Pain and discomfort following immediate and delayed loading by overdentures in the single mandibular implant study (SMIS).

OBJECTIVES: This randomized clinical trial compares immediate and delayed loading of single implants to support mandibular overdentures. The aim of this preliminary analysis is to test the hypothesis whether patients with immediate loading will experience less pain and discomfort through the intervention than patients with delayed loading. MATERIALS AND METHODS: Edentulous patients in nine German dental schools received a midline implant with a length of 11 mm. Implants with a minimum insertion torque of 30 Ncm and an implant stability quotient of ≥60 were randomly allocated to group A for immediate loading using ball attachments or to group B for delayed loading after 3 months. Patients completed questionnaires with 100-mm visual analogue scales about the items pain, pain during chewing, swelling, bleeding, and perception of the intervention at the day of surgery and 1, 2, 3, and 7 days, thereafter. Groups were compared by Wilcoxon-Mann-Whitney tests (P ≤ 0.05). RESULTS: The questionnaires of 81 patients in group A and 74 patients in group B were completed. The medians for pain and discomfort were moderate (<30). Participants of group A felt significantly more pain from the first day and more swelling from the third day after implantation than participants of group B. The individual perception of interventions showed no significant differences between groups. CONCLUSIONS: Immediate loading evoked more postoperative pain and swelling than the two stages of delayed loading. CLINICAL RELEVANCE: Immediate loading of a single mandibular midline implant supporting overdentures should be carefully considered.

Single mandibular implant study - denture satisfaction in the elderly.

To investigate whether there are differences in patients' denture satisfaction when an implant placed in the midline of the edentulous mandible is loaded either immediately or three months later, after second-stage surgery. One hundred and fifty-eight edentulous patients received a single implant in the midline of the mandible. After randomisation, it was loaded either immediately after implant placement (N = 81, group A) or three months later, after a submerged healing phase and a second-stage surgery (N = 77, group B). Patients' denture satisfaction aspects were assessed, using visual analogue scales (VAS), before treatment, one month after implant placement during the submerged healing phase (only group B) and one and four months after implant loading. The statistical analysis was performed using the Wilcoxon signed-rank and rank-sum tests. One month after loading, a significant improvement in comfort, function and stability of the mandibular denture could be observed in both groups (P ≤ 0·05). A slight but not significant improvement was found between one and four months after loading. Patients with second-stage surgery and delayed loading rated the stability and fit of the mandibular denture as significantly better than patients who had immediate loading. A single implant in the edentulous mandible significantly increased patients' denture satisfaction. After four months, stability and fit of the mandibular denture were considered better when a delayed loading protocol had been followed. A single mandibular implant in the edentulous mandible significantly increases patients' denture satisfaction, regardless of the loading protocol.

Clinically used adhesive ceramic bonding methods: a survey in 2007, 2011, and in 2015.

OBJECTIVES: The objective of the study is to evaluate practices of dentists regarding adhesive cementation of all-ceramic restorations over a period of 8 years. MATERIALS AND METHODS: The authors developed a questionnaire regarding adhesive cementation procedures for all-ceramic restorations. Restorations were distinguished between made out of silicate ceramic or oxide ceramic. The questionnaire was handed out to all dentists participating in a local annual dental meeting in Northern Germany. The returned questionnaires were analyzed to identify incorrect cementation procedures based upon current evidence-based technique from the scientific dental literature. The survey was conducted three times in 2007, 2011, and 2015 and their results were compared. RESULTS: For silicate ceramic restorations, 38-69 % of the participants used evidence-based bonding procedures; most of the incorrect bonding methods did not use a silane containing primer. In case of oxide ceramic restorations, most participants did not use air-abrasion prior to bonding. Only a relatively low rate (7-14 %) of dentists used evidence-based dental techniques for bonding oxide ceramics. CONCLUSION: In adhesive cementation of all-ceramic restorations, the practices of surveyed dentists in Northern Germany revealed high rates of incorrect bonding. During the observation period, the values of evidence-based bonding procedures for oxide ceramics improved while the values for silicate ceramics declined. Based on these results, some survey participants need additional education for adhesive techniques. CLINICAL RELEVANCE: Neglecting scientifically accepted methods for adhesive cementation of all-ceramic restorations may result in reduced longevity of all-ceramic restorations.

Implant placement under existing removable dental prostheses and its effect on masticatory performance.

