Robotic hernia repair: the trainee "Drag" factor-a single-surgeon 9-year experience.

PURPOSE: The use of robotic assisted surgery is increasing but training residents in its use may be associated with increased operative time and cost. The objective of this study is to compare the operative time of robotic incisional/ventral hernia repair (RIVHR) and robotic inguinal hernia repair (RIHR) when performed with and without a resident or fellow trainee. METHODS: A review of prospectively collected data was performed on all patients who underwent RIVHR and RIHR by a single surgeon over a 9-year period (2014-2023). Study variables included presence of trainee (resident or fellow), procedure time, console time, and recurrent hernia. Primary outcomes include procedure time and console time. RESULTS: A total of 402 surgeries were included for analysis. Residents assisted in 190 (47%) of the procedures, while fellows assisted in 97 (24%), and 115 (29%) were performed without a trainee. Median (IQR) console times in RIVHR assisted by fellows was 102 (72-145) minutes, compared to 90 (71-129) minutes among surgeries assisted by residents and 65 (52-82) minutes among surgeries performed without a trainee (p < 0.0001), a similar trend was observed for RIHR. The duration of hernia repair assisted by trainees was significantly longer than surgeries performed without a trainee. CONCLUSION: Operative time for RIVHR and RIHR is significantly lower when performed without a trainee. However, RIHR assisted by residents showed a consistent decrease in operative time over the 9-year period.

The relationship of hydrogen peroxide exposure protocol to bleaching efficacy.

The purpose of this study was to compare two in-office bleaching methods with respect to tooth color change and level of hydrogen peroxide penetration into the pulp cavity and to evaluate relationships between penetration level and color change. Eighty extracted canines were exposed to two different bleaching regimens (conventional vs sealed bleaching technique). After exposure to 38% hydrogen peroxide gel for one hour, hydrogen peroxide amount was estimated spectrophotometrically. Color change was measured per Commission Internationale de l'Eclairage methodology. Linear regression was used to evaluate factors affecting color change, including bleaching technique. The conventional and sealed bleaching groups showed no difference for any color change parameters (ΔL, Δa, Δb, ΔE); however, there was significantly greater hydrogen peroxide penetration in the conventional bleaching group (p<0.05). Linear modeling of the change in lightness (ΔL) showed that the increase in lightness tended to be greater for teeth with lower initial L* values (r=-0.32, p<0.05). After adjustment for initial L*, there was no evidence that ΔL differed with hydrogen peroxide penetration levels (p>0.05) or bleaching technique (mean group difference in ΔL=0.36; p>0.05).

Ethnic differences in reported unmet needs among male inpatients with severe mental illness.

Health services are failing to meet the needs of ethnic minority groups with severe mental illness in the UK. Understanding these unmet social and health needs will assist service providers in developing culturally sensitive and responsive care pathways. Using a cross-sectional design, 165 service users were recruited from 10 acute inpatient wards across four South London boroughs. Needs were assessed using the Camberwell Assessment of Need Short Assessment Schedule and substance dependence and antisocial personality disorder were measured using the Alcohol Use Disorders Identification Test, Drug Use Disorders Identification Test and the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders. African, but not African-Caribbean, heritage continued to predict lower rates of reported unmet needs compared to White British (P < 0.001) following multivariate analysis. Different patterns of unmet needs were observed across ethnic heritage groups. Antisocial personality disorder and alcohol dependence were also independently associated with unmet needs. Consideration of a patient's ethnic identity and comorbidities is essential for effective needs assessment within psychiatric and mental health nursing.

Cavity preparation devices: effect on microleakage of Class V resin-based composite restorations.

