Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide in a Rapid-Initiation Model of Care for Human Immunodeficiency Virus Type 1 Infection: Primary Analysis of the DIAMOND Study.

BACKGROUND: Most guidelines recommend rapid treatment initiation for patients with newly diagnosed human immunodeficiency virus type 1 (HIV-1) infection, but prospective US data are limited. The DIAMOND (NCT03227861) study using darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is a phase 3 prospective study evaluating efficacy/safety of a single-tablet regimen in a rapid-initiation model of care. METHODS: Adults aged ≥18 years began D/C/F/TAF ≤14 days from diagnosis without screening/baseline results; as results became available, participants not meeting predefined safety/resistance stopping rules continued. Primary endpoint was virologic response (HIV-1 RNA <50 copies/mL; intent-to-treat; US Food and Drug Administration [FDA] snapshot) at week 48; participant satisfaction was measured via the HIV Treatment Satisfaction Questionnaire status version (HIVTSQs). RESULTS: Of 109 participants, 87% were male, 32% black/African American, median (range) age was 28 (range, 19-66) years, 25% of participants had HIV-1 RNA ≥100 000 copies/mL, 21% had CD4+ cell count <200 cells/µL, and 31% enrolled ≤48 hours from diagnosis. At week 48, 97 (89%) participants completed the study and 92 (84%) achieved HIV-1 RNA <50 copies/mL (FDA snapshot). There were no protocol-defined virologic failures; incidences of adverse events (AEs) and adverse drug reactions (33%) were low, no serious AEs were study drug related, and 1 (<1%) participant discontinued due to study drug related AE(s). The overall HIVTSQs score at week 48 was 58 (maximum: 60). CONCLUSIONS: At week 48, a high proportion of participants starting D/C/F/TAF achieved HIV-1 RNA <50 copies/mL and very few discontinued therapy. D/C/F/TAF was well tolerated, no participants discontinued due to baseline resistance stopping criteria, and high treatment satisfaction among participants was recorded. CLINICAL TRIALS REGISTRATION: NCT03227861.

Assessment of root surfaces of apicected teeth: a scanning electron microscopy evaluation.

OBJECTIVES: The aim of this study was to determine the apical surface characteristics and presence of dental cracks in single-rooted premolars, resected 3.0 mm from the root apex, using the Er: YAG laser, tungsten carbide bur, and diamond-coated tip, by scanning electron microscopy (SEM). EXPERIMENTAL DESIGN: Thirty single-rooted premolar teeth were collected. The instrumented and obturated teeth were divided into three groups according to the root resection method (2.94 µm, 100 mj, 20-Hz Er: YAG laser, plain tapered fissure tungsten carbide bur at a low speed of 40,000 rpm, or a diamond-coated SG6D tip coupled to the handpiece of a conventional ultrasound device). The specimens were prepared for SEM and analyzed by the Kruskal-Wallis and Mann-Whitney statistical tests. RESULTS: The SEM images showed that tungsten carbide burs produced significantly smoother resected root surfaces than the diamond-coated tip. There was no statistically significant difference between the Er: YAG and tungsten carbide bur groups. The analysis of scores obtained for the cut quality by the Kruskal-Wallis test revealed no significant differences among the groups. In our study, five teeth had no cracks after the apical resection. The mean number of cracks per tooth was 3.5 ± 1.780 (Er: YAG laser group), 2.5 ± 1.716 (tungsten carbide bur group), and 4.5 ± 2.593 (diamond-coated tip group). CONCLUSIONS: Under the tested conditions smoother surfaces were observed in the groups treated with the tungsten carbide bur and Er: YAG laser when compared with the diamond-coated tips.

CVDentus® X micromotor na segunda infância: avaliação de aspectos técnicos, comportamentais e da agradabilidade / CVDentUS® x low speed handpiece in the 2nd childhood: evaluation of technical and behavioral aspects and pleasantness

