Development of Vancomycin Dose Individualization Strategy by Bayesian Prediction in Patients Receiving Continuous Renal Replacement Therapy.

PURPOSE: Vancomycin (VCM) concentration is often out of therapeutic range (10-20 µg/ml) in patients receiving continuous renal replacement therapy (CRRT). The purposes of this study were to develop a practical VCM population pharmacokinetic (PPK) model and to evaluate the potential of Bayesian prediction-based therapeutic drug monitoring (Bayes-TDM) in VCM dose individualization for patients receiving CRRT. METHODS: We developed a VCM PPK model using 80 therapeutic concentrations in 17 patients receiving CRRT. Bayes-TDM with the VCM PPK model was evaluated in 23 patients after PPK modeling. RESULTS: We identified the covariates reduced urine output (RUO, <0.5 ml/kg/h) and effluent flow rate of CRRT for the VCM PPK model. The mean VCM non CRRT clearance (CLnonCRRT) was 2.12 l/h. RUO lowered CLnonCRRT to 0.34 l/h. The volume of distribution was 91.3 l/70 kg. The target concentration attainment rate by Bayes-TDM was higher (87.0%) than that by the PPK modeling period (53.8%, P = 0.046). The variance of the second measured concentrations by the Bayes-TDM was lower (11.5, standard deviation: 3.4 µg/ml) than that by the PPK modeling period (50.5, standard deviation: 7.1 µg/ml, P = 0.003). CONCLUSIONS: Bayes-TDM could be a useful tool for VCM dose individualization in patients receiving CRRT.

A Randomized Phase 2 Trial of Antibiotic Prophylaxis Versus No Intervention for Muscle Biopsy in A Neurology Department.

Muscle biopsy can be used to confirm the diagnosis of neuromuscular diseases. However, it is unclear whether antibiotic prophylaxis prior to muscle biopsy is needed to prevent surgical site infection (SSI). We are conducting a phase 2, single-center, open-labeled, prospective randomized trial to clarify the need for antibiotic prophylaxis in patients at low risk for SSI undergoing muscle biopsy. Patients will be randomized to an antibiotic prophylaxis group or a control group, and the incidence of SSI will be compared between the groups. Our findings will clarify the need for antibiotic prophylaxis in this patient population.

Fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal clasps for removable partial dentures.

With the rapid development of computer-aided design/computer-aided manufacturing (CAD/CAM) systems, the application of zirconia in removable partial dentures is expected to expand. Clasps composed of zirconia should improve esthetics without inducing the risk of metal allergy. The aim of this study was to examine the fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) clasps for removable partial dentures. Yttria-stabilized tetragonal zirconia polycrystal and cobalt-chromium (Co-Cr) alloy were prepared using CAD/CAM systems. Specimens were either of the semicircular type or of the flat type, with cross-sectional areas of taper ratios of 0.50, 0.75, and 1.00. All specimens were tested using the cantilever test and the constant displacement fatigue test, and data were analyzed using ANOVA. During the cantilever test, the maximum displacement prior to fracture was greater than the required undercut, and the semicircular-type specimen exhibited a higher fracture load than the flat type. None of the specimens displayed permanent deformation and showed almost the same degree of deformation after fatigue testing. A lower taper ratio was associated with lower average load values and greater displacement. Within the limitations of this study, it was possible to conclude that Y-TZP provides the required undercut and adequate retentive force for removable partial denture clasps. Additionally, Y-TZP and Co-Cr alloy had almost the same degree of deformation even after the simulated lifespan of removable partial dentures.

Technique to Confirm Occlusal Contact Using an Articulating Paper Holder Equipped with Tongue Depressor.

This technical report describes a simple procedure for verifying occlusal contact with the use of a new device that combines the functions of a tongue depressor and an articulating paper holder. Verifying occlusal contact and/or the maxillomandibular relationship record can be expected to be simpler and easier with this device compared to the conventional holder, especially for patients with tongue hypertrophy or obesity and those treated under general anesthesia, among others.