PURPOSE: To evaluate the effect of cavity preparation device (i.e. carbide bur, diamond bur, air abrasive, Sonicsys, and Er:YAG laser) on microleakage of Class V resin-based composite (RBC) restorations, the tooth restoration interface and dentin ultrastructure. MATERIALS AND METHODS: Eight groups (n=18) of 9 human molars each were prepared on the buccal and lingual surfaces for Class V RBC restorations using five preparation devices: Group 1: carbide bur #8 round; Group 2: diamond bur #801; Group 3: KCP 1000 air abrasion unit; Group 4: Sonicsys Approx.; Group 5: Er:YAG laser; Group 6: carbide bur plus air abrasive; Group 7: carbide bur plus laser, and Group 8: laser without etching. Circular cavity preparations, 3 mm diameter and 1.5 mm deep, were cut at the CEJ on the buccal and lingual surfaces of each tooth. A bevel was placed on the enamel margin. All cavities were restored using Single Bond adhesive system and Silux Plus according to manufacturer's directions, with the exception that no etchant was used with Group 8. After thermocycling, specimens were tested for microleakage using silver nitrate methodology. Dye penetration data was collected and subjected to non-parametric statistical analysis. SEM analysis of the dentin-RBC interface, as well as the effect of each cavity preparation device on the surface of dentin was performed. RESULTS: Microleakage did not occur in enamel for any method of cavity preparation when the enamel was etched prior to adhesive application. Kruskal-Wallis One-way ANOVA revealed differences in dentin microleakage among the tested groups at alpha=0.05. Mann-Whitney Test for Paired Comparisons at alpha=0.01 demonstrated significantly greater dentin microleakage in Groups 5 and 7 compared to all groups except Group 3 (air abrasive). Although Group 8 had the least microleakage in dentin, this was not significantly different from Groups 1, 2, 4 and 6. SEM observation revealed hybridization at the dentin-resin interface for all groups except for Group 8 (laser prepared, non-etched). Surface analysis showed differences related to the operating mode of each preparation device. CLINICAL SIGNIFICANCE: The method of cavity preparation did not affect microleakage in etched enamel. When using a laser for cavity preparation, enamel should be etched although not etching dentin may help to improve marginal seal.

High-dose loratadine exposure in a six-year-old child.

Loratadine is a long-acting antihistamine indicated for the treatment of seasonal allergic rhinitis and chronic idiopathic urticaria in patients 6 years of age and older. The literature contains little information on high-dose loratadine exposures; as a consequence, poison centers are unsure of the loratadine dose that can be managed with observation and the dose that requires treatment. We report an intentional ingestion of 300 mg loratadine by a 6-y-old child that resulted in minor elevation of blood pressure and heart rate when managed with supportive care only. Further studies and case series are needed before a minimum toxic dose can be established.

Restoration of enamel and dentin erosion due to gastroesophageal reflux disease: a case report.

Gastroesophageal reflux disease (GERD) is a condition where acid contents of the stomach are regurgitated into the oral cavity, which results in continual exposure of the teeth to these acids. Knowledge of the relationship between GERD and dental erosion enables the appropriate diagnosis and treatment of the underlying medical condition as well as the affected teeth. This article details a case report where severe dental erosion was present due to GERD. After management of the disease, treatment (i.e., diagnosis, treatment planning, and restoration) of the eroded dentition is described.

Association between microtensile bond strength and leakage in the indirect resin composite/dentin adhesively bonded joint.

PURPOSE: Develop a methodology to correlate microtensile bond strength (microTBS) and leakage within the same site of a specimen and evaluate the predominate debond and leakage pathways. MATERIALS AND METHODS: A Class II (MO) slot cavity was prepared in 37 extracted human molars and restored with indirect resin composite restorations. The restored teeth were thermocycled 300X between 5 and 55 degrees C and then stained with silver. Two specimens per tooth were obtained by diamond saw sectioning for measurement of leakage (microm) and microtensile bond strength (MPa) at the gingival wall and then tested for association with regression analysis. Scanning electron microscopy techniques and energy dispersive spectroscopy (EDS) were used to evaluate the debond and leakage pathways. RESULTS: Association between leakage and bond strength was not significant (t=1.31, p=0.198). All 74 samples debonded within the joint, predominantly at the hybrid layer-adhesive resin region with only one specimen including a small portion of resin cement in the debond pathway. Secondary and backscatter imaging and EDS analysis showed leakage in all samples that involved the hybrid layer. CONCLUSION: This study demonstrates a feasible method for evaluating leakage and bond strength at the joint interface within the same specimen.

A conservative aesthetic solution for a single anterior edentulous space: case report and one-year follow-up.

Conservative solutions for the restoration of a single edentulous space in the anterior maxilla present an aesthetic challenge to the clinician. Treatment options for tooth replacement include implant placement, a classical fixed partial denture, or a resin-bonded appliance with a metal substructure or fiber-reinforced resin. The resin-bonded Encore Bridge (daVinci Studios, Woodland Hills, CA) offers a restorative solution that is conservative and aesthetic when compared to the required full-tooth preparation in a conventional three-unit fixed partial denture. This case report addresses the indications, preparation guidelines, and restorative procedures for an Encore Bridge.

The physical properties of packable and conventional posterior resin-based composites: a comparison.

