The Effect of Ground and Unground Enamel on the Clinical Performance of Direct Composite Build-up After Orthodontic Treatment: Five Years of Follow-up.

PURPOSE: To assess the clinical performance of restorations with ground and unground enamel for diastema closure. METHODS AND MATERIALS: Twenty-four patients attended and received two to ten composite build-ups for diastema closure. The restorations were performed separately by grinding and not grinding the enamel on the proximal surfaces on symmetric teeth. A nanofill direct composite (Filtek Ultimate Universal Restorative System, 3M ESPE, St Paul, MN, USA) was used with a three-step etch-and-rinse adhesive (Scotchbond Multi-Purpose, 3M ESPE) for restorations. Restorations were evaluated according to the modified United States Public Health Service (USPHS) criteria at baseline and 1-, 2-, 3-, 4-, and 5-year recalls. RESULTS: The cumulative success rate of direct composite build-up with ground and unground enamel was 100% and 88.7%, respectively. Six restorations with unground enamel failed due to fracture. No significant difference was found between the restorations with ground enamel and unground enamel with regard to the evaluation criteria. CONCLUSION: The 5-year success rates of restorations with ground and unground enamel were excellent. The success rate of restorations with ground enamel was higher than that of restorations with unground enamel. Fracture was the reason for failure in the restorations with unground enamel.

Short-Term Comparison of Clinical Performance of Universal Adhesives with Self-Etch Mode in NCCL Restorations.

OBJECTIVES: To evaluate the clinical performance of universal adhesives with self-etch mode regarding their functional monomer and HEMA contents. METHODS: The study involved 27 patients (108 restorations) aged between 34 and 69 (mean age: 53.8). Each restoration contained one of four different universal adhesives applied in self-etch mode: G-Premio Bond (HEMA-free, MDP and 4-MET containing), Xeno Select (HEMA and MDP-free), Tetric-n-Bond Universal (HEMA and MDP-containing) and Clearfil Universal Bond Quick (HEMA, MDP and amide monomers containing). The restorations were evaluated according to the FDI criteria at baseline, 6, and 12 months. The data were statistically analyzed using Friedman's and Kruskal-Wallis tests for significance in each pair (p⟨0.05). RESULTS: After 12 months, one restoration was lost in each of the G-Premio Bond and Clearfil Bond Quick groups. The success rate was 96.3% for both adhesives and 100% for Xeno Select and Tetric-n-Bond adhesives. There was no statistically significant difference between the four dentin adhesive groups among all the evaluation periods regarding any evaluation criteria. However, four universal adhesives showed clinically acceptable marginal discoloration and marginal deterioration in a few restorations. CONCLUSION: Monomer contents of universal adhesives with self-etch mode had no significant effect on the success of restorations.

Clinical Performance of Direct Posterior Composite Restorations in Patients with Amelogenesis Imperfecta.

The objective of this study was to analyze and assess the clinical performance of direct composite restorations using a nanohybrid and a nanofill composite material for posterior teeth in patients with amelogenesis imperfecta (AI). This study involved 15 patients between the ages of 14 and 30 years suffering from amelogenesis imperfecta (AI). During the study, the patients received direct composite restorations using either the Clearfil Majesty ES-2 (Kuraray Medical Inc, Tokyo, Japan) and Clearfil Universal Bond (Kuraray) or Filtek Ultimate Universal Restorative (3M ESPE, St Paul, MN, USA) and Single Bond Universal Adhesive (3M ESPE). The evaluations of the restorations were conducted per the modified USPHS criteria at the time of baseline as well as during the first-, second-, third-, and fourth-year follow-up sessions. After four years, it was observed that the cumulative success rate of direct posterior restorations was 98.1% for Clearfil Majesty ES-2 and 92.2% for Filtek Ultimate. During the study one Clearfil Majesty ES-2 restoration and four Filtek Ultimate restorations failed. There was a significant difference between Clearfil Majesty ES-2 and Filtek Ultimate in the color match in posterior restorations after three and four years. The causes of failure included marginal discoloration and caries, as well as fracture of the restoration. Hence, it can be stated that the use of nanohybrid or nanofill composites in posterior direct restorations in patients with AI looks promising. The failure rate of Clearfil Majesty ES-2 was found to be lower than that of Filtek Ultimate restorations. Clinically, the rate of optimum restorations conducted for partial discoloration, marginal adaptation, color match, and surface texture were observed to be higher when Clearfil Majesty ES-2 was used. However, additional studies are needed to assess the clinical performance of direct posterior composite materials in patients with AI.