Longevity of resin-bonded fixed partial dental prostheses made with metal alloys.

OBJECTIVES: The purpose of this study was to evaluate the clinical performance of resin-bonded fixed partial dental prostheses (RBFPDPs) made with metal alloys. MATERIALS AND METHODS: The retention of 311 RBFPDPs from 226 patients fabricated from 1983 to 2013 using an adhesive resin was clinically evaluated. Partial or complete debonding of the RBFPDP or framework fracture was considered a treatment failure. All data were obtained from clinical examinations, and missing data were censored at the date of the last available information. The effect of the following factors on survival rate were investigated: patient gender, location (maxilla/mandible and anterior/posterior), number of missing teeth, number of abutment teeth, framework structure, type of metal alloy, patient age at the point of cementation, cement type, and distinction of the treating dentist. Data were analyzed with the Kaplan-Meier survival tests, log-rank tests, and Cox regression analyses (α = 0.05). RESULTS: The Kaplan-Meier survival rate was 41.2 % ± 6.5 % (standard error) at 28.8 years (last outcome event). Significant differences were found for patient age and treating dentist (p < 0.05). The risk of failure in younger patients was 1.7 times greater than that in older patients and that of inexperienced dentists was 2.0 times greater than that of dentist experienced and specialized in adhesive dentistry. CONCLUSIONS: When fabricating RBFPDPs for younger patients, mechanical preparation for bonding may be necessary in consideration of the risk for debonding. Experienced dentists may achieve better results. CLINICAL RELEVANCE: Mastery of skills is necessary to ensure excellent prognoses for RBFPDPs.

A direct bonded fixed partial dental prosthesis: a clinical report.

A direct bonded fixed partial dental prosthesis, with a composite resin denture tooth as a pontic, a tri-n-butylborane initiated adhesive resin, and screw posts for reinforcement, was still functioning after an observation period of 20 years. The prosthesis was found to be reliable for long-term clinical use when chemically and mechanically reinforced.

Clinical use of duplicate complete dentures: A narrative review.

Most reports on duplicate dentures are introduction to fabrication methods or clinical case reports. Only a few studies have verified their clinical effectiveness; hence, evidence to construct useful clinical guidelines for duplicate denture use is lacking. This review aimed to comprehensively investigate reports on duplicate dentures to accumulate evidences that will contribute to the formulation of clinical practice guidelines. Duplicate dentures are effectively used for impression making and bite registration when fabricating new dentures, thereby reducing the number of clinic visits and treatment time. Duplicate denture can also be used as temporary or new dentures. Older people in whom various adaptive abilities have declined, may find it difficult to adjust to new dentures and experience stress, even if the shape is appropriate. Duplicate dentures, which reproduces the shape of old dentures that they are used to, have the advantage of being more familiar to older people and less stressful. When manufacturing duplicate dentures, digital methods such as milling and three-dimensional printing are superior to conventional methods regarding working time and cost. A notable advantage of the digital method is that the denture shape can be saved as digital data, and the denture can be easily duplicated if lost.

Improvement of drug-induced gingival overgrowth and cerebrovascular related dementia after dental treatments.

Drug-induced gingival overgrowth can occur as a side effect of specific drugs and lead to poor oral function. Appropriate dental management of the overgrowth may improve oral function and improve cognitive deficits after cerebrovascular accidents.

Properties of indirect composites reinforced with monomer-impregnated glass fiber.

Sufficient flexural strength is required for long-term clinical use of fixed partial dentures made with fiber-reinforced composite. The flexural strengths of indirect composite materials reinforced with a monomer-preimpregnated glass fiber material were determined to evaluate the compatibility of the composites to glass fiber material. Four types (microhybrid, nanohybrid, microfilled, and minifilled) of indirect composites and a unidirectional long glass fiber material were selected for investigation. The composites were placed on a fiber plate and polymerized in accordance with the respective manufacturer's instructions. Rectangular bar fiber-composite specimens were machined and the flexural strength was calculated. The flexural strength of each indirect composite was also measured. The microfilled composite with the lowest filler content (70 wt%) exhibited the highest increase ratio using the fiber, although its strength without fiber reinforcement was the lowest (62.1 MPa). The fiber-microhybrid specimen demonstrated the highest mean strength (355.9 MPa), although the filler content of the microhybrid composite was comparatively low (73 wt%). The type of composite material should be considered for the selection of an optimal fiber-composite combination.