OBJECTIVE: The aim of this within-subject study was to evaluate the outcome with implant-tooth-supported removable partial dental prostheses (RPDP group) and implant-supported removable complete dental prostheses (edentulous group) in terms of masticatory performance and self-assessment. MATERIALS AND METHODS: Thirty patients participated in this prospective clinical study (RPDP group: n = 12; edentulous group: n = 18). The prostheses were supported in strategically advantageous regions by placing implants with ball attachments and corresponding matrices in the existing dentures. The masticatory performance was evaluated with the Swallowing Threshold Test Index (STTI), the number of chewing strokes, and the time needed until swallowing at pre-treatment and 6 weeks after integration of ball attachments. Additionally, patients scored chewing satisfaction before and after implantation on a visual analogue scale. RESULTS: The STTI increased significantly (p ≤ 0.05) after implant therapy in the edentulous group but not in the RPDP group. Furthermore, the STTI was significantly higher (p ≤ 0.05) in the RPDP group than in the edentulous group at pre-treatment, however, not after therapy (P > 0.05). All patients were very satisfied after therapy concerning ability of speaking, chewing, and stability of their prosthesis. CONCLUSIONS: Patients of the edentulous group benefit more from strategically placed implants under the existing dentures than patients from the RPDP group. However, according to the subjective assessment, the chewing satisfaction generally increased for both groups after implant therapy. CLINICAL RELEVANCE: Patients with a strongly reduced dentition and edentulous patients benefit from strategically placed implants under the existing removable dentures.

The randomized shortened dental arch study: oral health-related quality of life.

OBJECTIVES: Although the shortened dental arch (SDA) concept is a widely accepted strategy to avoid overtreatment, little is known on its impact on oral health-related quality of life (OHRQoL). This multicenter randomized controlled trial aimed to investigate the OHRQoL for removable partial dental prostheses (RPDP) with molar replacement versus the SDA concept. MATERIAL AND METHODS: In both groups, missing anterior teeth were replaced with fixed dental prosthesis. Two hundred fifteen patients with bilateral molar loss in at least one jaw were included. The Oral Health Impact Profile (OHIP-49) was completed before; 6 weeks (baseline), 6 months, and 12 months after treatment; and thereafter annually until 5 years. RESULTS: Of the initial cohort, 81 patients were assigned to the RPDP group and 71 to the SDA group (age, 34 to 86 years). Before treatment, the median OHIP score was similar in both groups (RPDP, 38.0; SDA, 40.0; n.s.). Results indicate marked improvements in OHRQoL in both groups between pretreatment and baseline (RPDP, 27.0; SDA, 19.0; p ≤ 0.0001) which continued in the RPDP group until the 1-year follow-up (p = 0.0002). These significant reductions in OHIP scores are reflected in its subscales. No further differences were seen within and between groups during the remainder observation period. CONCLUSION: Both treatments show a significant improvement in OHRQoL which continued in the RPDP group until the 1-year follow-up. No significant differences were seen between groups. CLINICAL RELEVANCE: For improving OHRQoL, it is not necessary to replace missing molars with a RPDP.

Management of shortened dental arches and periodontal health: 5-year results of a randomised trial.

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2-1 to 2-6, WO 677/2-1.1 to 2-2.1.; controlled-trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre-molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior-most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL-V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL-V and PPD, significant differences were also found for the study jaw as a whole. For CAL-V, the estimated group differences over 5 years amounted to 0.27 mm (95% CI 0.05; 0.48; P = 0.016) for the study jaw and 0.25 mm (95% CI 0.05; 0.45; P = 0.014) for the distal sites of the posterior-most teeth. The respective values for PPD were 0.22 mm (95% CI 0.03; 0.41; P = 0.023) and 0.32 mm (95% CI 0.13; 0.5; P = 0.001). It can be concluded that even in a well-maintained.patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.

Impact of loading protocol of a mandibular single implant-supported complete denture on oral health-related quality of life over a period of 5 years: A randomized controlled trial.

