (95% CI: 44.9, 92.2) and 66.7% (95% CI: 38.4, 88.2), respectively. It was greater than that of the distopalatal groove in SB group with a success rate of 62.5% (95% CI: 35.4, 84.8), 31.3% (95% CI: 11.8, 58.7) and 31.3% (95% CI: 11.8, 58.7), at the three evaluation periods. The success rate of sealant in the mesial groove using SeB was 86.6% (95% CI: 59.5, 98.3), 53.3% (95% CI: 26.6, 78.7) and 53.3% (95% CI: 26.6, 78.7), while this was 100% (95% CI: 79.4, 100.0), 81.3% (95% CI: 54.4, 96.0) and 81.3% (95% CI: 54.4, 96.0) using SB, at 3, 6 and 12-month evaluation periods. CONCLUSIONS: These results support the use of these two bonding agents in pit-and-fissure sealants under both isolated and contaminated conditions. Further, Se bond seemed to be less sensitive to moisture contamination.

Five-year longitudinal assessment of the prognosis of apical microsurgery.

INTRODUCTION: Apical surgery is an important treatment option for teeth with post-treatment apical periodontitis. Knowledge of the long-term prognosis is necessary when weighing apical surgery against alternative treatments. This study assessed the 5-year outcome of apical surgery and its predictors in a cohort for which the 1-year outcome was previously reported. METHODS: Apical microsurgery procedures were uniformly performed using SuperEBA (Staident International, Staines, UK) or mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end fillings or alternatively Retroplast capping (Retroplast Trading, Rorvig, Denmark). Subjects examined at 1 year (n = 191) were invited for the 5-year clinical and radiographic examination. Based on blinded, independent assessment by 3 calibrated examiners, the dichotomous outcome (healed or nonhealed) was determined and associated with patient-, tooth-, and treatment-related variables using logistic regression. RESULTS: At the 5-year follow-up, 9 of 191 teeth were unavailable, 12 of 191 teeth were extracted, and 170 of 191 teeth were examined (87.6% recall rate). A total of 129 of 170 teeth were healed (75.9%) compared with 83.8% at 1 year, and 85.3% were asymptomatic. Two significant outcome predictors were identified: the mesial-distal bone level at ≤ 3 mm versus >3 mm from the cementoenamel junction (78.2% vs 52.9% healed, respectively; odds ratio = 5.10; confidence interval, 1.67-16.21; P < .02) and root-end fillings with ProRoot MTA versus SuperEBA (86.4% vs. 67.3% healed, respectively; odds ratio = 7.65; confidence interval, 2.60-25.27; P < .004). CONCLUSIONS: This study suggested that the 5-year prognosis after apical microsurgery was 8% poorer than assessed at 1 year. It also suggested that the prognosis was significantly impacted by the interproximal bone levels at the treated tooth and by the type of root-end filling material used.

Two-year clinical evaluation of three adhesive systems in non-carious cervical lesions

OBJECTIVES: Adhesive systems are continuously being introduced to Dentistry, unfortunately often without sufficient clinical validation. The aim of this study was to evaluate the clinical performance of cervical restorations done with three different adhesive systems. MATERIAL AND METHODS: 158 non-carious cervical lesions of 23 patients were restored with a nanofilled composite resin (Filtek Supreme, 3M/ESPE) combined with Single Bond (3M/ESPE, group SI), Clearfil SE (Kuraray Medical Inc., group CL) and Xeno III (De Trey Dentsply, group XE). In groups SI-B, CL-B and XE-B, the outer surface of the sclerotic dentin was removed by roughening with a diamond bur before application of the respective adhesive systems. In groups CL-BP and XE-BP, after removal of the outer surface of the sclerotic dentin with the bur, the remaining dentin was etched with 37% phosphoric acid and the self-etch adhesive systems Clearfil SE and Xeno III were applied, respectively. Lesions were evaluated at baseline, and restorations after 3 months, 1 year and 2 years using modified USPHS criteria. RESULTS: After 2 years, no significant difference was found between the retention rates of the groups (p >0.05). Although groups CL and SI showed significantly better marginal adaptation than group XE (p<0.05) at 2 years, no significant difference was found between the marginal adaptation of the groups SI-B, CL-B and XE-B (p>0.05). After 2 years no significant difference was observed among the marginal staining results of all groups (p>0.05). CONCLUSION: Although all adhesive systems showed similar retention rates, Clearfil SE and Single Bond showed better marginal adaptation than Xeno III after 2 years of follow-up.