Dental treatment under intravenous sedation prolongs longevity of a fixed prosthesis in patients with intellectual disabilities.

AIMS: This study aimed to assess the longevity of a fixed prosthesis in patients with intellectual disability (ID) and to investigate the risk factors associated with the failure of a prosthesis due to abutment tooth extraction or prosthesis dislodgement or removal. METHODS: We studied past medical records to evaluate the longevity of 315 prostheses that were luted in 76 patients with ID. We calculated the survival rates and assessed 15 variables potentially associated with prosthetic failure using multivariate Cox regression analyses with shared frailty for patients. RESULTS: Three-quarters of our sample population had severe or profound ID. The maximum observation period was 31.0 years, and the corresponding survival ratio was 32.5%; the survival ratio at 10 years was 59.4%. The use of intravenous sedation significantly influenced the success of the prosthesis, with the hazard ratio (HR) being 0.49 times that of conventional treatment without behavior-altering drug therapy. The most significant risk factor for prosthetic failure was age at placement; the HR for patients aged ≥31 years was 2.82 times that for patients aged ≤ 20 years. CONCLUSIONS: In patients with severe ID, appropriate intravenous sedation was effective in prolonging the longevity of a fixed prosthesis.

Longevity of resin-bonded fixed partial dentures made of metal alloys: A review of the literature.

Purpose In this review, we evaluate the survival rate of resin-bonded fixed partial dentures (RBFPDs) made of metal alloys.Methods An electronic search of English peer-reviewed dental literature on PubMed was conducted to identify all publications reporting on RBFPDs made of metal alloys until March 2019. The searched keywords were: bridge OR fixed partial denture OR fixed prosthesis OR fixed prostheses AND resin bonded AND metal OR alloy AND survival OR longevity (RBFPD was not included). Furthermore, the "Related Articles" feature of PubMed was used to identify further references of interest during the primary search. A definitive list of articles was screened to extract qualitative data after the application of the inclusion and exclusion criteria, and the results were analyzed.Results Overall, 977 publications were found through an electronic and manual search, out of which 130 articles were selected after screening based on title and abstract. A total of 52 publications passed the second review phase after assessment for eligibility, from which 24 studies were excluded after full-text screening. Finally, a total of 28 studies were selected.Conclusions The survival rate of RBFPDs differed greatly depending on the type of metal alloy, adhesion system, and observation period assessed, e.g. the 10-year survival rate ranged from 18% to 88%. The wide range of survival rates of the RBFPDs reported indicates that though RBFPD is a reliable prosthesis, it is prone to failure if some processes are not completed.

A prospective clinical evaluation of fixed dental prostheses made of metal alloys in patients with cerebral palsy.

BACKGROUND: In general, the prevalence of caries and other oral and dental issues is increased in patients with disabilities, such as those with cerebral palsy. Providing appropriate dental treatment at a primary dental clinic for patients with cerebral palsy and intellectual disability, among other conditions, is challenging. OBJECTIVE: The objective of this study was to evaluate the longevity and investigate the related prognostic factors of fixed prostheses in patients with cerebral palsy. METHODS: The records of 36 cerebral palsy patients were used for collecting and analyzing data. A total of 155 prostheses made from metal alloys were finally included in this study. Annual failure rates were calculated; patient- and tooth-related variables associated with prosthesis failure were assessed by a multivariate Cox-regression analysis and frailty models to introduce random effects. RESULTS: The 10-year prosthesis survival rate was 62% and the 20-year survival rate was 36%. In terms of prosthesis-related variables, the type of prosthesis had a significant effect, and the hazard ratio of fixed partial dentures was 2.32 times that of single-unit crowns. In terms of patient-related variables, the presence of epilepsy had a significant effect on survival, and the hazard ratio for comorbid epilepsy was 3.76 times that for those without comorbid epilepsy. CONCLUSIONS: Our findings suggested that fixed prostheses placed in patients with cerebral palsy might have a particularly low survival rate in cases with comorbid epilepsy. It might also be important to consider the type and/or design of the prosthesis carefully to ensure a better prognosis.

