Effects of Particle Abrasion Media and Pressure on Flexural Strength and Bond Strength of Zirconia.

OBJECTIVES: To compare the effects of particle abrasion medium and pressure on shear bond strength and biaxial flexural strength of three generations of zirconia (Lava Frame, Lava Plus, and Lava Esthetic) with the goal of optimizing the bond to zirconia. METHODS: 280 discs (14 mm diameter; 1 mm thickness) of each zirconia were milled and sintered. Specimens of each material were randomly distributed into 14 groups (n=20); half were tested for shear bond strength and half were tested for biaxial flexural strength. The specimens were particle abraded on one surface by 2 different media (50 µm alumina particles or 50 µm glass beads) for 10 seconds at three different pressures (15, 30, and 45 psi or 0.1, 0.2, 0.3 MPa). Untreated specimens served as positive control. A tube (1.50 mm diameter) filled with dual cured resin cement (Panavia SA) was placed onto the surface and light cured. Specimens were stored in water (37°C for 24 hours) and shear bond strength was measured in a universal testing machine (Instron). Biaxial flexural strength of each specimen was measured according to ISO 6872. Shear bond strength and biaxial flexural strength were compared individually with a 2-way analysis of variance (ANOVA) for factors surface treatment and zirconia composition. RESULTS: Significant differences were seen between surface treatments (p<0.01), zirconia composition (p<0.01) and their interaction (p<0.01) for both bond strength and flexural strength. With alumina particle abrasion, higher pressure produced higher bonds for Lava Frame and Lava Plus zirconia while the bond of Lava Esthetic declined with increased pressure. Higher pressure (>0.2 MPa or 30 psi) with alumina decreased biaxial flexural strength with Lava Esthetic zirconia. CONCLUSIONS: Particle abrasion with alumina produced a significantly better combination of bond strength while maintaining biaxial strength of three zirconia materials than particle abrasion with glass beads. The bond strength also depended upon the pressure of particle abrasion and the generation of zirconia used.

Two-year Randomized, Controlled Clinical Trial of a Flowable and Conventional Composite in Class I Restorations.

OBJECTIVES: This study evaluated the two-year clinical performance and volumetric wear of a flowable resin composite compared to a conventional highly filled composite resin in Class I restorations. METHODS AND MATERIALS: In this single-center, single-blinded, comparator-controlled clinical study (Institutional Review Board approved), 120 carious teeth distributed in 60 patients were randomly assigned to four calibrated practitioners who placed occlusal restorations (n=60 flowable and n=60 conventional composite). Direct and indirect assessment at baseline, six months, one year, and two years occurred during which the modified Cvar and Ryge criteria were evaluated. Volumetric wear was determined by superimposition of profilometer scans of baseline and two-year casts. RESULTS: At two years, there was no significant difference in anatomic form (p=0.80), color match (p=0.08), marginal adaptation (p=0.89), marginal discoloration (p=0.79), surface integrity (p=0.18), secondary caries (p=0.66), cold sensitivity (p=0.522), occlusal sensitivity (p=0.818), or volumetric wear (p=0.661) between materials. Both materials showed a decrease in all criteria except secondary caries (p=0.95) over time. Two-year mean volumetric wear was 3.16 ± 2.38 mm(3) for the flowable composite and 3.43 ± 2.50 mm(3) for the conventional composite. CONCLUSIONS: The flowable and conventional composites used in this study have similar clinical efficacy after two years of service when placed as Class I occlusal restorations having isthmus widths less than one-half the intercuspal distance.

Bond strength of prosthodontic luting materials to titanium after localized cyclic loading.

PURPOSE: To establish an in vitro analysis system to evaluate the effect of cyclic loading on the bond strengths and durability of luting materials bonded to titanium. MATERIALS AND METHODS: Machine-milled titanium disks were finished with 600 grit silicon-carbide paper and pairs of disks were bonded together using the five different luting materials. A stainless steel stylus was vertically loaded at a center position (Model 1) or at the border (Model 2) of the specimens with a force of 75.6 N at 7500 cycles/hr. When the stylus contacted the specimen surface through the water slurry of poly(methyl methacrylate) beads, it rotated clockwise up to 15 degrees and counter-rotated. Shear bond strengths were determined 1 hr after bonding, after storage in water at room temperature for 24 hr, and after the loading for 100,000 cycles. RESULTS: The bond strengths of the unfilled adhesive resin and resin-based composite cement (RBC) were significantly higher than those of the glass-ionomer cements. Zinc phosphate cement demonstrated no bonding ability to titanium. After 100,000 cycles, peripheral loading in Model 2 significantly reduced the bond strength of the RBC and glass-ionomer cements, while Model 1 loading did not. The highest and the most durable bonds were obtained with the unfilled adhesive resin in both models.

Common pleural effusions in children.

The evaluation of pleural effusions in children differ from that of the adult in cause, symptom presentation, character of the fluid, techniques for diagnosis, treatment or management, and prognosis. These similarities and differences are reviewed with emphasis on the treatment of empyema.

Tensile fatigue of 4-META cement bonding three base metal alloys to enamel and comparison to other resin cements.

