Assessment of pleural pressure during sleep in Marfan syndrome.

STUDY OBJECTIVES: Patients with Marfan syndrome (MFS) have a high risk for aortic aneurysms. They are also susceptible to sleep-disordered breathing that may expose them to highly negative intrathoracic pressures known to increase aortic transmural pressure, which may accelerate aortic dilatation. Our objective was to quantify overnight intrathoracic pressure changes during sleep in snoring patients with MFS and the therapeutic effect of continuous positive airway pressure (CPAP). METHODS: We used a questionnaire to identify self-reported snoring patients with MFS. In these patients, we monitored intrathoracic pressure using esophageal pressure (Pes) during overnight baseline and CPAP sleep studies. We defined a peak-inspiratory Pes (Pespeak-insp) < - 5 cm H2O as greater than normal and examined the distribution of Pespeak-insp during baseline and CPAP studies. RESULTS: In our sample of 23 snorers with MFS, we found that 70% of sleep breaths exhibited Pespeak-insp < -5 cm H2O, with apnea/hypopneass accounting for only 12%, suggesting prevalent stable flow-limited breathing and snoring. In a subset (n = 12) with Pes monitoring during a CPAP night, CPAP lowered the mean proportion of breaths with Pespeak-insp < -5 cm H2O from 83.7% ± 14.9% to 3.6% ± 3.0% (P < .001). In addition, contemporaneous aortic root diameter was associated with the mean Pespeak-insp during inspiratory flow-limited breathing and apneas/hypopneas (ß = -0.05, r = .675, P = .033). CONCLUSIONS: The sleep state in MFS revealed prolonged exposure to exaggerated negative inspiratory Pes, which was reversible with CPAP. Since negative intrathoracic pressure can contribute to thoracic aortic stress and aortic dilatation, snoring may be a reversible risk factor for progression of aortic pathology in MFS. CITATION: Sowho M, Jun J, Sgambati F, et al. Assessment of pleural pressure during sleep in Marfan syndrome. J Clin Sleep Med. 2022;18(6):1583-1592.

Clinical and OCT assessment of application modes of a universal adhesive in a 12-month RCT.

OBJECTIVES: To evaluate a universal adhesive clinically using FDI criteria and by optical coherence tomography (OCT). METHODS: In 50 patients, three or four non-carious cervical lesions (NCCL) were restored with composite (Venus® Diamond Flow, Kulzer) using iBond® Universal (iBU, Kulzer) applied in self-etch (iBU-SE, n = 50), selective-enamel-etch (iBU-SEE, n = 29) or etch-and-rinse mode (iBU-ER, n = 50) and the reference OptiBond™ FL (OFL, Kerr, n = 50). Restorations were imaged by SD-OCT. The weighted mean length of interfacial adhesive defects (AD, %) was quantified per restoration immediately after placement (t0), simultaneously with clinical assessment (FDI criteria) after 14 days (t1), 6 (t2) and 12 months (t3). Data were statistically analyzed (McNemar-/Wilcoxon-/Mann-Whitney-U test (α = 0.05), Kaplan-Meier survival curves). RESULTS: After 12 months, cumulative failure rates were lower with iBU-SE (0.0%; p = 0.016), iBU-SEE (0.0%; p = 0.125), and iBU-ER (2.1%; p = 0.070; loss t3) compared to OFL (16.7%; losses t2, t3). Generally, marginal adaptation decreased (pi < 0.001) and marginal staining increased (pi ≤ 0.031), without significant group differences (pi > 0.064). AD increased in all groups (pi < 0.001). At enamel, AD appeared more extended with iBU-SE vs. iBU-SEE (t2-t3; pi ≤ 0.005), iBU-ER (t1-t3; pi ≤ 0.051) and OFL (t0-t3; pi ≤ 0.018). At dentin/cement iBU generally caused fewer defects than OFL (t1-t3; pi ≤ 0.010) and with SE vs. ER (t2-t3; pi = 0.010). CONCLUSIONS: In NCCLs, iBU generally provides a more durable bond than OFL. Recommended mode is SEE. Clinic and OCT provided comparable results. OCT has higher statistical power, shows group differences earlier and specifically for the different hard tooth tissues. CLINICAL SIGNIFICANCE: The universal adhesive iBU was superior against the reference OFL in NCCLs. It can be recommended with SEE. Evaluation of interfacial adhesive defects by OCT seems to allow early prediction of adhesives' clinical performance.

Light-based diagnostic methods for the in vivo assessment of initial caries lesions: Laser fluorescence, QLF and OCT.