Comparison of the effect of three mechanical surface treatments on the repair bond strength of a laboratory composite.

OBJECTIVE: This study compared the effects of three mechanical surface treatments, including diamond bur, air-abrasion, and Er, Cr: YSGG laser on the repair bond strength of a laboratory composite resin. BACKGROUND DATA: A proper bonding must be created between the existing composite and the new one for successful repair. MATERIALS AND METHODS: Sixty cylindrical specimens of a laboratory composite resin (Gradia) were prepared and randomly divided into four groups (n = 15). Groups 2-4 were treated with diamond bur, air-abrasion, and Er, Cr: YSGG laser, respectively; group 1 was the control group, without any mechanical surface treatment. The topographical effects of different mechanical surface treatments were characterized by atomic force microscope. Silane and a bonding agent (Single Bond) were used in all of the groups before adding a direct resin composite. Then, the specimens were subjected to a shear bond strength test. Failure modes were evaluated under a stereomicroscope. All data were analyzed by one-way ANOVA and Tukey test at a significance level of p < 0.05. RESULTS: There were statistically significant differences in bond strengths between the groups (p < 0.0005). Differences in bond strengths between group 1 and the other groups were significant (p < 0.0005). Furthermore, there were significant differences in bond strengths between group 2 and groups 3 and 4 (p < 0.0005), while the bond strength differences between groups 3 and 4 were not significant. CONCLUSION: Based on the results of this study, Er, Cr: YSGG laser was confirmed to be as effective as air-abrasion for laboratory composite repair.

Clinical experience using Cortoss for treating vertebral compression fractures with vertebroplasty and kyphoplasty: twenty four-month follow-up.

STUDY DESIGN: Forty patients were enrolled in 2 FDA-approved pilot Investigational Device Exemption (IDE) studies using Cortoss for the treatment of vertebral compression fractures (VCF). Twenty patients were treated at 3 centers, using vertebroplasty (VP) and 20 patients were treated at 5 centers, using kyphoplasty (KP). OBJECTIVE: To assess the feasibility and clinical outcomes using Cortoss to treat osteoporotic VCF. SUMMARY OF BACKGROUND DATA: Cortoss is an injectable bioactive, self-setting, radiopaque composite shown to stabilize and provide immediate weight bearing support to fractured vertebrae. Cortoss is approved for use in Europe for both screw and vertebral augmentation. METHODS.: Patient assessments were conducted before surgery and after surgery through 24 months using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and quality-of-life assessment (SF-12) questionnaires. Extravasations were evaluated using radiographs and CT scans. RESULTS: Immediate pain improvement was seen in VP patients with VAS scores decreasing from 75.7 before surgery to 35.9 at 72 hours. Continued improvement from baseline was seen out to 2 years (average VAS of 48.9). Disability improved with average ODI scores decreasing from 52.2% preoperative to 38.3% at 2 years for VP patients. Immediate pain improvement was also seen in KP patients with VAS scores decreasing from 78.1 before surgery to 42.7 at 72 hours. Continued improvement from baseline was seen out to 2 years (average VAS of 25.4). ODI scores improved from 60.5% preoperative to 34.5% at 2 years for KP patients. Average material volumes injected were 1.85 mL for VP and 4.13 mL for KP. Extravasations from both techniques were minor, anatomically close to the treated vertebrae and asymptomatic. No cardiac irregularities or pulmonary emboli were observed. CONCLUSION: These studies indicate Cortoss is safe and effective in treating osteoporotic VCF using vertebroplasty or kyphoplasty. Pain relief and restoration of function with Cortoss is comparable to results found in the literature for polymethylmethacrylate.