OBJECTIVES: The aim of the present study was to assess the long-term course of OHRQoL and the impact of the loading protocol in patients receiving a single mandibular implant supporting a complete denture over a period of five years. METHODS: In this multicenter RCT, a total of 158 edentulous patients were initially included and were randomly allocated immediately after placement of a mandibular midline implant to either immediate loading (IL) or to conventional loading (CL) with submerged healing. The assessment of OHRQoL was performed with the 49-item Oral Health Impact Profile (OHIP) at baseline and 1, 4, 12, 24, and 60 months after loading. At 5-year follow-up, 100 patients (mean age: 69.2 years; 45.0% female) with completed OHIP were available for analyses. A mixed-effects model with patients as random effect and an unstructured covariance matrix was developed to address repeated outcome measurement. RESULTS: The OHRQoL improved substantially after loading, indicated by a decrease of mean OHIP summary scores from 51.0 points at baseline, by 14.2 (95%-CI: 9.4 - 19.1; p<0.001) points to 37.2 points at 1-month follow-up, and by continuous improvement to 20.4 OHIP points at final follow-up. Considering constant treatment effects, the loading protocol had no significant effect on OHIP scores (-3.7, 95%-CI: -9.4 - 2.2; p = 0.204). Time effect was statistically significant with -0.21 (95%-CI: -0.28 - -0.15; p<0.001) points per month. CONCLUSION: Both the immediate and conventional loading of a single mandibular midline implant supporting a complete denture offer long-lasting high levels of OHRQoL, with no significant or clinically relevant long-term differences. CLINICAL SIGNIFICANCE: The study firstly presents long-term data for OHRQoL by investigating the loading protocol of single mandibular implant-supported complete dentures. Since immediate loading has been associated with a reduced implant survival rate for this concept, information on patient benefits is essential for evidence-based decision making.

The randomized shortened dental arch study: tooth loss over five years.

OBJECTIVES: The study was designed to provide clinical outcome data for two treatments of the shortened dental arch (SDA). MATERIAL AND METHODS: In a multicenter randomized controlled clinical trial, patients with complete molar loss in one jaw were provided with either a partial removable dental prosthesis (PRDP) retained with precision attachments or treated according to the SDA concept preserving or restoring a premolar occlusion. No implants were placed. The primary outcome was tooth loss. RESULTS: Of 152 treated patients, 132 patients reached the 5-year examination. Over 5 years, 38 patients experienced tooth loss. For the primary outcome tooth loss, the Kaplan-Meier survival rates at 5 years were 0.74 (95% CI 0.64, 0.84) in the PRDP group and 0.74 (95% CI 0.63, 0.85) in the SDA group. For tooth loss in the study jaw, the survival rates at 5 years were 0.88 (95% CI 0.80, 0.95) in the PRDP group and 0.84 (95% CI 0.74, 0.93) in the SDA group. The differences were not significant. No Cox regression models of appropriate fit explaining tooth loss on the patient level could be found. CONCLUSIONS: The overall treatment goals of a sustainable oral rehabilitation and the avoidance of further tooth loss over longer periods were not reliably achievable. The influence of the type of prosthetic treatment on tooth loss might have been overestimated. CLINICAL RELEVANCE: Regarding our results, the patient's view will gain even more importance in the clinical decision between removable and fixed restorations in SDAs.

CAD/CAM single retainer zirconia-ceramic resin-bonded fixed dental prostheses: clinical outcome after 5 years.

PURPOSE: This study evaluated the clinical outcome of CAD/CAM zirconia-ceramic resin-bonded fixed dental prostheses (RBFDPs) with a cantilevered single-retainer design. MATERIALS AND METHODS: Thirty anterior zirconia-ceramic RBFDPs fabricated with the Cerec CAD/CAM system were inserted using either a phosphate monomer containing resin (Panavia 21 TC; N = 16) or an adhesive bonding system with a phosphoric acid acrylate primer (Multilink-Automix with Metal/Zirconia primer; N = 14). RESULTS: During a mean observation time of 64.2 months, one debonding occurred in each group. Both RBFDPs could be rebonded successfully resulting in a five-year survival rate of 100%. CONCLUSION: Independent of the bonding system, cantilevered zirconia-ceramic RBFDPs showed promising results during the first five years. (ClinicalTrials.gov Identifier: NCT01411592). CLINICAL SIGNIFICANCE: Single-retainer zirconia ceramic RBFDPs present an alternative treatment option offering good esthetics, a minimally invasive preparation, a high biocompatibility and can even be used to treat juvenile patients who do not yet come into consideration for implant placement. No significant influence of the bonding system used has been detected so far.

[Preventive strategies in prosthetic dentistry]. / Präventionsorientierte Strategien in der prothetischen Zahnmedizin.