Direct bonded fixed partial denture with an artificial denture tooth as a pontic.

Background: The present review aimed to investigate the feasibility and clinical effectiveness of a direct bonded fixed partial denture (DBFPD) based on available literature. The efficiency of a DBFPD is mainly affected by the type of artificial denture tooth, the type of luting agent, and the adhesive preparation. Methods: The parameters were reviewed based on the in vitro and in vivo studies conducted. An acrylic resin tooth or a composite resin tooth for removable dentures should be used as the artificial tooth for the pontic. Results: Considering the luting agent, a methyl methacrylate-based resin luting agent, which has low mechanical strength but is capable of plastic deformation and could sustain for a long time, should be used. Appropriate pre-adhesive treatment should be performed on both the artificial and abutment teeth. The cases in which a DBFPD can be applied are limited to one missing anterior tooth, as long as it is not overstressed. Patient cooperation in cases of occlusion seems to be another prerequisite. Conclusion: Knowledge and selection of the material and case indications are essential, and patient cooperation is pertinent in studying the long-term prognosis of a DBFPD.

Evaluation of the effects of three pretreatment conditioners and a surface preparation system on the bonding durability of composite resin adhesive to a gold alloy.

This study aimed to evaluate the effect of three pretreatment conditioners and surface preparations on a composite resin adhesive for a gold alloy. Cast disk specimens were made and bonded with RelyX Unicem luting agent under six surface conditions: 1) polished with No.600 carbide paper, 2) air-abraded with alumina, 3) Alloy Primer metal conditioner was applied after alumina-abrasion, 4) Monobond Plus multipurpose conditioner was applied after alumina-abrasion, 5) M. L. Primer metal conditioner was applied after alumina-abrasion, and 6) Rocatec multipurpose silica-coating system was applied. The bond strengths were determined before and after thermocycling (50,000 cycles). The bond strengths of the alumina-abrasion group were significantly decreased after thermocycling. The Rocatec and M. L. Primer exhibited higher bond strengths than other treatments. The application of metal conditioners and multipurpose surface preparations was recommended for improved bonding between the evaluated adhesive resin and gold alloy.

Bond strength of poly(methyl methacrylate) denture base material to cast titanium and cobalt-chromium alloy.

PURPOSE: The shear bond strength of an auto-polymerizing poly(methyl methacrylate) denture base resin material to cast titanium and cobalt-chromium alloy treated with six conditioning methods was investigated. MATERIALS AND METHODS: Disk specimens (10 mm in diameter and 2.5 mm in thickness) were cast from pure titanium and cobalt-chromium alloy. The specimens were wet ground to a final surface finish of 600 grit, air dried, and treated with the following bonding systems: 1) air abraded with 50-70-microm-grain alumina (SAN); 2) air abraded with 50-70-microm-grain alumina + conditioned with Alloy Primer (ALP); 3) air abraded with 50-70-microm-grain alumina + conditioned with AZ Primer (AZP); 4) air abraded with 50-70-microm-grain alumina + conditioned with Estenia Opaque Primer (EOP); 5) air abraded with 50-70-microm-grain alumina + conditioned with Metal Link Primer (MLP), and 6) treated with ROCATEC system (ROC). A denture base material (Palapress Vario) was then applied to each metal specimen. Shear bond strengths were determined before and after 10,000 thermocycles. RESULTS: The strengths decreased after thermocycling in all combinations. Among the treatment methods assessed, groups 2 and 4 showed significantly (p < 0.05) enhanced shear bond strengths for both metals. In group 4, the strength in MPa (n = 7) after thermocycling for cobalt-chromium alloy was 38.3, which was statistically (p < 0.05) higher than that for cast titanium (34.7). CONCLUSION: Air abrasion followed by the application of two primers containing a hydrophobic phosphate monomer (MDP) effectively improved the strength of the bond of denture base material to cast titanium and cobalt-chromium alloy.