OBJECTIVES: To evaluate different light-based caries diagnostic methods for assessment of non-cavitated initial carious lesions on smooth surfaces. METHODS: 39 participants were included. For each participant, three regions of interest (ROI) with ICDAS codes 0, 1 or 2 were defined. All ROIs (n = 117) were investigated/imaged with laser fluorescence (LF, DIAGNOdent 2095; KaVo dental GmbH), quantitative light-induced fluorescence (QLF; Biluminator 2+, Inspektor Research Systems B.V.) and spectral-domain optical coherence tomography (SD-OCT; Telesto II, Thorlabs GmbH). The values of LF, ΔF of QLF, and the lesion extent assessed by OCT were categorized. Frequency distribution of LF-/QLF- and OCT-scores was determined for each ICDAS code included. Inter- and intra-examiner reproducibility of QLF and OCT measurements were assessed by unweighted kappa coefficient (ĸ) and Wilcoxon test (α = 0.05). RESULTS: Compared with LF and QLF, OCT showed various manifestations of carious lesions for visually sound ROIs and a larger variation of caries extent in depth within the same ICDAS code groups. Intra-examiner reproducibility ranged between 0.49 and 1.00 for the QLF analysis and between 0.95 and 0.99 for the OCT analysis. Inter-examiner reproducibility ranged between 0.17 and 0.32 for the QLF analysis and between 0.65 and 0.79 for the OCT analysis. CONCLUSION: LF and QLF were insensitive to less pronounced smooth-surface lesions while OCT allowed differentiation based on the penetration depth of the carious lesions. This makes OCT a suitable method to complement conventional visual inspection in order to detect and assess (very) early lesions.

Is There an Association Between Clinical and SEM Quantitative Marginal Analysis in a 90-month Trial?

PURPOSE: To assess possible correlations between clinical outcomes and SEM marginal analysis in a prospective long-term clinical study using two adhesives in incisors and canines. Materials and Methods: Thirty-five patients received class III and IV restorations with two different adhesives, either the one-step self-etch adhesive iBond Gluma inside (1-SE) or the two-step etch-and-rinse adhesive Gluma Comfort Bond (2-ER) combined with the fine particle hybrid composite Venus. The restorations were clinically evaluated (modified USPHS criteria) over 90 months. Based on resin replicas, a quantitative marginal SEM analysis was performed using the criteria "gap", "perfect margin", "overhang", and "underfilled". The results of the quantitative marginal analysis were statistically compared and related to clinical evaluations. The SEM data were analyzed statistically using the Kolmogorov-Smirnov test, Wilcoxon test, and mixed models test. Results: Of the 35 subjects at baseline, 16 (1-SE) and 17 (2-ER) were clinically re-examined after 90 months. 13 patients were included in the SEM analysis due to uninterrupted documentation over 90 months or until restoration loss. SEM analysis showed larger discriminative power between groups than did the clinical examination, but the trend was the same. Marginal analysis ("gap", "perfect margin") showed significant differences between the materials after 12 months, which clinically began to show a trend from 12 months, and were statistically verified after 48 and 90 months. "Overhang" and "underfilled" did not reveal significant differences between the systems or over time. Conclusion: SEM marginal analysis using the replication technique is a powerful tool to reveal differences between adhesives. Compared to clinical evaluation, group differences can be detected earlier, with both outcome parameters confirming each other over long observation periods.

An Intraoral OCT Probe to Enhanced Detection of Approximal Carious Lesions and Assessment of Restorations.

Caries, the world's most common chronic disease, remains a major cause of invasive restorative dental treatment. To take advantage of the diagnostic potential of optical coherence tomography (OCT) in contemporary dental prevention and treatment, an intraorally applicable spectral-domain OCT probe has been developed based on an OCT hand-held scanner equipped with a rigid 90°-optics endoscope. The probe was verified in vitro. In vivo, all tooth surfaces could be imaged with the OCT probe, except the vestibular surfaces of third molars and the proximal surface sections of molars within a "blind spot" at a distance greater than 2.5 mm from the tooth surface. Proximal surfaces of 64 posterior teeth of four volunteers were assessed by intraoral OCT, visual-tactile inspection, bitewing radiography and fiber-optic transillumination. The agreement in detecting healthy and carious surfaces varied greatly between OCT and established methods (18.2-94.7%), whereby the established methods could always be supplemented by OCT. Direct and indirect composite and ceramic restorations with inherent imperfections and failures of the tooth-restoration bond were imaged and qualitatively evaluated. The intraoral OCT probe proved to be a powerful technological approach for the non-invasive imaging of healthy and carious hard tooth tissues and gingiva as well as tooth-colored restorations.