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

Wear of human enamel and nano-filled composite resin denture teeth under different loading forces.

To evaluate and correlate the two-body wear of human enamel and nano-filled composite resin teeth with the loading forces used in a dual-axis chewing simulator. Three groups of human enamel and three of nano-filled composite resin teeth were tested in a chewing simulator. Zirconia ceramic balls were used as antagonists. The teeth were tested with three different loading forces (20, 49 and 78 N). Wear was analysed by measuring the volume and vertical substance loss using a laser scanner after 300000 chewing cycles. Data were statistically analysed using two-way anova followed by the Scheffé test (P < or = 0.05). Spearman correlation test was used to determine whether there was a relationship between the loading force and the degree to which the human enamel and composite resin had worn. An increase in the loading force significantly increased the wear of composite resin and of human enamel. The effect of the loading force on the wear was statistically significant at the 0.001 level. Human enamel showed a lower volume and vertical substance loss than composite resin under loading forces of 20 and 49 N and lower vertical loss under loading force of 78 N. The correlation between the volume loss and loading force was statistically significant (r = 0.616, P < 0.001). Nano-filled composite resin and human enamel exhibited different amount of wear under different loading forces. In general, human enamel showed less vertical substance loss than nano-filled composite resin.

Influence of saliva contamination on zirconia ceramic bonding.

OBJECTIVES: The purpose of this study was to investigate the influence of saliva contamination and cleaning methods on adhesive bonding to dental zirconia ceramic with a phosphate-monomer-containing luting resin. METHODS: After saliva immersion, airborne-particle abraded ceramic specimens were cleaned with water rinsing, with isopropanol, with phosphoric acid gel, or with additional airborne-particle abrasion. Airborne-particle abraded specimens without contamination were used as the control group. Chemical analysis of the ceramic surfaces of all groups was done using X-ray photoelectron spectroscopy (XPS). The influence of contamination and cleaning methods on ceramic bond durability was examined by tensile bond strength (TBS) testing after 3 days or 150 days water storage with 37,500 thermal cycles. RESULTS: After saliva contamination XPS revealed an organic coating which was not removed completely with water rinsing, with isopropanol, or with phosphoric acid. Using TBS testing a strong influence of contamination and cleaning methods on resin bond strength and its durability was found. SIGNIFICANCE: Saliva contamination significantly affected resin bonds to zirconia ceramic and its durability. Airborne-particle abrasion was the most effective cleaning method.

The ability of different materials to reproduce accurate records of interocclusal relationships in the vertical dimension.

Restorations made on incorrectly mounted casts might require considerable intra-oral adjustments to correct the occlusion or might even necessitate a remake of the restoration. The aim of this study was to evaluate interocclusal recording materials for their ability to reproduce accurate vertical interocclusal relationships after a storage time of 1 and 48 h, respectively. A custom-made apparatus was used to simulate the maxilla and mandible. Eight interocclusal records were made in each of the following groups: G1: Aluwax (aluminium wax), G2: Beauty Pink wax (hydrocarbon wax compound), G3: Futar D, G4: Futar D Fast, G5: Futar Scan (G3-G5: vinyl polysiloxane), G6: Ramitec (polyether). The vertical discrepancies were measured by an inductive displacement transducer connected to a carrier frequency amplifier after storage of the records for two periods of 1 and 48 h. Two-way anova was used for statistical analysis. The mean vertical discrepancies in mum (1/48 h) for G1 (31/35) and G2 (35/38) were statistically significantly higher than for the other groups G3 (8/10), G4 (11/12), G5 (6/8) and G6 (5/8) (P < or = 0.05). There were no statistically significant differences between the elastomers tested. The effect of storage on the vertical discrepancies was statistically significant (P < 0.001). Vinyl polysiloxane and polyether interocclusal records can be used to relate working casts during mounting procedures without significant vertical displacement of the casts.

Survival and Complications of Single Dental Implants in the Edentulous Mandible Following Immediate or Delayed Loading: A Randomized Controlled Clinical Trial.

