Retrospective assessment of 546 all-ceramic anterior and posterior crowns in a general practice.

STATEMENT OF PROBLEM: There is need to determine whether following a consistent procedural protocol in a private dental practice will result in high success rates for all-ceramic anterior and posterior crowns fabricated from aluminous porcelain veneered to high-alumina content-supporting cores. Aluminous porcelain is known to have poor tensile strength and fracture resistance when subjected to shear forces. PURPOSE: This study examined the long-term survivability of alumina core, all-ceramic crowns in both anterior and posterior locations. MATERIAL AND METHODS: Following a consistent protocol over 6 years, 546 all-ceramic, In-Ceram crowns (32.4% anterior [n = 177] and 67.6% posterior [n = 369]) were consecutively luted with glass ionomer resin hybrid cement and periodically observed by the same dentist who prepared and cemented them. RESULTS: The overall success rate was 99.1% (n = 541) with a 0.9% (n = 5) failure rate. The success-to-failure ratio for anterior all-ceramic crowns was 98.9% to 1.1% (n = 175:2); the posterior crown ratio was 99.2% to 0.8% (n = 366:3). CONCLUSION: Following a consistent protocol of careful tooth preparation and crown cementation resulted in high success rates for anterior and posterior all-ceramic crowns. Glass ionomer resin hybrid cement appeared to be a reliable luting agent. All-ceramic alumina core crowns are durable and provide optimum esthetic choices for anterior and posterior locations.

A pragmatic perspective on reconstructive dentistry and the utilization of posterior all-ceramic crowns.

The placement of well over 500 units of all-ceramic crowns with internally supported aluminous porcelain cores, on anterior (37 percent) and posterior (63 percent) teeth, has demonstrated no greater fracture rate than what might be expected from ceramometal crowns. This esthetic option further expands reconstructive vistas. However, this option must be accompanied by inclusive patient management and education, proper examination and integrated comprehensive treatment planning based upon a sound knowledge of the biology and biomechanics of the stomatognathic system.

Individualized feedback of volatile agent use reduces fresh gas flow rate, but fails to favorably affect agent choice.

BACKGROUND: Cost reduction has become an important fiscal aim of many hospitals and anesthetic departments, despite its inherent limitations. Volatile anesthetic agents are some of the few drugs that are amenable to such treatment because fresh gas flow rate (FGFR) can be independent of patient volatile anesthetic agent requirement. METHODS: FGFR and drug use were recorded at the temporal midpoint of 2,031 general anesthetics during a 2-month preintervention period. Staff and residents were provided with their preintervention individual mean FGFR, their peer group mean, and educational material regarding volatile agent costs and low-flow anesthesia. FGFR and drug use were remeasured over a 2-month period (postintervention) immediately after this information (N = 2,242) and again 5 months later (delayed follow-up), for a further 2-month period (N = 2,056). RESULTS: For all cases, FGFR decreased from 2.4+/-1.1 to 1.8+/-1.0 l/min (26% reduction) after the intervention and increased to 1.9+/-1.1 l/min (5% increase of preintervention FGFR) at the time of delayed follow-up. Use of more expensive volatile agents (desflurane and sevoflurane) increased during the study period (P < 0.01). In a subgroup of 44 staff members with more than five cases in all study periods, 42 members decreased their mean FGFR after intervention. At delayed follow-up, 30 members had increased their FGFR above postintervention FGFR but below their initial FGFR. After accounting for other predictors of FGFR, the effectiveness of the intervention was significantly reduced at follow-up (28% reduction), but retained a significant effect compared to preintervention FGFR (19% reduction). CONCLUSIONS: Although individual feedback and education regarding volatile agent use was effective at reducing FGFR, effectiveness was reduced without continued feedback. Use of more expensive volatile agents was not reduced by education regarding drug cost, and actually increased.

Occlusion pressure response to inspiratory flow-resistive loading in anesthetized swine.

Conscious animals subjected to inspiratory flow-resistive loading augment respiratory drive [as measured by airway occlusion pressure (P100)] independently of changes in chemical drive. Past studies of anesthetized subjects, however, have failed to demonstrate this response, and investigators have concluded that its presence depends on a state of consciousness. We tested the hypothesis that respiratory depression due to anesthesia or endogenous opioids rather than unconsciousness per se was responsible for this observation. Miniature piglets were anesthetized with ketamine and xylazine and subjected to hyperoxic CO2 rebreathing trials with and without added inspiratory resistance, before and after treatment with the opioid antagonist naltrexone. Before naltrexone there was a parallel leftward shift in the occlusion pressure vs. PCO2 relationship without a change in slope (delta P100/delta PCO2). After naltrexone there was a 45.5 +/- 15% increase in slope with loading. Addition of incremental doses of pentobarbital markedly reduced this increase in slope. We conclude that anesthetized animals can demonstrate flow-resistive load compensation in the form of augmented neuromuscular output not due to increased chemical drive. Failure to observe this response in past studies may reflect respiratory depression due to the anesthetic agents employed.

Respiratory responses of piglets to hypercapnia during postnatal development: effects of opioids.

Resting respiratory and cardiovascular functions and the response to CO2 rebreathing were compared between 2.5 +/- 0.7 (mean +/- SE) and 34.1 +/- 1.9 day old piglets, before and after the opioid antagonist naltrexone (1 mg/kg IV). At rest, tidal volume, both absolute and per m2, inspiratory and expiratory time, absolute minute ventilation, and mean arterial pressure increased with age, and breathing frequency, minute ventilation per m2, and heart rate decreased, all of these with as well as without naltrexone. During hypercapnia, the pattern, but not the quantitative aspects of breathing changed with age. At rest, naltrexone produced hyperventilation in the young, but not in the older group. During hypercapnia, naltrexone had a sparse effect in both ages. We conclude that, in the anesthetized piglet, ventilatory functions at rest undergo change with postnatal age, but breathing responses to hypercapnia exhibit maturation in pattern only and not in magnitude. Whereas resting ventilation of young piglets is modulated by endogenous opioids, hypercapnia may activate opioids to a limited extent and in a manner unrelated to age.

The retinopathy of dystrophia myotonia Steinert.

Ophthalmologic examination with ERG investigation in "Ganzfeld" of 11 patients with dystrophia myotonia Steinert, showed decreased "b" wave amplitude in photopic and scotopic conditions, and delayed scotopic "implicit time" in all subjects. That therefore concerns the so called "Rod dysfunction syndrome," a type of ERG abnormality found to appear in retinitis pigmentosa dominantly inherited. A possible relation between ERG abnormality and inheritance in dystrophia myotonia Steinert is suggested. ERG appears to be an useful investigation for ill-defined, congenital and unapparent form of disease, in affected families.