Factors influencing the survival of implant-supported ceramic-ceramic prostheses: A randomized, controlled clinical trial.

OBJECTIVE: The goals of this research are: (1) to determine the clinical survival of ceramic-ceramic 3-unit implant supported fixed dental prostheses (FDPs) compared with control metal-ceramic and; (2) to analyze the effects of design parameters such as connector height, radius of curvature of gingival embrasure, and occlusal veneer thickness. MATERIALS AND METHODS: This randomized, controlled clinical trial enrolled 96 participants with 129 3-unit implant-supported FDPs. Participants were randomized to receive different design combinations to include FDP material, thickness of occlusal veneer ceramic, radius of curvature of gingival embrasure and connector height. Participants were recalled for 6 months, 1year and yearly thereafter for the next 5 years. FDPs were examined for evidence of fracture and radiographs were made to assess viability of implants. Fractographic analyses and Kaplan Meier survival analysis was used to analyze the data. RESULTS: 27 FDPs, representing 21%, exhibited chipping fractures of the veneer during the 5-year observation period. There was no statistically significant effect of type of material, veneer thickness, radius of curvature of gingival embrasure and connector height on occurrence of fracture. Fractographic and occlusal analyses reveal that fractures originated from the occlusal surface and that occlusion was the most important factor in determining survival. Stresses calculated at failure demonstrated lower values compared with in vitro data. CONCLUSION: Implant-supported ceramic-ceramic prosthesis is a viable alternative to metal-ceramic. Survival analysis for both materials were comparable and design parameters employed in this study did not affect survival as long as zirconia was used as the core material.

Developing and testing an algorithm for automatic segmentation of the fetal face from three-dimensional ultrasound images.

Fetal craniofacial abnormalities are challenging to detect and diagnose on prenatal ultrasound (US). Image segmentation and computer analysis of three-dimensional US volumes of the fetal face may provide an objective measure to quantify fetal facial features and identify abnormalities. We have developed and tested an atlas-based partially automated facial segmentation algorithm; however, the volumes require additional manual segmentation (MS), which is time and labour intensive and may preclude this method from clinical adoption. These manually refined segmentations can then be used as a reference (atlas) by the partially automated segmentation algorithm to improve algorithmic performance with the aim of eliminating the need for manual refinement and developing a fully automated system. This study assesses the inter- and intra-operator variability of MS and tests an optimized version of our automatic segmentation (AS) algorithm. The manual refinements of 15 fetal faces performed by three operators and repeated by one operator were assessed by Dice score, average symmetrical surface distance and volume difference. The performance of the partially automatic algorithm with difference size atlases was evaluated by Dice score and computational time. Assessment of the manual refinements showed low inter- and intra-operator variability demonstrating its suitability for optimizing the AS algorithm. The algorithm showed improved performance following an increase in the atlas size in turn reducing the need for manual refinement.

A homoleptic chromium(iii) carboxylate.

Structurally characterized chromium(iii) carboxylates form clusters with a variety of bridging groups introduced from aqueous reaction conditions. The first homoleptic monomeric chromium(iii) carboxylate has been prepared using an anhydrous salt metathesis synthetic route. The carboxylate groups coordinate the chromium in a bidentate chelate yielding an aliphatic soluble complex. The complex was characterized by a variety of methods including high energy X-ray diffraction, FD-MS, IR and Raman spectroscopy, complemented by DFT modeling.

Novel Testing for Corrosion of Glass-Ceramics for Dental Applications.

The effects of pH cycling immersion on the corrosion of glass-based ceramic materials were investigated by examining the silicon release level in the immersion solution and the surface morphology of the ceramic after immersion. The hypothesis that pH cycling causes more surface degradation than constant immersion was tested. An inductively coupled plasma atomic emission spectrometer was used for Si ion concentration determination and scanning electron microscopy for surface morphology analyses. Two pH cycling sequences (pH 2, 7, 10 and pH 10, 2, 7) were employed in this study. Glass-ceramic disks were immersed in each pH solution for 3 d, then cycled for 27 d. The silicon release levels during the pH cycling were significantly higher than those in the constant pH immersion. The silicon levels for both cycling sequences were around 47 and 2 times higher than that in constant pH conditions for 2 and 10, respectively. The morphology of the ceramic treated with cycling was also significantly degraded as compared with the ceramic immersed in the constant pH solution. Thus, the severity of glass-ceramic degradation depends not only on the pH of the immersed solution but also on the pH of the previous solution. Since the pH of the oral environment can vary depending on the diet and buffering capacity of saliva, materials testing in constant pH immersion might underestimate the in vivo corrosion. New mechanisms were proposed to account for the effect of pH cycling on glass-ceramic corrosion.