The tensile median fatigue limits and fracture mode of 4-META cement were evaluated after bonding Ni-Cr, Ni-Cr-Be, and Co-Cr alloys to enamel. Alloy surfaces, 6 mm in diameter, were grit blasted with 50 microns Al2O3 and cemented to etched bovine enamel under a 2 kg load. Samples were cycled in tension to failure or 10(6) cycles at 5 Hz in Ringer's solution at 37 degrees C. Two-point strategy was used to determine median fatigue limits (S50). Fracture modes were evaluated by SEM on samples failing before 10(6) cycles. Results indicated differences between all sample groups where S50 (Ni-Cr-Be) > S50 (Co-Cr) > S50 (Ni-Cr). Failure analysis revealed mixed cohesive fractures near both interfaces with small areas of delamination within the cement. Comparison to reported median fatigue limits of two commercially available cements were discussed.

Shear bond strengths of composite to chlorhexidine-treated enamel.

This study determined the shear bond strength (SBS) of composite bonded to chlorhexidine-treated enamel and untreated enamel. Fifty human molars were mounted in cold- cure acrylic and the superficial enamel of the buccal or lingual surface was exposed using 600-grit silicon carbide paper. During the experimental protocol, the control group (n = 25) and the experimental group (n = 25) were stored in distilled water at 37 degrees C. The experimental group was immersed in 0.12% chlorhexidine gluconate for 1 minute, 4 times daily, for 7 days. Prisma APH composite was then bonded to all samples following acid etching for 30 seconds, and the SBS was determined. Shear bond strengths for the control (13.23 +/- 3.22 MPa) and the experimental (13.67 +/- 4.59 MPa) groups were not significantly different using a t-test. The result may be attributed to either a lack of effect of chlorhexidine or to the acid etch which dissolves the affected superficial enamel leaving an unaffected substrate for bonding.

Perceived stress and coping strategies among candidates for heart transplantation during the organ waiting period.

The effectiveness of the transplantation team in diffusing stress during the pretransplantation period is increasingly important the longer the patient remains on the transplant waiting list. This study describes the stressors and coping strategies of heart transplant candidates during the waiting period. Thirty-nine candidates on the active list for heart transplantation from four mid-East Coast transplantation centers participated. With a possible stress score of 0 to 243, the mean score for this sample was a low 72.84 (standard deviation = 37.47). The three most common stressors were (1) requiring a heart transplant, (2) having terminal heart disease, and (3) worrying family members. The three most common coping strategies were (1) thinking positively, (2) using humor, and (3) trying to keep life as normal as possible. The finding of low stress levels was surprising but may reflect the presence of hope or the patient's desire to spare family members worry--a concern commonly cited by patients. Another explanation is that patients desiring to be perceived as ideal transplant recipients may have underreported their stress. This suggests that the transplantation team should support positive coping strategies when possible and that both patient and family coping should be closely monitored throughout the waiting period.

Tensile fatigue of two composite cements bonding three base metal alloys to bovine enamel.

Tensile fatigue endurance limits were determined for three base metals (Ni-Cr, Ni-Cr-Be, and Co-Cr) bonded to bovine enamel using two composite cements: a Bis-GMA/phosphate ester composite cement which relies on a sand-blasted metal surface, and a Bis-GMA composite luting cement which relies on electrolytically etched metal surfaces. Samples were tested to failure or to 10(6) cycles at 5 hz in Ringer's solution at 37 degrees C, and endurance limits were determined using a two-point test strategy. SEM evaluation was performed on fractured samples to determine failure mode. Statistical analysis of the results showed no difference between cements when using Ni-Cr-Be; however when using Co-Cr, the Bis-GMA/phosphate ester cement produced greater values than the Bis-GMA cement that relied on electrolytical etching. The opposite result occurred when a Ni-Cr alloy was tested with both cements. Evaluation of the results for each cement with the three different alloys showed statistical significant differences. SEM fracture analysis revealed a mixed failure pattern with apparent adhesive fracture from both the composite-enamel and composite-metal interfaces and cohesive failure throughout the cement.

Torsional properties of implant grade titanium.

The purpose of this research was to evaluate the torsional strength and ductility of CP titanium in the as received condition, heat treated below the alpha----beta transition temperature, and glass bead blasted. Results were compared to as-received samples of implant quality 316L stainless steel. Little or no effect of any of the treatments was noted. The torsional strength of all titanium samples was comparable to 316L stainless and the torsional ductility of the titanium was significantly greater than 316L stainless (p less than .01). These results are significantly different than those obtained when torsion testing bone screws of the same material. A hypothesis is proposed for the differences in these results.

Improved outcome in Pierre Robin sequence: effect of multidisciplinary evaluation and management.

Infants with complications of Pierre Robin sequence are at increased risk of airway obstruction and resultant hypoxia, cor pulmonale, failure to thrive, and cerebral impairment. In an effort to minimize such complications, patients with Pierre Robin sequence were examined prospectively by a multidisciplinary team using polysomnography and continuous oximetry. Obstructive apnea and desaturation occurred in 18 of the 21 patients studied. Four children required only home apnea monitoring, and six required only monitoring and supplemental oxygen. Seven children had lip-tongue adhesion procedures performed, and four required tracheostomy. No patients died. All patients with isolated Pierre Robin sequence had normal development at follow-up except for one child who had experienced a respiratory arrest before referral. With improvements in neonatal intensive care, testing for respiratory assessment, improved surgical and postoperative intervention and home monitoring, the morbidity and mortality for children with Pierre Robin sequence can be reduced markedly.

Achalasia and tracheal obstruction in a child.

A 13-year-old patient was referred for evaluation of pulmonary symptoms and was subsequently diagnosed to have achalasia. An esophagram revealed a dilated esophagus which obstructed the trachea at the thoracic outlet during a forced expiratory maneuver. Pulmonary function tests, obtained before and after esophagomyotomy, are presented.