O tratamento odontológico geralmente envolve ansiedade nos pacientes decorrente da vibração e ruído provocado pelos instrumentos rotatórios. A instrumentação ultrassônica é uma alternativa ao instrumento rotatório convencional, pois proporciona segurança e conforto ao paciente, além de execução simples e fácil. O presente estudo teve como objetivo comparar o uso de brocas convencionais usadas em micromotor (MM) com, pontas diamantadas CVDentus® no equipamento CVDent1000 (CVD) para remoção de tecido cariado e preparo cavitário em crianças, avaliando os aspectos técnicos das pontas, o comportamento das crianças e a agradabilidade dos equipamentos. Participaram 30 crianças de 36 a 71 meses, apresentando pelo menos dois molares decíduos com lesão de cárie oclusal ativa incipiente, ou com lesão questionável, em fossas e fissuras. A amostra foi subdividida em duas fases. Na fase 1, o CVD foi comparado ao MM sem refrigeração e, na fase 2, com o MM sob refrigeração. Este estudo seguiu o modelo split mouth, e o critério de escolha do dente e do equipamento usado na primeira criança foi aleatório, através de sorteios inicialmente e depois, programado para o equipamento. O tratamento foi realizado em uma única sessão, sem anestesia local, sob isolamento relativo, e os dentes restaurados com cimento de ionômero de vidro convencional. Os aspectos técnicos dos sistemas nas fases 1 e 2, avaliados pelo operador, incluíram os parâmetros visualização da área de trabalho (VAT), acesso á cavidade (AC), remoção do tecido cariado (RTC) e ruído e vibração (RV). O comportamento da criança (Cpt) também foi avaliado. As crianças avaliaram a agradabilidade dos equipamentos pela Escala Analógica Visual de Faces de McGrath (1990) Modificada, somente na fase 2. Na fase 1 houve diferença significantemente superior para o CVD nos critérios Cpt (p=0,0431), AC (p=0,0009) e RV (p=0,0006), sendo estes dois últimos também significantes na fase 2, com o...

The dental treatment usually involves anxiety in patients due to vibration and noise caused by the rotary instruments. The ultrasonic instrumentation is an alternative to the conventional rotatory instrument, device as it provides security and comfort to the patients, beyond simple and easy execution. The objective of this study was to compare the use of conventional handpiece and drills versus diamond burs CVDentus® system CVDent1000® equipment (CVD) for caries removal and cavity preparation in children, evaluating their clinical performance, behavior children and the pleasantness of the equipment. The sample was composed by 30 children from 36 to 71 months, with at least two primary molars with occlusal incipient active or questionable pits and fissures dental caries. The study was divided into two phases. In the phase one, the CVD was compared to HP without refrigeration, and in the phase two, with HP under refrigeration. This study followed a "split mouth" design, and the tooth and the equipment used for the first child were randomly selected by lottery at the beginning, then the selection was programmed for the equipment. The treatment was performed in a single session, without local anesthesia, under rubber dam isolation, and the teeth were restored with conventional glass ionomer cement. The clinical performance of the systems in the two phases was evaluated by the operator, and included the parameters working area view (WAV), access to the cavity (AC), removal of carious tissue (RCT) and noise and vibration (NV). The child's behavior (B) was also evaluated. Children rated the pleasantness of the equipment by the modified VAS Faces of McGrath (1990), only in phase 2. There was a higher and significant difference for CVD in the criteria B (p = 0.0431), AC (p = 0.0009) and NV (p = 0.0006). These last two criteria were also significant in phase 2, with the same p value (Mann-Whitney). For the other...

Avaliação da definição do ângulo cavossuperficial em preparos cavitários realizados com instrumentações rotatória e ultrassônica / Evaluation of cavosurface margin definition in dental cavity preparations made with rotary and ultrasonic instrumentation

O objetivo deste estudo foi avaliar a definição do ângulo cavossuperficial em preparos realizados com instrumentações rotatória e ultrassônica com o sistema CVDentUS utilizando potências variadas do aparelho de ultrassom. Quatro cavidades em forma de circunferência foram realizadas na face vestibular de 10 dentes incisivos bovinos, utilizando-se as pontas cilíndricas CVDentUS (n.82137) e diamantada convencional para alta rotação (n.1092). A amostra foi dividida em 4 grupos: G1 Alta rotação; G2 Ultrassom com potência de 30%; G3 Ultrassom com potência de 60%; G4 Ultrassom com potência de 90%. Os preparos realizados foram padronizados medindo aproximadamente 2 mm de diâmetro e 4 mm de profundidade. Os preparos foram examinados em MEV, o que possibilitou avaliar o ângulo cavossuperficial de cada preparo. Cada preparo foi registrado por meio de fotomoicrografias para serem analisados no programa computadorizado Image pró-plus, que permitiu quantificar a área irregular de cada preparo. Os resultados foram analisados com ANOVA (p< 0,00003), verificando-se a significância estatística entre os fatores, foi aplicado o teste de Tukey que demonstrou haver diferenças na área das irregularidades dos preparos avaliados. Com base na metodologia empregada pôde-se concluir que a definição do ângulo cavossuperficial sofre influência relativa em função do tipo de instrumentação, sendo que a instrumentação rotatóra demonstrou similaridade quanto a regularidade marginal dos preparos cavitários quando comparada com a instrumentação ultrassônica utilizada na faixa de 30% da potencia máxima do aparelho, no entanto quando utilizada nas outras potências avaliadas (60 e 90%) houve alterações mais significativas na definição marginal dos preparos cavitários.