Randomized clinical study of wear of enamel antagonists against polished monolithic zirconia crowns.

OBJECTIVES: To test the hypothesis that there is no difference in the in vivo maximum wear of enamel opposing monolithic zirconia crowns, enamel opposing porcelain fused to metal crowns and enamel opposing enamel. METHODS: Thirty patients needing single crowns were randomized to receive either a monolithic zirconia or metal-ceramic crown. Two non-restored opposing teeth in the same quadrants were identified to serve as enamel controls. After cementation, quadrants were scanned for baseline data. Polyvinylsiloxane impressions were obtained and poured in white stone. Patients were recalled at six-months and one-year for re-impression. Stone models were scanned using a tabletop laserscanner to determine maximum wear. Statistical analysis was performed using Mann-Whitney U to determine any significant differences between the wear of enamel against zirconia and metal-ceramic crowns. RESULTS: Sixteen zirconia and 14 metal-ceramic crowns were delivered. There were no statistical differences in mean wear of crown types (p=0.165); enamel antagonists (p=0.235) and enamel controls (p=0.843) after one year. CONCLUSION: Monolithic zirconia exhibited comparable wear of enamel compared with metal-ceramic crowns and control enamel after one year. SIGNIFICANCE: This study is clinically significant because the use of polished monolithic zirconia demonstrated comparable wear of opposing enamel to metal-ceramic and enamel antagonists.

Social comparisons, health and well-being.

Health and well-being are socially determined. One of the ways in which this comes about is via social comparisons with other individuals in the same personal, geographic or social networks, with the comparisons referring either to income or other aspects of economic and social life. The existence of such comparison effects with respect to income may help to explain the social gradient in health.

Surface degradation of dental ceramics as a function of environmental pH.

We tested the hypotheses that glass-ceramic veneers and overglazes degrade by ion exchange in an acidic environment, and that they degrade by breakdown of the silica network in a basic environment. Disk specimens of glass-ceramic veneer and glaze were fabricated and immersed in pH 2, 7, or 10 buffer solutions, for 1, 3, 5, 10, 15, and 30 days. Each specimen was placed in a shaker bath containing de-ionized distilled water at 80°C. Concentrations of Al(3+), Ca(2+), Zn(2+), Li(2+), and Si(4+) were analyzed by means of inductively coupled plasma atomic emission spectrometry (ICP/AES). Statistical analyses were performed by factorial ANOVA. Significant differences occurred among leached ion concentrations as a function of material type, solution pH, and exposure time. A substantial release of Si occurred at pH 10 over time, leading to a breakdown of the glass phase. At pH 2, dissolution was controlled by an ionic exchange mechanism. We conclude that ceramic veneers and glazes may be susceptible to considerable degradation in low- and high-pH buffer solutions.

Pulp capping with a modified bioglass formula (#A68-modified).

PURPOSE: To evaluate a modified Bioglass (Formula #68 (MBF68) when used as a pulp capping agent. MATERIALS AND METHODS: After exposure, the pulps were contaminated with saliva for 60s, rinsed, dried and treated with Consepsis, acting as a hemostatic and bactericidal agent. After drying the Consepsis, the MFB68, having been pre-mixed in sterile saline, was carefully deposited over the pulp exposure, covered with polycarboxylate cement and restored with the ProBond bonding resin system. A calcium hydroxide group was used as control. RESULTS: There was no evidence of mummification, the incidence of properly positioned dentin bridge formation was higher and the incidence of extruded dentin bridge formation was reduced.

Model studies of hydrogen atom addition and abstraction processes involving ortho-, meta-, and para-benzynes.