It was the aim of this 24-mo randomized controlled clinical trial to investigate whether the survival of a single median implant placed in the edentulous mandible to retain a complete denture is not compromised by immediate loading. Secondary outcomes were differences in prosthetic complications between the loading principles. Each of the 158 patients who received an implant was randomly assigned to the immediate loading group ( n = 81) or the delayed loading group ( n = 77). Recall visits were performed 1 mo after implant placement (for only the delayed loading group) and 1, 4, 12, and 24 mo after implant loading. Nine implants failed in the immediate loading group, all within the first 3 mo of implant loading, and 1 implant failed in the delayed loading group prior to loading. Noninferiority of implant survival of the immediate loading group, as compared with the delayed loading group, could not be shown ( P = 0.81). Consistent with this result, a secondary analysis with Fisher exact test revealed that the observed difference in implant survival between the treatment groups was indeed statistically significant ( P = 0.019). The most frequent prosthetic complications and maintenance interventions in the mandible were retention adjustments, denture fractures, pressure sores, and matrix exchanges. There was only 1 statistically significant difference between the groups regarding the parameter "fracture of the denture base in the ball attachment area" ( P = 0.007). The results indicate that immediate loading of a single implant in the edentulous mandible reveals inferior survival than that of delayed loading and therefore should be considered only in exceptional cases (German Clinical Trials Register: DRKS00003730).

Influence of contamination on zirconia ceramic bonding.

The removal of contaminants prior to the bonding of ceramics is critical for the clinical success of a long-term durable resin bond. This study tested the null hypotheses that there are no contaminants on the zirconia ceramic surface left after try-in simulation, and there are no influences of contamination and cleaning methods on zirconia ceramic bonding durability with 10-methacryloyloxy-decyl dihydrogenphosphate-containing composite resins. After saliva immersion and the use of a silicone disclosing agent, airborne-particle-abraded ceramic specimens were cleaned with acetone, 36% phosphoric acid, additional airborne-particle abrasion, or only water spray. Chemical analyses of specimen surfaces were performed by x-ray photoelectron spectroscopy. The influences of contamination and cleaning methods on ceramic bond durability were examined by tensile testing after 3 or 150 days' water storage with 37,500 thermal cycles. Contamination, existing after try-in simulation as confirmed by chemical analysis, significantly reduced zirconia ceramic-resin bonds. Airborne-particle abrasion may be the most effective cleaning method.

Panavia F 2.0 bonding to contaminated zirconia ceramic after different cleaning procedures.

OBJECTIVES: The purpose of this laboratory study was to evaluate the influence of different cleaning methods after saliva contamination and after using a silicone disclosing medium on the resin bond strength to zirconia ceramic. The hypothesis was that the resin-ceramic bond strength and its durability are related to the ceramic surface condition. METHODS: Plexiglas tubes filled with composite resin were bonded to air-abraded zirconia ceramic disks using a phosphate monomer containing composite resin. Four surface cleaning methods were used after contaminating the ceramic surface: air abrasion with 50 mum Al(2)O(3) at 2.5 bar pressure for 15s, cleaning with 37% phosphoric acid for 60s once or for 30s twice, or cleaning in 96% isopropanol for 15s. The specimens of the control group were not cleaned after using the silicone disclosing medium. For each combination 16 specimens were bonded in an alignment apparatus. Subgroups of eight bonded specimens were tested for tensile bond strength (TBS) after storage for either 3 or 150 days combined with 37,500 thermal cycles. The statistical analyses were performed with the Kruskal-Wallis test, followed by multiple pair-wise comparisons using the Wilcoxon rank sum test. RESULTS: The mean TBS ranged from 6.6 to 49.9 MPa after 3 days and from 0 to 19.8 MPa after 150 days. Air abrasion of the ceramic surface provided statistically significantly higher bond strengths than the other cleaning methods after 3 and 150 days. Alcohol cleaning of the ceramic did not provide durable bond strengths over time. SIGNIFICANCE: Ceramic cleaning methods after try-in procedures have a significant influence on the resin-ceramic bond strength. Air abrasion of contaminated zirconia ceramic is the most effective.

The Prx1 homeobox gene is critical for molar tooth morphogenesis.

The paired-related homeobox genes, Prx1 and Prx2, encode transcription factors critical for orofacial development. Prx1(-/-)/Prx2(-/-) neonates have mandibular hypoplasia and malformed mandibular incisors. Although the mandibular incisor phenotype has been briefly described (ten Berge et al., 1998, 2001; Lu et al., 1999), very little is known about the role of Prx proteins during tooth morphogenesis. Since the posterior mandibular region was relatively normal, we examined molar tooth development in Prx1(-/-)/Prx2(-/-) embryos to determine whether the tooth malformation is primary to the loss of Prx protein or secondary to defects in surrounding tissues. Three-dimensional (3D) morphological reconstructions demonstrated that Prx1(-/-)/Prx2(-/-) embryos had molar malformations, including cuspal changes and ectopic epithelial projections. Although we demonstrate that Prx1 protein is expressed only mesenchymally, 3D reconstructions showed important morphological defects in epithelial tissues at the cap and bell stages. Analysis of these data suggests that the Prx homeoproteins are critical for mesenchymal-epithelial signaling during tooth morphogenesis.