Clinical Performance of Direct Posterior Composite Restorations in Patients with Amelogenesis Imperfecta.

The objective of this study was to analyze and assess the clinical performance of direct composite restorations using a nanohybrid and a nanofill composite material for posterior teeth in patients with amelogenesis imperfecta (AI). This study involved 15 patients between the ages of 14 and 30 years suffering from amelogenesis imperfecta (AI). During the study, the patients received direct composite restorations using either the Clearfil Majesty ES-2 (Kuraray Medical Inc, Tokyo, Japan) and Clearfil Universal Bond (Kuraray) or Filtek Ultimate Universal Restorative (3M ESPE, St Paul, MN, USA) and Single Bond Universal Adhesive (3M ESPE). The evaluations of the restorations were conducted per the modified USPHS criteria at the time of baseline as well as during the first-, second-, third-, and fourth-year follow-up sessions. After four years, it was observed that the cumulative success rate of direct posterior restorations was 98.1% for Clearfil Majesty ES-2 and 92.2% for Filtek Ultimate. During the study one Clearfil Majesty ES-2 restoration and four Filtek Ultimate restorations failed. There was a significant difference between Clearfil Majesty ES-2 and Filtek Ultimate in the color match in posterior restorations after three and four years. The causes of failure included marginal discoloration and caries, as well as fracture of the restoration. Hence, it can be stated that the use of nanohybrid or nanofill composites in posterior direct restorations in patients with AI looks promising. The failure rate of Clearfil Majesty ES-2 was found to be lower than that of Filtek Ultimate restorations. Clinically, the rate of optimum restorations conducted for partial discoloration, marginal adaptation, color match, and surface texture were observed to be higher when Clearfil Majesty ES-2 was used. However, additional studies are needed to assess the clinical performance of direct posterior composite materials in patients with AI.

Predicting outgrowth of IgE-mediated cow's milk allergy: Diagnostic tests in children under two years of age

Background: Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow's milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODPfo) with SPT for commercial cow's milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children < 2 years old. Methods: SPTs for CE and FM, tests for sIgEs (cow's milk, casein, alfa-lactoalbumin, Beta-lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis. Results: Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODPfo of 7 mm, 9 mm, and 10.5 kU/L, respectively; these values remained higher with ODPfo of 4 mm, 11 mm, and 10.5 kU/L at the last OFC. Conclusion: Higher initial SPTs for FM and CE and higher initial sIgE levels for cow's milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level < 10.5 kU/L and initial SPT for fresh milk < 9mm are related to the acquisition of tolerance in the follow-up period

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Predicting outgrowth of IgE-mediated cow's milk allergy: Diagnostic tests in children under two years of age.

BACKGROUND: Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow's milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODPfo) with SPT for commercial cow's milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children <2 years old. METHODS: SPTs for CE and FM, tests for sIgEs (cow's milk, casein, α-lactoalbumin, ß-lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis. RESULTS: Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODPfo of 7mm, 9mm, and 10.5kU/L, respectively; these values remained higher with ODPfo of 4mm, 11mm, and 10.5kU/L at the last OFC. CONCLUSION: Higher initial SPTs for FM and CE and higher initial sIgE levels for cow's milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level <10.5kU/L and initial SPT for fresh milk <9mm are related to the acquisition of tolerance in the follow-up period.

Five-year Clinical Evaluation of a Nanofilled and a Nanohybrid Composite in Class IV Cavities.

