Neutrophil-to-lymphocyte ratio decreases in obstructive sleep apnea treated with mandibular advancement devices.

PURPOSE: Obstructive sleep apnea has been associated with chronic inflammation triggered by nocturnal hypoxemia. The neutrophil-to-lymphocyte ratio (NLR) is a measure of subclinical systemic inflammation. We hypothesize that NLR levels would improve as chronic inflammation diminishes in obstructive sleep apnea (OSA) patients treated with mandibular advancement devices (MADs). METHODS: We studied patients with OSA who were treated with MAD as a first-line treatment or because they could not tolerate CPAP. We obtained pre-treatment and post-treatment complete blood counts. NLR was calculated by dividing the number of neutrophils by the number of lymphocytes obtained from the CBCs. Patients with other conditions known to affect NLR were excluded from the study. RESULTS: We compared the values of NLR and oxygen desaturation index (ODI) before and after treatment with MAD in 22 patients who met inclusion criteria and completed the study protocol. There was a significant difference in NLR before and after treatment (p = 0.01). There was also a significant difference in the 3% ODI and 4% ODI before and after treatment with MAD (p = 0.014, 0.007), respectively. A subgroup analysis compared NLR in two groups of patients, the optimally treated and suboptimally treated. There was a significant decrease in the NLR in the optimally treated group (n = 10) (p < 0.01), whereas it did not change in the suboptimally treated group (n = 12) (p = 0.349). CONCLUSION: The neutrophil-to-lymphocyte ratio may be useful in documenting improvement in inflammation for OSA patients treated with mandibular advancement devices. Our results specifically suggest that the NLR values are associated with the decrease in the ODI.

Fixed retention of congenitally missing maxillary lateral incisors using a chairside, prefabricated fiber-reinforced composite bridge.

Adolescents with congenitally missing lateral incisors require an interim space maintainer to restore function and esthetics before craniofacial growth is complete and an endosseous implant can be placed. This article presents 2 patients, each with a missing lateral incisor, who underwent orthodontic therapy. A chairside, prefabricated fiber-reinforced composite bridge was used as a fixed space maintainer after the appliances were removed.

Economic impact of regulating the use of amalgam restorations.

OBJECTIVE: This article estimates the financial impact of a ban on amalgam restorations for selected population groups: the entire population, children, and children and women of childbearing age. METHODS: Using claim and enrollment data from Delta Dental of Michigan, Ohio, and Indiana and the American Dental Association Survey of Dental Services Rendered, we estimated the per capita use and annual rate of change in amalgam restorations for each age, gender, and socioeconomic subgroup. We used population projections to obtain national estimates of amalgam use, and the dental component of the Consumer Price Index to estimate the annual rate of change in fees. We then calculated the number of dental amalgams affected by the regulation, and the fees for each of the years 2005 to 2020. RESULTS: If amalgam restorations are banned for the entire population, the average price of restorations before 2005 and after the ban would increase $52 from $278 to $330, and total expenditures for restorations would increase from $46.2 billion to $49.7 billion. As the price of restorations increases, there would be 15,444,021 fewer restorations inserted per year. The estimated first-year impact of banning dental amalgams in the entire population is an increase in expenditures of $8.2 billion. CONCLUSIONS: An amalgam ban would have a substantial short- and long-term impact on increasing expenditures for dental care, decreasing utilization, and increasing untreated disease. Based on the available evidence, we believe that state legislatures should seriously consider these effects when contemplating possible restrictions on the use of amalgam restorations.

Design and use of a prefabricated fiber-reinforced composite substructure for the chairside replacement of missing premolars.

Fiber-reinforced resin composites (FRCs) have been used to make frameworks to support particulate resin composite veneers in the replacement of missing teeth. Both prosthetic laboratory-fabricated and chairside-fabricated approaches have been used with varying degrees of success. The chairside FRC fixed partial denture has been mainly used for anterior tooth replacement where the emphasis is on esthetics rather than withstanding occlusal load. This article focuses on the use of this technology in the chairside replacement of premolars. The concept of using a prefabricated framework is described in detail. This approach allows for the efficient delivery of a consistently made chairside prosthesis. This is in contrast with the time-consuming and less consistent result of FRC framework fabrication directly in the mouth. The goal for this concept is to use a premade framework finalized by the provider at chairside to provide medium- to long-term posterior tooth replacement, with minimal abutment tooth reduction.