Mechanical resistance of the periorbita and the orbital floor complex--are isolated orbital floor fractures only a soft tissue problem?

The primary aims of orbital floor reconstruction are to prevent enophthalmos and herniation of the orbital contents in order to achieve correct globe position. Theoretically, the mechanical load of the orbital floor is approximately 0.0005N/mm(2) (30g orbital content onto 600mm(2) of orbital floor area). Therefore, low mechanical stress from orbital floor reconstruction materials is expected. The periorbita and orbital floor complex (bony orbital floor with periorbita) of 12 human cadavers were investigated for their mechanical resistance to distortion and compared to different absorbable pliable reconstruction materials after modification with pores (Bio-Gide, Creos, and PDS). The human periorbita resistance (approximately 1.4N/mm(2)) was comparable to that of the absorbable membranes (Creos, Bio-Gide), and the resistance of PDS (approximately 2.3N/mm(2)) was comparable to that of the orbital floor complex. The periorbita has a higher stability than the bony orbital floor. Therefore, in isolated orbital floor fractures with a traumatized bony orbital floor and periorbita, reconstruction of the soft tissue as a periorbita equivalent with a resorbable membrane appears to be adequate to prevent enophthalmos and herniation of the orbital contents.

Malformations of the heart, kidney, palate, and skeleton in alpha-MHC-Hoxb-7 transgenic mice.

To begin to define the genetic network involved in cardiogenesis, we generated mice bearing the alpha-myosin heavy chain (MHC)-Hoxb-7 transgene. We hypothesized that using the cardiac-specific alpha-MHC promoter, we can direct ectopic expression of Hoxb-7 in the heart and perturb its normal development. Both whole mount in situ hybridization and northern analyses showed that this alpha-MHC promoter resulted in transgene expression in the developing heart. Severe ventricular septal defects (VSD) were found in several mutant mice. Interestingly, transgenic mice were observed to have other malformations as well, including cleft palate, renal anomalies, and skeletal abnormalities in the craniocervical and costosternal regions. The kidney defect consisted of double ureter and pelvis. In summary, we have shown that a dominant gain-of-function mutation of Hoxb-7 using the murine alpha-MHC promoter results in perturbation of the genetic circuitry underlying multiple developmental processes, including cardiogenesis. Misexpression of Hoxb-7 during heart development may be involved in the pathogenesis of VSD.

Influence of metal cleaning methods on the resin bond strength to NiCr alloy.

OBJECTIVES: The purpose of this laboratory study was to evaluate the influence of different metal cleaning methods on the bond strength of various resin bonding systems and its durability to a NiCr alloy. The hypothesis was that the resin bond strength and its durability is related to the cleaning method and to the bonding system used. METHODS: Plexiglas tubes filled with composite resin were bonded to NiCr disks using three different bonding systems: tribochemical silica-coating and silanization of the alloy, acrylization of the alloy, or bonding with a phosphate monomer containing composite resin. For each bonding system, three cleaning methods were used after the last air abrasion step: cleaning with a stiff brush, ultrasonic cleaning in alcohol or in a neutral detergent. For each combination 20 samples were bonded. Subgroups of 10 bonded samples were tested for tensile strength following storage for either 3 or 150 days. In addition, the 150-day samples were thermal cycled 37,500 times. The statistical analyses were made by ANOVA, followed by multiple pair-wise comparison of the groups using Scheffe and t-tests with Bonferroni-Holm correction. RESULTS: The mean tensile bond strengths ranged from 34.8 to 49.2 MPa after 3 days and from 2.1 to 43.1 MPa after 150 days. Acrylization of the alloy did not provide durable bond strength to NiCr alloy over storage time. Cleaning the alloy surface with alcohol provided statistically significant higher bond strength than the other cleaning methods after 3 days. SIGNIFICANCE: Alloy cleaning methods after air abrasion have a significant influence on the resin bond strength.