BACKGROUND: The authors compared the physical properties of three packable hybrid resin-based composites with those of a conventional hybrid and a microfill composite material advocated for use as posterior restorative materials. They evaluated diametral tensile strength, or DTS; compressive strength, or CS; flexural strength, or FS; and depth of cure, or DC. METHODS: The authors studied the following resin-based restorative materials: three packable composites, Alert Condensable Composite (Jeneric Pentron), SureFil High Density Posterior Restorative (Dentsply Caulk) and Solitaire (Heraeus Kulzer); one conventional hybrid composite, TPH Spectrum (Dentsply Caulk); and one microfill, Heliomolar Radiopaque (Ivoclar-Vivadent). The authors evaluated DTS, CS, FS and DC, according to American National Standards Institute criteria. They made scanning electron micrographs of the packable resin-based composites. RESULTS: Results demonstrated that the conventional hybrid, TPH Spectrum, had significantly greater DTS and FS than other resin-based composites. Alert and SureFil had comparable DTS and FS, which were significantly greater than Heliomolar's DTS and FS. Solitaire had significantly lower DTS and FS than all other resin-based composites. SureFil had the highest CS, followed by TPH Spectrum, Solitaire and Alert, which were comparable and had significantly greater CS than Heliomolar. TPH Spectrum and Alert had significantly greater DC than all other resin-based composites, followed in decreasing order by SureFil, Solitaire and Heliomolar. CONCLUSION: While the packable composites tested in this study had physical properties superior to those of the microfill composite, they were no better suited for use as a posterior restorative material than was the conventional hybrid resin-based composite. CLINICAL IMPLICATIONS: Packable composites may be easier for clinicians to handle than conventional resin-based composites; however, their physical properties were not superior to those of the conventional small-particle hybrid resin-based composite. In addition, these materials may have the clinical drawback of increased wear and surface roughness that was seen with early, large-particle composite restorative materials.

Botulism-like syndrome after injections of botulinum toxin.

Botulinum type A toxin (BTA) is an orphan drug used to treat several disorders of muscle spasticity. We report the first known case of systemic botulism-like syndrome induced by BTA therapy which resulted in respiratory arrest. Clinicians should be aware that systemic effects may occur with localized BTA therapy and may be life-threatening.

In vitro temperature change at the dentin/pulpal interface by using conventional visible light versus argon laser.

BACKGROUND AND OBJECTIVE: The argon laser has been promoted as a competing technology to multi-wavelength visible light as a curing source for dental restorative resins. However, the comparative thermal risk to the pulp between these two sources of light energy requires determination. The objective of this study is to compare the temperature induced at the dentin-pulpal interface between the argon laser and visible light curing unit at a variety of exposure regimens and conditions. STUDY DESIGN/MATERIALS AND METHODS: In vitro temperatures were measured and recorded at the dentin-pulpal interface upon external light exposure. Independent variables included the dentin thickness, duration and waveform of exposure, and presence of composite resin. RESULTS: In most instances, the argon laser resulted in less temperature rise on the pulpal-dentin interface. CONCLUSION: The argon laser should not pose a serious thermal risk to the pulp if used at recommended energies.

Metal surface treatment: characterization and effect on composite-to-metal bond strength.

This study evaluated the effect of four methods of metal surface preparation and the use of silane on the bond strength between resin and a Noble metal alloy. SEM Examination and x-ray energy-dispersive spectroscopy (EDS) of the various metal surface treatments was also performed. One-hundred metal disks were cast in a Noble metal alloy (Porcelain #76). Ninety disks were polished flat and the surfaces received one of four abrasive treatments (n = 20). 1) Roughening with a diamond bur at high speed; 2) Air abrasion with an intraoral sandblaster using alumina particles; 3) Air abrasion with KCP-2000 and 4) Air abrasion with an intraoral sandblaster using silanated silica covered alumina particles (CoJet-Sand). Half the specimens from each treatment group (n = 10) were silanated prior to bonding procedures (All-Bond 2 adhesive system, Pertac-Hybrid composite). Specimens were stored in distilled water at 37 degrees C and thermocycled prior to shear strength testing. The 10 remaining metal disks were used for scanning electron microscopy and x-ray energy-dispersive spectroscopy (EDS). Scanning electron microscopy examined the micromorphology of the metal surfaces produced by the four abrasive treatments and x-ray energy-dispersive spectroscopy (EDS) to evaluate changes in surface composition. Two untreated disks served as controls. One-way ANOVA and Tukey's HSD post-hoc test demonstrated that air abrasion with CoJet-Sand and silane resulted in significantly higher resin-to-metal bond strength than all other metal surface treatments, while roughening with a diamond bur produced the lowest bond strength. Resin-to-metal bond strength was similar for all other particle abrasive treatments with or without silane. Using silane significantly improved bond strength only for metal surfaces treated with CoJet-Sand. An increase in Al concentration was observed on metal surfaces sandblasted with aluminum oxide, and an increase in the concentration of both Al and Si was observed on surfaces air-abraded with CoJet-Sand.