The purpose of this study was to evaluate a nanofilled and a nanohybrid composite, in combination with manufacturer-recommended etch-and-rinse adhesives, in class IV cavities. Thirty-four patients aged 14-46 years (mean age, 27.1 years) comprised the study group. Twenty-six patients received two class IV restorations and eight patients received four class IV restorations. For each patient, half the number of restorations were performed using a nanohybrid composite (Ceram X duo) and the remaining half used a nanofilled resin composite (Filtek Supreme XT), with two- (XP Bond) and three-step (Scotchbond Multipurpose) etch-and-rinse adhesives, respectively. Two experienced examiners evaluated the restorations for retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture to compare the baseline (after placement) and annual recalls over 5 years. The cumulative success rates for the Filtek Supreme XT and Ceram X duo restorations after five years were 86.2% and 89.7%, respectively. Four Filtek Supreme XT and three Ceram X duo restorations failed. There was no statistically significant difference between the nanofilled and nanohybrid composites at any of the evaluation periods for any of the parameters evaluated. Despite the limited number of restorations, all restorations were clinically acceptable regarding retention, color match, marginal discoloration, wear or loss of anatomic form, the formation of caries, marginal adaptation, and surface texture, except the failed restorations. Fracture was the main cause of restoration failure.

Clinical Performance of Different Solvent-based Dentin Adhesives With Nanofill or Nanohybrid Composites in Class III Restorations: Five Year Results.

PURPOSE: To evaluate the clinical performance of water, acetone, ethanol, and ethanol-water solvent-based dentin adhesives with nanofill or nanohybrid composites in Class III restorations. METHODS AND MATERIALS: A total of 22 patients aged between 14 and 48 years (mean age: 25.2 years) participated in the study. Each patient received four Class III restorations, which were performed using water (Scotchbond Multipurpose), acetone (Prime&Bond NT), ethanol (XP Bond) and ethanol-water (Xeno V) solvent-based dentin adhesive systems with a nanofill (Filtek Supreme XT) or nanohybrid composite (CeramX Duo). Two experienced examiners evaluated the restorations with regard to retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture at baseline and at one-, two-, three-, four-, and five-year recalls. RESULTS: The five-year survival rates were 100% for Scotchbond Multipurpose, Prime&Bond NT, and XP Bond and 81.2% for Xeno V-bonded restorations. Only three Xeno V-bonded restorations failed. With the exception of marginal discoloration, there were no statistically significant differences among the four adhesive-bonded restorations in any of the evaluation periods in terms of the evaluation criteria. CONCLUSIONS: With the exception of marginal discoloration and marginal integrity deterioration of Xeno V-bonded restorations, all four adhesive-bonded restorations exhibited good long-term results. However, adhesion strategy (such as self-etch or etch-and-rinse) is more important than the solvent content of dentin adhesive systems in the success of Class III restorations.

The predictive factors for remission of chronic spontaneous urticaria in childhood: Outcome from a prospective study

BACKGROUND: There are few studies in children on the natural course of chronic spontaneous urticaria (CSU) because of its relative infrequency in childhood. OBJECTIVE: To estimate the rate of remission and evaluate the prognostic factors in children with CSU. METHOD: A total of 52 children with CSU were prospectively followed over a period of three years. RESULTS: The remission rates at 12 months and 36 months were 32.7% and 48.1%. The mean duration of disease at the first visit in the non-remission group was higher than in the remission group at the end of the study (P=0.016). The remission rate of the patients who had been treated by standard dose antihistamine was higher than that of the patients who had been treated with the high-dose antihistamine and combination medications (P=0.004, P<0.001). The treatment steps were independent prognostic factors for remission by logistic regression analysis. CONCLUSION: Our study indicates that urticaria controlled by a standard dose of antihistamine can predict a good prognosis independently from disease duration at first visit

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Violence against emergency department employees and the attitude of employees towards violence.