H-atom addition and abstraction processes involving ortho-, meta-, and para-benzyne have been investigated by multiconfigurational self-consistent field methods. The H(A) + H(B)...H(C) reaction (where r(BC) is adjusted to mimic the appropriate singlet-triplet energy gap) is shown to effectively model H-atom addition to benzyne. The doublet multiconfiguration wave functions are shown to mix the "singlet" and "triplet" valence bond structures of H(B)...H(C) along the reaction coordinate; however, the extent of mixing is dependent on the singlet-triplet energy gap (DeltaE(ST)) of the H(B)...H(C) diradical. Early in the reaction, the ground-state wave function is essentially the "singlet" VB function, yet it gains significant "triplet" VB character along the reaction coordinate that allows H(A)-H(B) bond formation. Conversely, the wave function of the first excited state is predominantly the "triplet" VB configuration early in the reaction coordinate, but gains "singlet" VB character when the H-atom is close to a radical center. As a result, the potential energy surface (PES) for H-atom addition to triplet H(B)...H(C) diradical is repulsive! The H3 model predicts, in agreement with the actual calculations on benzyne, that the singlet diradical electrons are not coupled strongly enough to give rise to an activation barrier associated with C-H bond formation. Moreover, this model predicts that the PES for H-atom addition to triplet benzyne will be characterized by a repulsive curve early in the reaction coordinate, followed by a potential avoided crossing with the (pi)1(sigma*)1 state of the phenyl radical. In contrast to H-atom addition, large activation barriers characterize the abstraction process in both the singlet ground state and first triplet state. In the ground state, this barrier results from the weakly avoided crossing of the dominant VB configurations in the ground-state singlet (S0) and first excited singlet (S1) because of the large energy gap between S0 and S1 early in the reaction coordinate. Because the S1 state is best described as the combination of the triplet X-H bond and the triplet H(B)...H(C) spin couplings, the activation barrier along the S0 abstraction PES will have much less dependence on the DeltaE(ST) of H(B)...H(C) than previously speculated. For similar reasons, the T1 potential surface is quite comparable to the S0 PES.

UDFT and MCSCF descriptions of the photochemical Bergman cyclization of enediynes.

Several singlet and triplet potential energy surfaces (PES) for the Bergman cyclization of cis-1,5-hexadiyne-3-ene (1a) have been computed by UDFT, CI, CASCI, CASSCF, and CASMP2 methods. It is found that the first six excited states of 1a can be qualitatively described as linear combinations of the configurations of weakly interacting ethylene and acetylene units. Although the symmetry relaxation from C2nu to C2 makes cyclization of the 13B state Woodward-Hoffmann allowed, it also increases the probability of competing cis-trans isomerization. Hydrogen atom abstraction is another plausible pathway because the terminal alkyne carbons possess a large radical character. In view of the competing processes, we conclude that the Bergman cyclization along the 13B path is unlikely despite its exothermicity (Delta = -42 kcal/mol). Calculations on cyclic analogues of 1a lead to similar conclusions. A less exothermic, but more plausible pathway for photochemical cyclization lies on the 2(1)A PES (Delta = -18 kcal/mol). Compared to the 1(1)A(1) and 1(3)B states, the 2(1)A state has less in-plane electron repulsion which may facilitate cyclization. The resulting p-benzyne intermediate has an unusual electronic structure combining singlet carbene and open-shell diradical features. Deactivation of the 2(1)A state of 1a is a competing pathway.

Novel sol-gel bioactive fibers.

Bioactive fibers were produced using a sol-gel method. The rheological properties of two different sol compositions prepared from a mixture of TEOS, phosphorous alkoxide and calcium nitrate, or calcium chloride in a water-ethanol solution, are reported. The sols were extruded through a spinneret to produce continuous 10 microm-diameter fibers. Discontinuous fibers and fibrous mats were prepared by air-spraying the multicomponent sols. The sol-gel fibers were converted to the bioactive fibers by three different thermal treatments at either 600 degrees, 700 degrees, or 900 degrees C for 3 h. SEM, BET, EDX, and FTIR were used to characterize the morphology and structure of the fibers. The BET measured surface area of the fibers sintered at 900 degrees C was 0 m(2)/gm compared to a value of 200 m(2)/gm for a typical sol-gel-derived particle of similar composition. Both the continuous and discontinuous fibers exhibited in vitro bioactivity in a simulated body fluid.

A sol-gel derived bioactive fibrous mesh.

Nonwoven sheets of bioactive fibers were produced using a sol-gel process. A high velocity spray process was used to prepare fibers of two compositions in the SiO(2)-CaO-P(2)O(5) ternary system. Both discontinuous fibers and dispersed fibers were evaluated. Viscosity and pH of the sol were the two primary processing variables studied. The formation of hydroxy carbonate apatite (HCA) on the surface of the fibers was used to evaluate the kinetics of the bioactivity in a simulated body fluid (SBF). Diffuse reflection infrared fourier transform spectroscopic (DRIFTS) analysis confirmed the presence of HCA (P-O). A homogenous layer of HCA, as observed with SEM (scanning electron microscopy), typically formed after 3-h immersion in the SBF. The concentration of HCA formed was greater for samples richer in silica. The new bioactive fiber sheets produced by this process are chemically more stable than powders or monoliths prepared from similar precursors. Potential applications are as scaffold for both mineralized and nonmineralized structural tissues.