Technique for placement of a posterior prefabricated fiber-reinforced composite bridge.

Fiber-reinforced composite (FRC) materials currently are used as alternatives for fixed restorations of edentulous areas within the posterior and anterior regions of the mouth. A chairside technique, using a prefabricated FRC framework, allows the clinician to offer the patient another fixed option for replacing a missing posterior tooth that is more time-efficient and cost-effective than other, more traditional approaches. Procedures that incorporate adhesive dentistry give dentists the ability to replace missing teeth and splint unstable teeth for periodontal or orthodontic purposes. This article demonstrates the sequence and chairside technique for placing a prefabricated FRC framework to restore a posterior edentulous area.

Effect of fatigue testing on core integrity and post microleakage of teeth restored with different post systems.

The purpose of this study was to evaluate a new nondestructive test system, which could test concurrently fatigue and microleakage. Fifty, single-rooted teeth were restored with one of the following posts systems and a composite core: titanium ParaPost cemented with zinc phosphate cement; CosmoPost; C-Post; Esthetic C-Post; and FibreKor post, all cemented with resin cement. Samples were embedded and placed in a positioning jig. They were impacted at 45 degrees to the long axis of the tooth with a force of 55 N at a frequency of 3 Hz for a total of 100,000 impacts. After 60,000 impacts, samples were thermocycled. Core integrity and post microleakage were evaluated periodically throughout the 100,000 impacts. Samples showed no detectable displacement of any of the cores, but the metallic group showed a statistically significant increase in microleakage (p < 0.05) at the conclusion of the study compared with the nonmetallic groups.

Clinical evaluation of fiber-reinforced fixed bridges.

BACKGROUND: This study evaluated the clinical performance of 39 light and heat polymerized fixed partial bridges made with a substructure of preimpregnated, unidirectional fiber-reinforced composite, or FRC, veneered with a hybrid particu late composite. METHODS: The authors evaluated 22 extracoronal, full-coverage retainer prostheses and 17 intracoronal, partial-coverage retainer prostheses placed over a 37-month period. All substructures initially were fabricated with a low-volume FRC. The authors reevaluated this design after early failures occurred, leading to a substructure with a higher volume of FRC. All prostheses were assessed for surface integrity, anatomical contour, marginal integrity and structural integrity at several intervals. RESULTS: The data show that survival was associated primarily with substructure design volume. When patients with severe parafunctional habits were excluded, the survival rate was 95 percent for prostheses made with a high-volume substructure (survival range, 2.77 to 4.30 years; mean +/- standard deviation survival, 3.75 +/- 0.4 years). Retainer configuration did not have a statistically significant influence on clinical survival. For all surviving prostheses, the authors observed few changes in any clinical parameters from baseline to 48 months. A loss of surface luster was observed in the majority of cases. Repairable surface defects were detected on two prostheses at 24 months. Scanning electron microscopic analyses indicated no exposed fibers on the occlusal surface and minimal wear. CONCLUSIONS: This study shows that a unidirectional, preimpregnated FRC can be used successfully to make bridges of variable retainer designs that last up to four or more years when a high-volume substructure is used. CLINICAL IMPLICATIONS: Short-span polymer prostheses made with particulate composite and unidirectional glass FRC can be used in certain clinical situations in which a metal substructure is not desired.

Effect of caries disclosing agents on bond strengths of total-etch and self-etching primer dentin bonding systems to resin composite.