INTRODUCTION: This study was conducted to evaluate the occurrence of violent incidents in the workplace among the various professional groups working in the emergency department. We characterised the types of violence encountered by different occupation groups and the attitude of individuals working in different capacities. METHODS: This cross-sectional study included 323 people representing various professional groups working in two distinct emergency departments in Turkey. The participants were asked to complete questionnaires prepared in advance by the researchers. The data were analysed using the Statistical Package for the Social Sciences (Windows version 15.0). RESULTS: A total of 323 subjects including 189 (58.5%) men and 134 (41.5%) women participated in the study. Their mean (± standard deviation) age was 31.5 ± 6.5 years and 32.0 ± 6.9 years, respectively. In all, 74.0% of participants had been subjected to verbal or physical violence at any point since starting employment in a medical profession. Moreover, 50.2% of participants stated that they had been subjected to violence for more than 5 times. Among those who reported being subjected to violence, 42.7% had formally reported the incident(s). Besides, 74.3% of participants did not enjoy their profession, did not want to work in the emergency department, or would prefer employment in a non-health care field after being subjected to violence. According to the study participants, the most common cause of violence was the attitude of patients or their family members (28.7%). In addition, 79.6% (n=257) of participants stated that they did not have adequate safety protection in their working area. According to the study participants, there is a need for legal regulations to effectively deter violence and increased safety measures designed to reduce the incidence of violence in the emergency department. CONCLUSION: Violence against employees in the emergency department is a widespread problem. This situation has a strong negative effect on employee satisfaction and work performance. In order to reduce the incidence of violence in the emergency department, both patients and their families should be better informed so they have realistic expectations as an emergency patient, deterrent legal regulations should be put in place, and increased efforts should be made to provide enhanced security for emergency department personnel. These measures will reduce workplace violence and the stress experienced by emergency workers. We expect this to have a positive impact on emergency health care service delivery.

The predictive factors for remission of chronic spontaneous urticaria in childhood: Outcome from a prospective study.

BACKGROUND: There are few studies in children on the natural course of chronic spontaneous urticaria (CSU) because of its relative infrequency in childhood. OBJECTIVE: To estimate the rate of remission and evaluate the prognostic factors in children with CSU. METHOD: A total of 52 children with CSU were prospectively followed over a period of three years. RESULTS: The remission rates at 12 months and 36 months were 32.7% and 48.1%. The mean duration of disease at the first visit in the non-remission group was higher than in the remission group at the end of the study (P=0.016). The remission rate of the patients who had been treated by standard dose antihistamine was higher than that of the patients who had been treated with the high-dose antihistamine and combination medications (P=0.004, P<0.001). The treatment steps were independent prognostic factors for remission by logistic regression analysis. CONCLUSION: Our study indicates that urticaria controlled by a standard dose of antihistamine can predict a good prognosis independently from disease duration at first visit.

The relationship between neutrophil/lymphocyte and platelet/lymphocyte ratios with oxidative stress in active Crohn's disease patients.

BACKGROUND: This study investigated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values with oxidative stress in active Crohn's disease (CD) patients. We investigated whether these parameters were useful for follow-up assessments of CD activity. METHODS: Forty-nine patients with a confirmed diagnosis of CD (24 active and 25 inactive) and 38 control subjects were enrolled in the study. We measured serum activity of superoxide dismutase (SOD) using an enzyme-linked immunosorbent assay (ELISA) and malondialdehyde (MDA) levels using a spectrophotometric method. Neutrophil, lymphocyte and platelet counts were recorded, and the NLR and PLR values were calculated from these parameters. RESULTS: Patients with active CD exhibited significantly higher serum levels of MDA (p =0.007), NLR (p =0.034), and PLR (p =0.026) than inactive CD patients. Receiver operating characteristic (ROC) curve analysis demonstrated that the optimum cut-off values of MDA, NLR, and PLR based on the differences between active and inactive patients were 0.14 µmol/L, 2.58, and 192.26, respectively. The NLR value increased in active patients with elevated MDA levels as a dependent variable (B: 0.422, p =0.029). CONCLUSIONS: We suggest the use of MDA, PLR, and NLR values as a noninvasive test to evaluate disease activity in CD patients. NLR values may also reflect the presence of oxidative stress, and this value may be efficient and useful in determining CD activity. Hippokratia 2016, 20(4): 268-273.

Comparison of injection pain caused by the DentalVibe Injection System versus a traditional syringe for inferior alveolar nerve block anaesthesia in paediatric patients.