Effectiveness of metal surface treatments in controlling microleakage of the acrylic resin-metal framework interface.

STATEMENT OF PROBLEM: Microleakage at the junction between the metal alloy and acrylic resin in a removable partial denture may result in discoloration, fluid percolation, and acrylic resin deterioration. The junction between a metal alloy and acrylic resin is an area of clinical concern. Failure of a removable partial denture may be linked to this interface. Enhancing resistance to microleakage at this interface may improve the long-term union between the 2 materials. PURPOSE: This investigation was designed to determine the effects of various metal surface treatment protocols on microleakage and bond strength between the metal alloy and acrylic resin used in the fabrication of a removable partial denture. MATERIAL AND METHODS: Ninety-six nickel-chromium-beryllium alloy specimens were randomly divided into 8 groups. After adaptation of baseplate wax, each specimen was invested. Subsequent to wax removal, each specimen was divided into a control half and an experimental half. Air abrasion, tinplating/oxidation, and silanation were evaluated individually and in all combinations. Heat-polymerized acrylic resin was processed against all specimens before storage in distilled water at 37 degrees C for 72 hours. Each specimen then was thermocycled in distilled water (3000 cycles) before immersion in sodium fluorescein dye for 24 hours. Counting grids that exhibited dye penetration under ultraviolet light exposure allowed assessment of microleakage. RESULTS: Air abrasion resulted in a significant decrease in microleakage when used individually and in all combinations (P<0.05). All experimental combinations that did not involve air abrasion demonstrated no significant reduction in measured microleakage between the experimental and control sides. Tukey's pair-wise comparison of the difference in the mean number of squares exhibiting microleakage between the control and treated sites for each experimental group revealed a significant difference, based on the involvement of air abrasion. Groups involving air abrasion did not differ significantly from each other (P<0.05). In addition, no significant difference was detected between groups not involving air abrasion (P<0.05). CONCLUSION: Air abrasion, alone and in combination with tinplating/oxidation and with silanation, resulted in a significant reduction in microleakage between the metal alloy and acrylic resin.

Chronic insulin effects on insulin signalling and GLUT4 endocytosis are reversed by metformin.

Decreases in insulin-responsive glucose transport and associated levels of cell surface GLUT4 occur in rat adipocytes maintained in culture for 20 h under hyperinsulinaemic and hyperglycaemic conditions. We have investigated whether this defect is due to reduced signalling from the insulin receptor, GLUT4 expression or impaired GLUT4 trafficking. The effects of chronic insulin treatment on glucose transport and GLUT4 trafficking were ameliorated by inclusion of metformin in the culture medium. In comparison with the ic insulin treatment attenuated changes in signalling processes leading to glucose transport. These included insulin receptor tyrosine phosphorylation, phosphoinositide 3-kinase activity and Akt activity, which were all reduced by 60-70%. Inclusion of metformin in the culture medium prevented the effects of the chronic insulin treatment on these signalling processes. In comparison with cells maintained in culture without insulin, the total expression of GLUT4 protein was not significantly altered by chronic insulin treatment, although the level of GLUT1 expression was increased. Trafficking rate constants for wortmannin-induced cell-surface loss of GLUT4 and GLUT1 were assessed by 2-N-4-(1-azi-2, 2,2-trifluoroethyl)benzoyl-1,3-bis(D-mannose-4-yloxy)-2-propyla min e (ATB-BMPA) photolabelling. In comparison with cells acutely treated with insulin, chronic insulin treatment resulted in a doubling of the rate constants for GLUT4 endocytosis. These results suggest that the GLUT4 endocytosis process is very sensitive to the perturbations in signalling that occur under hyperinsulinaemic and hyperglycaemic conditions, and that the resulting elevation of endocytosis accounts for the reduced levels of net GLUT4 translocation observed.

Cyclic anhydride ring opening reactions: theory and application.