This study examined the effect of caries disclosing dyes on composite to dentin shear bond strengths of a total etch, one-bottle and two self-etching, non-rinsing primer dental adhesives. Two caries disclosing dyes were evaluated, Seek and Snoop, with three dentin adhesives, Prime & Bond NT, Prompt L-Pop and Clearfil SE Bond. Extracted human molars stored in 0.2% sodium azide were sectioned longitudinally to expose dentin and embedded in acrylic, leaving the dentin exposed. Each dentin adhesive had three test groups (n=12); a control and one with each of the caries disclosing dyes. The control group had the dentin conditioned and the adhesive applied following the manufacturer's instructions. The caries disclosing dye groups had the dentin first treated for 10 seconds with the disclosing dye, rinsed, then the dentin adhesives were applied as in the controls. A column of Tetric Ceram was bonded after dentin adhesive placement to each specimen and light cured. Specimens were stored in room temperature water for 24 hours, thermocycled for 1,000 cycles between 5 degrees C and 55 degrees C and tested in shear until failure. Mean +/- SD shear bond values (SBV) were determined in MPa. A one-way ANOVA and Student Neuman Keuls multiple comparison test within each DBS were performed at a significance level ofp<0.05 to analyze the caries disclosing dyes input on SBV versus the controls. Surface analysis to determine the nature of the type of dentin/composite fracture/ separation was also performed. For the fracture analysis data, a Chi-Square test was performed at a significance level of p<0.05. The results of this study indicate that using the two tested caries disclosing dyes, with a total etch, one bottle and two self-etching, non-rinsing primer dental adhesives did not negatively affect the dentin-to-composite shear bond strengths of the three tested dentin bonding systems (p>0.05).

Fiber-reinforced composite prostheses.

Metal-free prosthetic dentistry continues to gain interest. Although the metal alloys contribute great strength and stiffness to restorations and prostheses, they do so at a considerable esthetic liability. Two somewhat divergent metal-free approaches to fixed tooth replacement continue to be developed for a variety of clinical applications. These are all-ceramic and all-polymeric systems. The polymeric prostheses are the subject of this article.

Single-tooth replacement with a chairside prefabricated fiber-reinforced resin composite bridge: a case study.

There are many fixed options for replacing a single anterior tooth, including implants; conventional full coverage; porcelain-fused-to-metal, all-ceramic, and fiber-reinforced composite designs; and minimal preparation designs that utilize lingual wing frameworks made from metal, ceramic, or fiber-reinforced composite. All of these approaches require at least two visits; however, it is possible to replace a missing anterior tooth in a single visit by using adhesive techniques with resin composite and fiber-reinforced resin composite materials. This approach has been developed and refined with a bridge created at chairside, using a prefabricated fiber-reinforced composite framework. This framework consists of a pontic substructure that is shaped to support a resin composite pontic, with one or two wings used to attach the pontic substructure to either the lingual or facial surfaces of the abutment teeth. This article describes a chairside technique for replacing a maxillary central incisor by using a prefabricated fiber-reinforced framework.

Identification of occlusal sealants using optical coherence tomography.

OBJECTIVE: Optical coherence tomography (OCT) is a new imaging technique that uses light to image dental structures interferometrically. OCT creates cross-sectional images that have potential diagnostic value for dental applications. When used in epidemiological studies, OCT offers a safe, non-invasive technique to discriminate occlusal sealants and composite restorations. This paper summarizes a study in which dentists were asked to interpret and discriminate between OCT images. METHODOLOGY: Twenty-one dentists were asked to interpret OCT images of nine extracted premolars that were either not restored, contained an occlusal sealant or were restored with a composite restoration. RESULTS: Although the dentists were previously unfamiliar with OCT images, they adapted well and felt confident in their diagnoses using this new technology. The sensitivity of OCT to discriminate composite and sealants was > 0.92, while the specificity of discrimination was > 0.94. The capacity of OCT to discriminate sealants from non-restored occlusal surfaces was slightly less (sensitivity 0.88; specificity 0.86), but still within a clinically acceptable level. Inter- and intra-rater reliability, as measured by the kappa statistic, also revealed excellent performance by dentists using this new imaging technology. Intra-rater reliability was very good, ranging from 0.82 to 1.0. Inter-rater reliability was also high, predominately in the "Good" to "Very Good" agreement range. CONCLUSION: This preliminary study indicates OCT imaging may be an important new technology for discriminating occlusal sealants and composite restorations.