AIM: To compare paediatric patients' pain during needle insertion and injection in inferior alveoler nerve block (IANB) anaesthesia injected by either a traditional syringe (TS) or the DentalVibe Injection Comfort System (DV). STUDY DESIGN: the study was a randomised controlled crossover clinical trial, comprised of 60 children aged 6-12 requiring an operative procedure with IANB anaesthesia on their mandibular molars bilaterally. One of the molar teeth was treated with TS and the contralateral tooth was treated with DV. On each visit, subjective and objective pain was evaluated using the Wond-Baker Faces Pain Rating Scale (PRS) and the Face, Legg, Cry, Consolability Scale (FLACC Scale). Patients were asked which anaesthesia technique they preferred. Data were analysed using Wilcoxon signed rank, Spearman correlation, and Mann-Whitney U tests. RESULTS: There were no statistically significant differences for pain evalution during needle insertion and injection of each injection system. However, a negative correlation was found on the FLACC between age and pain scores during injection after using DV. CONCLUSION: Paediatric patients experienced similar pain during IANB anaesthesia administered with TS and DV. With increased age, pain values reduced during anaesthetic agent injection with DV according to FLACC. The traditional procedure was preferred to DV in paediatric patients.

Effect of etanercept and lithium chloride on preventing secondary tissue damage in rats with experimental diffuse severe brain injury.

OBJECTIVE: Studies in animals have provided key evidence that antagonizing TNF-α is a viable therapeutic strategy for diffuse severe brain injury. This study is planned to prevent post-traumatic secondary tissue damages in rat diffuse severe brain injury model, which is induced by alone or combined administration of Etanercept and lithium chloride (LiCl). MATERIALS AND METHODS: Male Sprague-Dawley rats were used in the current study. Rats were divided into 5 groups. Trauma was not induced and treatment was not applied to rats of Sham group. For rats of Trauma+Saline group, saline 0.9% was administered via intraperitoneal (i.p.) route at dose of 1 mg/100 g body weight 1 hour after trauma. For rats of Trauma+Etanercept group, Etanercept was administered via i.p. route at dose of 5 mg/kg body weight 1 hour after trauma. For rats of Trauma+LiCl group, LiCl was administered via i.p. route at dose of 50 mg/kg body weight 1 hour after trauma. For rats of Etanercept+LiCl group, Etanercept and LiCl were administered via i.p. route at dose of 5 mg/kg body weight and 50 mg/kg body weight, respectively, 1 hour after trauma. Serum glial fibrillary acidic protein (GFAP) and Tau levels were analyzed with ELISA. For analyses H&E, TUNEL, GFAP and TNF-α staining methods were used. RESULTS: We demonstrate that Etanercept treatment reduced the TBI-induced brain tissues alteration, reduced the expression of TNF-α and improve edema and axonal swelling. We observed a significant decrease in TNF-α and GFAP positivity after LiCl was administered. CONCLUSIONS: The findings obtained in this study suggest that the combination therapy with Etanercept and LiCl decreased neuronal degeneration and alleviated secondary tissue damage in post-traumatic period.

Investigation of the course of GFAP in blood in the initial 24 hours in rats subjected to minor head trauma.

AIM: Aim of this study is to evaluate the diagnostic efficacy of Glial Fibrillar Acidic Protein (GFAP) particularly in minor head traumas. MATERIALS AND METHODS: 72 female and male, 3 month-old, Sprague Dawley rats were used in the study. The rats were divided into 9 groups. Following anesthesia, all rats were placed in prone position. A 10 mm long and 3 mm thick stainless steel metal disc was fixed onto the skull using dental paste in order to sustain a closed head trauma and evenly distribute the weight throughout the skull. After placing it under the metallic pipe arrangement over a height of 80 centimeters and fixing to make it constant, 50 g metallic discs were released by free fall, and the head trauma was sustained thanks to the gravity-generated force. Blood samples were collected from the rats under anesthesia for biochemical GFAP analysis 10 minutes after the trauma and in 1, 2, 3, 4, 5, 6 and 24 consecutive hours later. RESULTS: GFAP has a peak, and its peak level at hours 1 and 2 in rats subjected to a minor head trauma, with a slight decrease afterwards. CONCLUSIONS: GFAP is an important marker in determining the severity of traumatic brain injury.