Effectiveness of sealing active proximal caries lesions with an adhesive system: 1-year clinical evaluation

The objective of this study was to evaluate the effectiveness of a therapeutic sealant to arrest non-cavitated proximal carious lesion progression. The study population comprised 44 adolescents who had bitewing radiographs taken for caries diagnosis. Non-cavitated lesions extending up to half of dentin thickness were included in the sample. In the experimental group (n = 33), the proximal caries-lesion surfaces were sealed with an adhesive (OptiBond Solo, Kerr) after tooth separation. The control group (n = 11) received no treatment, except for oral hygiene instructions including use of dental floss. Follow-up radiographs were taken after one year and were analyzed in comparison with baseline radiographs. In a blind study setting, visual readings were performed by two examiners, blinded to whether the examined radiograph was baseline or follow-up, and whether it concerned a test or control lesion. The efficacy of sealing treatment was evaluated by the McNemar test (0.05). About 22 percent of the sealed lesions showed reduction, 61 percent showed no change and 16 percent showed progression. For the control lesions, the corresponding values were 27 percent, 36 percent and 36 percent respectively. The number of lesions that showed reduction and no changes were merged and therefore 83.3 percent of the sealed lesions and 63.6 percent of the control lesions were considered clinically successful. No statistical significance was detected (p > 0.05). In the course of 1 year, sealing proximal caries lesions was not shown to be superior to lesion monitoring.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite.

INTRODUCTION: The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). METHODS: The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS: The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. CONCLUSIONS: MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars.

Treatment of Alzheimer's disease with a cholinesterase inhibitor combined with antioxidants.

A formula (formula F) was prepared to counteract oxidative stress (OS) in the brain. The formula contained the most common antioxidants and was intended to: (a) protect proteins, lipids, DNA and proteoglycans from oxidation (carnosine, coenzyme Q(10), vitamin E, vitamin C, beta-carotene, selenium, L-cysteine and ginkgo biloba); (b) reduce homocysteine (HCy) blood levels (vitamins B(6), B(9) and B(12)), and (c) sustain the pentose phosphate cycle in circulating cells (vitamins B(1), B(2) and B(3)). Formula F contained low doses of each antioxidant component and was administered in a two-phase ampoule. A cohort of 52 patients (21 males and 31 females) affected with moderate probable AD (according to NINCDS-ARDA and NINCS-AIREN criteria) already being treated with donepezil (5 mg/day for at least two months) was randomly divided into two groups, and followed for 6 months. A double-blind design was used in which 26 cases were treated once a day with formula F plus donepezil, and the other 26 with placebo plus donepezil. The level of OS was measured on the basis of a d-ROMs test (which measures plasma hydroperoxides), plasma HCy and glutathione, and percentage of sickle erythrocytes. The two patient groups were comparable for all variables (age, sex, concomitant diseases, ApoE epsilon4, MMSE II score, OS, antioxidant reserve and sickle erythrocytes). Forty-eight subjects completed the trial. Significant decreases in OS and HCy were only observed when there was an increase in glutathione (in erythrocytes) and a decrease in sickle erythrocytes in patients treated with formula F. The MMSE II score remained almost the same in the group treated with donepezil and placebo, whereas some significant improvements were found in the group treated with donepezil plus formula F.

Percutaneous in situ cementation of a loose femoral stem.

This case report describes a patient with aseptic loosening of the femoral component of her total hip arthroplasty 33 years after the initial implantation. The patient was treated with a percutaneous cementation technique using Cortoss (Orthovita, Malvern, Pa) synthetic cortical bone void filler.