Use of a prefabricated fiber-reinforced composite resin framework to provide a provisional fixed partial denture over an integrating implant: a clinical report.

The development of fiber-reinforced composites offers new possibilities in minimally invasive tooth replacement approaches. This article describes the use of a prefabricated fiber-reinforced composite resin framework for the chairside fabrication of a provisional fixed partial denture over an integrating implant. The framework fabrication, theory, and a clinical scenario are illustrated.

Chairside replacement of posterior teeth using a prefabricated fiber-reinforced resin composite framework technique: a case report.

UNLABELLED: The fixed replacement of a single posterior missing tooth for those patients who cannot have either implants or conventional laboratory-generated fixed prostheses has always been a challenge to clinicians. The development of fiber-reinforced composites (FRCs) has opened up new possibilities of chairside treatment options to manage these types of clinical situations. Techniques using FRCs as frameworks with traditional restorative resin composites as veneering materials can provide chairside fixed prostheses that are esthetic and potentially durable, with minimal abutment tooth loss. A clinical case is presented that will illustrate a novel concept for tooth replacement--the use of an FRC prefabricated framework--to allow for a single visit, chairside replacement of a missing molar. The assembly of the framework and the clinical steps used in the framework placement and pontic fabrication are shown in detail. CLINICAL SIGNIFICANCE: The combination of FRC technology and adhesive techniques can provide minimally invasive and cost-effective treatment options for the chairside replacement of missing posterior teeth.

The influence of fiber reinforcement of composites on shear bond strengths to enamel.

STATEMENT OF PROBLEM: Fiber-reinforced composites (FRC) are used in direct intra-oral applications as periodontal splints and chairside tooth replacement by bonding them to etched enamel with resin adhesives and composites. There is little information regarding the effect of FRC on the shear bond strength of composite to etched enamel. PURPOSE: The purpose of this study was to examine the effect of resin preimpregnated and non-preimpregnated fiber-reinforced composites on enamel to composite shear bond strength (SBS). MATERIAL AND METHODS: Specimen groups (n = 12) consisted of a control (composite with no fiber reinforcement), Ribbond, Splint-It Unidirectional, Splint-It Woven, and Connect, which were bonded to 37% phosphoric acid etched Prime and Bond NT adhesive-treated bovine enamel surfaces on a bed of Tetric Flow composite. Specimens were thermocycled 1000 times between 5 degrees and 55 degrees C and loaded on a universal testing machine in shear at a linear increasing load until fracture (MPa). The fractured surfaces of the debonded specimens were evaluated to determine the nature of the fracture with a light binocular microscope (x10). Shear bond strength data were subjected to analysis of variance (ANOVA) and Student-Newman-Kuels tests (P <.05). RESULTS: Mean MPa +/- SD for the test groups were as follows: Control, 15.6 +/- 2.4; Splint-It Unidirectional, 15.3 +/- 2.4; Splint-It Woven, 16.5 +/- 1.8; Connect, 18.8 +/- 1.5; and Ribbond, 15.8 +/- 2.2. The Connect FRC group had significantly higher (P <0.05) enamel SBS than all other groups. Fracture analysis showed varying types of failures among the groups, with cohesive fractures within the fiber reinforcement of Splint-It Unidirectional and Connect, cohesive fractures within the bonding resin/flowable composite for Ribbond and the control, and adhesive fracture at the fiber reinforcement interface with Splint-It Woven. CONCLUSION: Within the limitations of this study, no differences in SBS were observed with the addition of 3 of the 4 FRCs compared to composite without FRC, with the exception of the Connect product which provided significantly higher SBS values.

Consensus statement on fiber-reinforced polymers: current status, future directions, and how they can be used to enhance dental care.

The Second Scientific Fibre Reinforcement Symposium was held in Nijmegen, The Netherlands, on October 13th, 2001. The participants were invited speakers with extensive scientific and clinical backgrounds in glass fiber and polyethylene fiber research. The symposium reports focused on four areas of fiber reinforcement research: materials development, laboratory testing, clinical systems development, and clinical data. The consensus reached on the current status and future directions of this technology is reported here.