OCT assessment of non-cavitated occlusal carious lesions by variation of incidence angle of probe light and refractive index matching.

OBJECTIVES: This study evaluated (1) the detection and assessment of non-cavitated occlusal carious lesions by spectral domain optical coherence tomography (SD-OCT) and (2) the impact of varying angle of incidence (AI) of probe light and refractive index matching (RIM). METHODS: Nine extracted human molars with 18 occlusal lesions (ICDAS code 2) were visually selected. 18 regions of interest (ROI) were imaged with SD-OCT under varying AI (0°, ±5°, ±10°, ±15°) and with/without application of glycerine at 0°. X-ray micro computed tomography (µCT) was used as a validation standard. µCT and OCT signals were categorized according to the lesion extent: 1-sound, 2-lesion limited to half of enamel, 3-lesion limited to enamel, 4-lesion into dentin. Agreement between both methods was assessed. Intra- and inter-examiner reproducibility analyses were conducted. STATISTICS: Cohen's kappa coefficient (κ), Spearman's rho correlation (rs) and Wilcoxon test (α=0.05). RESULTS: Slight to moderate agreement (κ=0.153) between µCT and OCT was obtained at an AI of 0° (Wilcoxon: p=0.02). With variation of Al a substantial agreement (κ=0.607) was observed (p=0.74). Spearman's correlation between both methods was 0.428 at 0°, 0.75 with varying AI and 0.573 with glycerine. Kappa values for intra-and inter-examiner analysis ranged between 0.81 and 0.88 and between 0.25 and 0.73, respectively. CONCLUSION: Variation of AI improves the detectability of non-cavitated occlusal carious lesions. RIM can enhance signal-to-noise ratio. CLINICAL RELEVANCE: OCT could provide additional diagnostic information in single and longitudinal assessments of occlusal carious lesions.

Assessment of defects at tooth/self-adhering flowable composite interface using swept-source optical coherence tomography (SS-OCT).

OBJECTIVES: Assessment of adhesive defects of a self-etch adhesive and a self-adhering flowable composite at the tooth/composite interface before and after water storage by optical coherence tomography (OCT). METHODS: 16 extracted human molars (n=8 each) with box-shaped, class-V cavities were restored either with an experimental self-adhering flowable composite (EF, DMG) or with the filling system Adper™ Prompt™ L-Pop™/Filtek™ Supreme XT Flowable composite (PLP, 3M ESPE). Restorations of both groups were non-invasively imaged using swept-source OCT before and after storage in water. The OCT signal for adhesive defects at the tooth/composite interface was quantified. RESULTS: At enamel, significantly fewer adhesive defects were detected at EF restorations than at PLP restorations, before water storage (4%/48%, p<0.001) and thereafter (8%/49%, p<0.001); in contrast, at dentin more interfacial defects were observed with EF (before water storage: 75%/11%; p<0.001, after water storage: 77%/52%; pi=0.001). In the case of slight initial adhesive defects, water storage caused a statistically verifiable increase in adhesive defects at the enamel interface with EF (before/after storage: 4%/8%; p=0.023) and at dentin with PLP (before/after storage: 11%/52%; p=0.008). SIGNIFICANCE: Given the high proportion of adhesive defects with the experimental self-adhering flowable composite, its use as the definitive restorative material in class-V cavities must be critically scrutinized and clinical indications must be investigated further with in vitro and in vivo trials.

Assessment of interfacial defects at composite restorations by swept source optical coherence tomography.

ABSTRACT. In clinical dental practice, it is often difficult or even impossible to detect and assess interfacial adhesive defects at adhesive restorations by means of visual inspection or other established diagnostic methods. However, nondestructive optical coherence tomography (OCT) may provide a better picture in this diagnostic scenario. The aim of this study was to evaluate the suitability of swept source OCT (SS-OCT) for the nondestructive assessment of interfacial deficiencies at composite restorations and the evaluation of cohesive defects within composite material. Ten class V composite restorations that were not adhesively luted were taken as validation objects and examined for frequency of interfacial gaps, air entrapments, and defects between composite layers using SS-OCT with a 1325-nm center wavelength. Light microscopy was used to inspect for inherent structures. SS-OCT detected 79.5%±1.8% of the total gap lengths at the enamel interface and 70.9%±0.4% at the dentin interface. Additionally, defective structures in composite restorations were displayed. It was shown that OCT imaging has the potential to nondestructively assess the interfacial adaptation of composite restorations and to detect internal defects in the layered composite material.