The aim of this study was to evaluated the definition of the cavosurface margin in cavity preparations made with a high speed dental handpieces (360.000 rpm) and with ultrasonic devices. Four cavities in the form of a circle were performed in a buccal surface of 10 bovine incisor teeth, using cylindrical tips CVDentUS (n.82137) for ultrasound and conventional cylindrical diamond bur (n.1092) for rotary instrumentation. The sample was divided into 4 groups: G1 - High speed, G2 - Ultrasound with power level of 30%, G3 - Ultrasound with power level of 60%, G4 - Ultrasound with power level of 90%. The preparations were standardized measuring approximately 2 mm in diameter and 4 mm in depth. The specimens were examined by SEM to evaluate the cavosurface margin of each preparation. The images were analyzed in a computer program, Image Pro-Plus 4.5, which allowed quantifying the irregular area of each preparation. The results were analyzed by ANOVA (p<0, 00003) showed statistically significant differences. The Tukey test pointed differences in the irregularities areas of the preparations. According to the methodology used, rotary instrumentation showed similarity, as the marginal regularity of dental cavities, compared to ultrasonic instrumentation used in the range of 30%. It was concluded that both instruments are effective for the realization of cavity preparations, however when the powers of 60 and 90% were used, cavity margins showed less defined.

The use of CVD diamond burs for ultraconservative cavity preparations: a report of two cases.

UNLABELLED: During the past decades, scientific developments in cutting instruments have changed the conventional techniques used to remove caries lesions. Ultrasound emerged as an alternative for caries removal since the 1950s. However, the conventional technology for diamond powder aggregation with nickel metallic binders could not withstand ultrasonic power. Around 5 years ago, an alternative approach using chemical vapor deposition (CVD) resulted in synthetic diamond technology. CVD diamond burs are obtained with high adherence of the diamond as a unique stone on the metallic surface with excellent abrading performance. This technology allows for diamond deposition with coalescent granulation in different formats of substrates. When connected to an ultrasonic handpiece, CVD diamond burs become an option for cavity preparation, maximizing preservation of tooth structure. Potential advantages such as reduced noise, minimal damage to the gingival tissue, extended bur durability, improved proximal cavity access, reduced risk of hitting the adjacent tooth resulting from the high inclination angles, and minimal patient's risk of metal contamination. These innovative instruments also potentially eliminate some problems regarding decreased cutting efficiency of conventional diamond burs. CLINICAL SIGNIFICANCE: This clinical report presents the benefits of using CVD diamond burs coupled with an ultrasonic handpiece in the treatment of incipient caries. CVD diamond burs coupled with an ultrasonic device offer a promising alternative for removal of carious lesions when ultraconservative cavity preparations are required. Additionally, this system provides a less-painful technique for caries removal, with minimal noise.

Controlling thermal damage of incisions using diamond, copper, and sapphire heat-conducting templates with and without cooling.

INTRODUCTION: We investigated the reduction of thermal damage to the surrounding tissue when laser incisions were made with and without using thermal conducting templates at room temperature and cooled to 5 degrees C. STUDY DESIGN/MATERIALS AND METHODS: We used the Vanderbilt free-electron laser (FEL) at 5.4, 6.1, 6.45, and 7.7 microns. We also used a conventional continuous wave (CW) carbon dioxide laser at 10.6 microns. Incisions were made on 5x10 mm pieces of human breast skin (in vitro) and analyzed with histology. Computer morphometrics were used to measure the amount of thermal damage. RESULTS: All templates produced a statistically significant reduction in the thermal damage. Additionally, we showed that cooling the templates made a statistically significant greater reduction in the thermal damage. The cooled diamond template reduced the thermal damage from the FEL to 28% of the damage observed without a template. The same cooled template reduced the thermal damage from the CO(2) laser to 56% of the damage observed without a template. Lesser reductions were observed with the copper template and even less with the sapphire template. The sapphire template reduced the thermal damage to 39 and 67% of the damage observed without a template for the FEL and the CO(2) laser, respectively. CONCLUSION: These results indicate that unwanted lateral thermal damage from laser incisions can be reduced with cooled thermally conductive templates with the best results obtained with the diamond template, which is also the best thermal conductor.