Effects of triazine dithione and hydrophobic phosphate monomers on bonding to Ag-Pd-Cu-Au alloy and titanium with a methacrylic resin-based luting agent.

PURPOSE: The purpose of the current study was to evaluate the effects of thione and phosphate functional monomers on bond strength and durability of a methacrylic resin luting agent joined to silver-palladium based alloy and titanium. MATERIALS AND METHODS: Disk specimens of two different sizes (10 mm and 8 mm in diameter by 2.5 mm thickness) were prepared from silver-palladium-copper-gold (Ag-Pd-Cu-Au) alloy and titanium. The specimens were ground with abrasive paper, and divided into four groups based on the following conditions: 1) unprimed control; 2) priming with Alloy Primer (thione and phosphate); 3) priming with Estenia Opaque Primer (phosphate); and 4) priming with VPrimer (thione). The disks were bonded with tri-n-butylborane (TBB)-initiated resin, and shear bond strengths were determined both before and after thermocycling. RESULTS: The Alloy Primer and V-Primer agents containing a triazine dithione monomer (VTD) bonded the Ag-Pd-Cu-Au alloy, whereas the Alloy Primer and Estenia Opaque Primer agents containing a hydrophobic phosphate monomer (MDP) bonded titanium. The reduction in bond strength after 20,000 thermocycles was not remarkable for the two groups (Alloy Primer and Ag-Pd-Cu-Au alloy; V-Primer and Ag-Pd-Cu-Au alloy). CONCLUSION: The thione monomer was effective in bonding the Ag-Pd-Cu-Au alloy, whereas the phosphate monomer was useful for bonding titanium. The thione did not interfere with the bonding of MDP to titanium, and MDP did not negatively affect bonding of VTD to the Ag-Pd-Cu-Au alloy. The combinations of two thione primers and the Ag-Pd-Cu- Au alloy exhibited the best adhesive performance within the limitations of the current experiment.

Adhesive bonding of zirconia with single-liquid acidic primers and a tri-n-butylborane initiated acrylic resin.

PURPOSE: The purpose of the current study was to evaluate the effect of acidic primers on the bond strength and durability of an acrylic resin luting agent to zirconia. MATERIALS AND METHODS: Disk specimens were fabricated from zirconia partially stabilized with yttrium oxide (Katana, Noritake Dental Supply). The disks were treated with one of the following acidic primers: Acryl Bond (Shofu), All Bond II Primer B (Bisco), Alloy Primer (Kuraray), Estenia Opaque Primer (Kuraray), Eye Sight Opaque Primer (Kanebo), M.L. Primer (Shofu), MR. Bond (Tokuyama Dental), or Super-Bond Liquid (Sun Medical). Unprimed specimens served as the control. The disks were bonded with a tri-n-butylborane (TBB)-initiated acrylic resin. Shear bond strengths were determined both before and after 10,000 thermocycles (5°C and 55°C, 1 min dwell time each). RESULTS: The pre-thermocycling bond strength ranged from 0.7 MPa to 30.8 MPa, whereas post-thermocycling bond strength varied from 0.3 MPa to 17.6 MPa. The significantly highest post-thermocycling bond strength was obtained when using the Alloy Primer and Estenia Opaque Primer agents. CONCLUSION: Within the limitations of the current experiment, it can be concluded that application of either the Alloy Primer or the Estenia Opaque Primer, both of which contain 10-methacryloyloxydecyl dihydrogen phosphate (MDP), is recommended for bonding the Katana zirconia material with TBB-initiated acrylic resin.

Evaluation of single liquid primers with organic sulfur compound for bonding between indirect composite material and silver-palladium-copper-gold alloy.