The development of a zero net shrinkage dental restorative material based upon a polymer-bioactive-glass composite requires a second-phase material that expands. This study details the mechanisms of organic cyclic anhydride ring expansion via hydrolysis. Six cyclic anhydrides were used to represent potential side groups, each of which could be an expanding phase or component. Maleic, 4META, tetrahydrophthalic, norbornene, itaconic, and succinic anhydrides were modeled using the Austin method (AM1), a semi-empirical molecular orbital method. The reaction pathways were determined for the anhydride ring opening reaction to form an acid for each case. The activation barriers (Ea) for the ring openings were found from the transition state geometries wherein only one imaginary eigen value in the vibration spectrum existed (a true saddle point). In each case the reaction pathway included the hydrogen bonding of a H2O molecule to the ring, weakening of the C-O bridging bonds of the ring, and, finally, the dissociation of the H2O, forming two carboxyl groups and opening the ring. The activation for the ring openings are +34.3, +36.9, +40.6, +43.1, +45.9, and +47.7 kcal/mol, respectively. The volumetric expansion of the anhydrides was estimated based upon the dilation of C-O-C atomic distances. The dimensional change was found to be 24.0%, 24.0%, 19.1%, 20.3%, 20.8%, and 17.9% for the anhydride rings, respectively. Finally, it was found that a linear correlation exists between the cyclic anhydride C-O asymmetric rocking (as-v) vibration and the activation energy (Ea) for hydrolysis to an acid. This may be used as an experimental indicator of a cyclic anhydride's activity.

Dietary fiber differentially alters cellular fatty acid-binding protein expression in exfoliated colonocytes during tumor development.

We investigated the utility of noninvasive technology utilizing feces containing exfoliated colonocytes to determine whether changes in fecal fatty acid-binding proteins have predictive value in monitoring the neoplastic process. Ninety male Sprague-Dawley rats were randomly divided into four groups in a 2 x 2 factorial design, with two dietary fiber sources (wheat bran or oat bran) and two treatment groups (injection with a carcinogen, azoxymethane, or saline). Fresh fecal samples were collected at Week 16 postinjection, and tumor frequency was determined at Week 36 of the study. Semiquantitative "mimic" reverse transcriptase polymerase chain reaction was used to quantitate the expression of liver fatty acid-binding protein (L-FABP), intestinal fatty acid-binding protein (i-FABP), and acyl CoA-binding protein (ACBP) mRNA in fecal samples to establish their prognostic value. Rats fed wheat bran diets had a lower incidence of tumors (p < 0.05). There was no effect of carcinogen injection or tumor incidence on the expression of L-FABP, i-FABP, or ACBP mRNA, L-FABP and i-FABP mRNA expression were significantly higher (p < 0.05) in feces from animals fed a wheat bran diet than in feces from animals fed an oat bran diet. In contrast, the expression of ACBP mRNA was significantly lower (p < 0.05) in animals fed a wheat bran diet than in animals fed an oat bran diet. Wheat bran also increased (p < 0.05) the total excretion of L-FABP, i-FABP, and ACBP over a 48-hour period. These data suggest that exfoliated colonocyte fatty acid-binding protein mRNA status may provide insight into the mechanisms by which diet influences colonic physiology.

Effect of insulin on GLUT4 cell surface content and turnover rate in human skeletal muscle as measured by the exofacial bis-mannose photolabeling technique.

Insulin-stimulated glucose transport across the skeletal muscle cell membrane is a major regulatory step in postprandial glucose disposal. To estimate the total molar concentration of GLUT4 as well as the turnover rate of GLUT4 in human vastus lateralis muscles at the cell surface in the basal state and after insulin exposure, we have applied the sensitive exofacial bis-mannose photolabeling technique on in vitro incubated human skeletal muscle strips from healthy subjects. In addition, we have measured 3-O-methylglucose transport in other muscle strips prepared from the same surgically removed human skeletal muscle biopsies to compare glucose transport with cell surface level of GLUT4. Maximal in vitro insulin stimulation (2,400 pmol/l) resulted in a twofold increase compared with basal in both surface GLUT4 content (0.38 +/- 0.05 vs. 0.19 +/- 0.03 pmol/g wet muscle wt, P < 0.005) and 3-O-methylglucose transport (1.24 +/- 0.13 vs. 0.63 +/- 0.08 pmol x ml(-1) x h(-1), P < 0.005). The insulin-induced increment in 3-O-methylglucose transport was strongly correlated with the insulin-induced increase in cell surface GLUT4 content (r2 = 0.91; P < 0.005). The calculated turnover rate of human skeletal muscle GLUT4 amounted to approximately 8 x 10(4) min(-1) at 35 degrees C and was unaffected by insulin. In conclusion, maximal in vitro insulin stimulation of vastus lateralis muscle strips from healthy subjects resulted in a twofold rise in glucose transport as well as in cell surface content, whereas the turnover rate of GLUT4 was unaffected by insulin under the chosen experimental conditions.