Effects of various finishing procedures on the staining of provisional restorative materials.

STATEMENT OF PROBLEM: The color stability of tooth-colored restorative materials for provisional restorations is of primary importance when provisional prostheses are worn long term. However, the effect of different polishing methods on the color difference of provisional restorative (PR) materials has not been completely clarified. PURPOSE: The purpose of this study was to investigate the effect of different polishing methods on color stability of 2- and 3-component autopolymerized bis-acrylic composites, a light polymerized composite, and a methyl methacrylate-based PR material upon exposure to a staining agent. Material and methods Sixty cylindrical specimens (15 x 2 mm) were prepared for each of bis-acryl composites (Protemp II and Luxatemp), a light-polymerized composite (Revotek LC), and a methyl methacrylate-based (TemDent) PR material by using a brass mold. The specimens were divided into 6 groups (n=10), and different polishing procedures were used, including pumice (P), diamond polishing paste (Dpp), polishing discs (Pd), and combinations of these. Unpolished specimens served as the control. The specimens were stored for 48 hours at 37 degrees C in a coffee solution. The color of all specimens was measured with a colorimeter (Minolta CR-300) before and after exposure, and color changes (DeltaE) were calculated. The data were analyzed with a 2-way analysis of variance, and mean values were compared by the Tukey Honestly Significant Difference test (alpha=.05). RESULTS: The provisional materials, surface polishing procedures, and interaction were significant (P <.05). In the light-polymerized composite group, the lowest color difference (DeltaE) was observed in Group P-Dpp (4.9) and Group P (5.3), which were not significantly different from each other. In the autopolymerized bis-acryl composites and the methyl methacrylate-based provisional materials, the lowest color difference (DeltaE) was observed in Group P-Dpp. The largest color difference for the light-polymerized and autopolymerized composites was observed in Group Pd-Dpp and Group Pd, which were not significantly different from each other. In the methyl methacrylate-based material group, the largest color difference was observed in Group Pd. When comparing the 4 different PR materials, the methyl methacrylate-based material group demonstrated statistically significantly less color change than the other provisional material tested. CONCLUSION: The methyl methacrylate-based PR material (TemDent) was found to be more color stable than the autopolymerized (Protemp II and Luxatemp) and light-polymerized (Revotek LC) composites tested. The use of diamond polishing paste after polishing with pumice significantly decreased the staining of methyl metacrylate and bis-acryl composites tested. The highest color-change values were obtained in the groups polished with polishing discs, which were found to be significantly different compared to values obtained with other polishing techniques.

Conventional diamond fraise vs manual spot dermabrasion with drywall sanding screen for scars from skin cancer surgery.

OBJECTIVE: To directly compare cosmetic improvement and postoperative sequelae resulting from dermabrasion of surgical scars with conventional motor-powered diamond fraise vs manual dermabrasion with medium-grade drywall sanding screen. DESIGN: Patients were randomly assigned to receive treatment with conventional diamond fraise dermabrasion to one half of the scar and manual dermabrasion with a drywall sanding screen to the other half in a prospective, comparative clinical study. Blinded observers assessed clinical variables during a 6-month follow-up period. SETTING: University hospital/cancer center-based cutaneous surgery unit. PATIENTS: Twenty-one healthy volunteers, Fitzpatrick skin type I to III, with contour irregularities resulting from granulation (7 patients) or reconstruction (14 patients) after skin cancer excision. INTERVENTIONS: One half of the patient's scar was treated with motor-powered diamond fraise dermabrasion and the other half was treated with manual dermabrasion with medium-grade drywall sanding screen. MAIN OUTCOME MEASURES: Correction of contour, scarline visibility, time to reepithelialization, presence or absence of milia, degree of postoperative erythema, hypertrophic scarring, patients' subjective reports of postoperative pain, and presence of pigmentary changes were observed for both methods. Standardized scoring systems were used to quantify outcome measures. RESULTS: According to the standardized scoring systems, no differences were found between the 2 methods at any point. In addition, no significant differences were found between the methods for any measure at any of the time points. CONCLUSION: Both dermabrasion techniques are equally effective in improving the cosmetic appearance of surgical scars.