The purpose of this study was to evaluate the effect of primers on bonding between a silver-palladium-copper-gold alloy and an indirect composite material. Cast disks were air-abraded with alumina, conditioned with one of five primers (Alloy Primer, Luna-Wing Primer, Metal Primer II, Metaltite, M.L. Primer), and bonded with a light-activated indirect composite. Shear bond strengths were determined after 20,000 times of thermocycling. The results showed that four of the primers, except the Luna-Wing Primer, were effective in enhancing the bond strength as compared with the unprimed control group. Of these four primers, Alloy Primer, Metal Primer II, and M.L. Primer exhibited significantly greater bond strengths. It can be concluded that the effectiveness of primers varies considerably according to the organic sulfur compounds added to the solvent, and that care must be taken in selecting priming agents for bonding the composite material and the silver-palladium-copper-gold alloy.

Effect of preliminary irradiation on the bond strength between a veneering composite and alloy.

The shear bond strength of a veneering composite (Solidex) and silver-palladium-copper-gold alloy (Castwell M.C.12) was evaluated for different duration times and irradiance for preliminary photo-polymerization. A veneering composite was applied onto a cast disk. Preliminary photo irradiation was performed using different duration times or irradiance. After final polymerization, the bond strength and the spectral distribution of each curing unit were determined. Shear bond strength was significantly higher for 90 s (12.4 MPa), than that for 0 s (8.3 MPa). With regard to the effect of irradiance, that from Solidilite (11.4 MPa) was significantly higher than that from Sublite S at 3 cm (8.7 MPa). The irradiance of Hyper LII and Sublite S at 3 cm was higher than Sublite S at 15 cm or Solidilite unit. Long time irradiation and low intensity is effective for preliminary irradiation in order to enhance the bond strength.

Study on the preventive effect of ramelteon on the onset of sleep disorder after general anesthesia in patients with autism spectrum disorder: A study protocol.

BACKGROUND: The persistent loss of consciousness caused by general anesthesia without the existence of repeated 90-minute cycles of non-REM and REM sleep might significantly disturb and suppress the cycle of normal physiological sleep in postoperative periods after general anesthesia. Patients with autism spectrum disorders (ASD) with existing circadian rhythm disorder are reported to rapidly deteriorate due to acute sleep disorder during the perioperative period after general anesthesia.A melatonin receptor agonist, ramelteon (Rozerem), which is a sleep cycle regulator, is used as a therapeutic drug for patients with sleep disorders, but there are no studies on the prevention of postoperative sleep disorder after general anesthesia.In this study, we investigate whether prophylactic administration of a sleep-inducing substance, a melatonin receptor agonist, is effective against sleep disorder after general anesthesia in patients with ASD. METHODS/DESIGN: This study is intended for patients with ASD aged 12 years and above who undergo treatment at Nagasaki University Hospital, Isahaya General Hospital Dentistry, and Sasebo City General Medical Center Dentistry and undergo dental treatment under general anesthesia. A melatonin receptor agonist (Rozerem) will be taken 7 days prior and 7 days postsurgery in patients diagnosed with insomnia. A randomized comparison will be made between 2 groups: an experimental group that is additionally administered Rozerem and a control group.The primary endpoint is the incidence of NREM-REM sleep disorders that occur within 3 to 5 days after general anesthesia. The secondary endpoint is the incidence of circadian rhythm sleep disorders (rate of occurrence of sleep-retardation syndrome with drowsiness and strong fatigue). DISCUSSION: Postoperative sleep disorders after general anesthesia has been reported in patients with ASD; however, effective preventive pharmacological treatments have not been established. A sleep cycle regulator, ramelteon (Rozerem), is used as a therapeutic drug for patients with sleep disorders by decreasing the difficulty of falling asleep in insomnia. If sleep disorder can be prevented after the administration of general anesthesia in patients with ASD, we can support social participation while maintaining their quality of life. TRIAL REGISTRATION: The study was registered with the jRCT1071200030.