Evolución y tendencias actuales en resinas compuestas / Current trends and evolution on dental composites

La introducción de la tecnología de las resinas compuestas dentro de la odontología restauradora, ha sido una de las contribuciones más significativas para la odontología en los últimos veinte años. Las ventajas de las restauraciones adheridas a la estructura dental, incluyen conservación de tejido dental sano, reducción de la microfiltración, prevención de la sensibilidad postoperatoria, refuerzo de la estructura dental y la transmisión / distribución de las fuerzas masticatorias a través de la interfase adhesiva del diente. A pesar de sus ventajas, las resinas compuestas presentan significativas deficiencias en cuanto a su desempeño, sobre todo lo relacionado con la contracción de polimerización y al estrés que esta produce en la interfase diente - restauración. Actualmente, las mejoras en las formulaciones, el desarrollo de nuevas técnicas de colocación y la optimización de sus propiedades físicas y mecánicas, han hecho la restauración de resina compuesta más confiable y predecible. El objetivo principal de este artículo fue analizar los avances en los materiales de restauración de resina compuesta, a través de una exhaustiva revisión de la literatura, donde se valoraron aspectos tales como: composición, clasificación, propiedades físicas y mecánicas, aspectos de manipulación y tendencias actuales de estos materiales

The introduction of composite-based resin technology to restorative dentistry was one of the most significant contributions to dentistry in the last twenty year. The advantages of bonded restorations include conservation of sound tooth structure, reduction of microleakage, prevention of postoperative sensitivity, tooth reinforcement and the transmission / distribution of functional stress across the bonding interface of the tooth. Today, improvements in formulations, development of new placement techniques and the optimization of physical and mechanicals properties had made the direct composite restoration more reliable and predictable. The main objective of this article was analyzing the advances of resin composites restoration material. Trought an exhaustive literature revision. Valuing aspect as composition, classification, phisycal and mechanical properties, manipulation and current trends of this material.

Augmented pin fixation with Cortoss for an unstable AO-A3 type distal radius fracture in a patient with a manifest osteoporosis.

Distal radius fractures are one of the most common fractures in the elderly females. In this article, we report a case of a distal radius fracture type AO-A3 with dorsal instability, in an older woman with manifest osteoporosis, treated with minimally invasive Cortoss composite and FFS-wires(R). A 63-year-old woman sustained an unstable distal radial fracture of her left wrist after falling from a kitchen step. She underwent an open reduction of the fracture and fixation with two crossed-fixation pins and Cortoss composite. Post-operative plaster cast immobilization was given for 2 weeks, after which the plaster cast and the fixation pins were removed. At 4 weeks follow-up, she had a good functional result of her left wrist, after 11 months there was a complete return of grip strength with also, except for the palmar flexion, a full return of function. We report here the first case of a successful surgical treatment with Cortoss composite of an AO-A3 type distal radius fracture.

The safety and efficacy of vertebroplasty using Cortoss cement in a newly established vertebroplasty service.

Vertebroplasty provides an effective means of treating painful vertebral lesions although the majority of the literature relates to vertebroplasty using PMMA cement. The purpose of this study is to assess the safety and efficacy of vertebroplasty using Cortoss, a recently developed bis-GMA resin. Our newly established vertebroplasty service exclusively uses Cortoss cement and has a patient database which is updated on a regular basis using the medical records. To date, there are 34 patients on this database, mean age 66, in whom a vertebroplasty has been performed on 42 vertebral lesions with a mean of 2.2 ml of Cortoss injected into each lesion. The mean duration of follow up was 9.5 months. Eighty-two per cent of patients reported an improvement in their symptoms, while 79% required less analgesia post vertebroplasty. A total of 88.2% experienced no significant complications. In 38% there was an asymptomatic leakage of Cortoss. Four patients (11.8%) experienced significant complications: one asymptomatic PE, one episode of transient radicular leg pain, one generalized rash and one patient suffered retropulsion of the Cortoss due to further vertebral malignancy. Cortoss vertebroplasty provides comparable efficacy and safety to the published literature for PMMA.