Colorimetric assessment of laser and home bleaching techniques.

PURPOSE: This study recorded in vitro color change of three tooth bleaching techniques that included laser-activated hydrogen peroxide and two concentrations of carbamide peroxide. MATERIALS AND METHODS: Forty extracted human central incisors were exposed to argon laser-activated 35% H2O2, 10% carbamide peroxide, or 20% carbamide peroxide. A fourth group (control) did not receive any bleach treatment (n = 10/group). Commission International de l'Eclariage (CIE) L*a*b* coordinates were recorded prior to bleaching (baseline), at 1 week, and at 2 weeks. The color difference (delta E*ab) between baseline and subsequent measurements was calculated. RESULTS: The control group did not demonstrate significant color difference over time (p > .05). The laser group was not statistically different from the control group (p > .01). The color difference of the 10% and 20% carbamide peroxide groups was statistically different from the control group (p < .01). CLINICAL SIGNIFICANCE: Exposure to 20% carbamide peroxide produced the greatest perceivable change in color. The recommended one-time application of laser-activated hydrogen peroxide did not demonstrate any perceivable color change. The clinician should be aware that additional or longer applications may be required.

Effect of head position on vertical mandibular opening.

STUDY DESIGN: A within-subjects repeated measures design. OBJECTIVES: To determine differences in the amount of vertical opening of the mandible among 3 different head positions. BACKGROUND: Results from several studies have suggested that the position of the head and neck may affect temporomandibular joint function. Presently no standardized position of the head and neck has been recommended for measuring vertical opening of the mandible. METHODS AND MEASURES: Twenty males and 20 females (32.9 +/- 8.3 years) participated in the study. We obtained 3 measurements of vertical mandibular opening using a millimeter ruler on each subject in the forward, neutral, and retracted head positions. RESULTS: A 1-way repeated measures analysis of variance followed by pairwise comparisons indicated that the vertical mandibular opening was significantly greater in the forward head position (44 +/- 5.3 mm) than in the neutral head position (41.5 +/- 4.8 mm) and in the retracted head position (36.2 +/- 4.5 mm). In addition, vertical mandibular opening was significantly greater in the neutral head position than in the retracted head position. Interclass correlation coefficients for the 3 head positions ranged from 0.90 to 0.97 for intrarater, interrater, and day-to-day reliability. CONCLUSIONS: Head position is an important factor in determining the amount of vertical mandibular opening in healthy adults.

Radiopacity of compomers, flowable and conventional resin composites for posterior restorations.

The objective of this study was to densitometrically determine the relative radiopacity (aluminum [Al]-equivalent values) of dentin, enamel, and 20 resin composite materials currently used for posterior restorations. Specimens 5 mm in diameter and 2 mm thick were fabricated from 20 materials (n = 7) for a total of 140 specimens. Human molars were longitudinally sectioned 2.0 mm thick to include both enamel and dentin. The optical densities of enamel, dentin, restorative materials, lead, and aluminum step wedge were obtained from radiographic images, using a transmission photodensitometer. The Al equivalent (mm) for each material was calculated from the linear regression equation of the log of normalized optical density and Al mm thickness obtained from the step wedge. A linear regression of the logarithm of normalized optical density and Al mm thickness was plotted (r2 = 0.9953), and the relative radiopacities, expressed as equivalent thickness of Al, were ranked ordinally. All materials tested, with the exception of an unfilled resin adhesive, complied with ISO Standard 4049, being at least as radiopaque as a 2.0 mm thickness of 99.6% pure Al. Four of six flowable composites had radiopacity values that fell between that of dentin and enamel, while two materials were more radiopaque than enamel. The three compomers tested had radiopacities greater than enamel. In addition, all traditional light- and chemical-cure resin composite materials tested were more radiopaque than enamel. All materials tested, with the exception of one adhesive resin, were at least as radiopaque as dentin and complied with ISO Standard 4049. Clinicians should be able to distinguish these restorative materials radiographically from recurrent decay, voids, gaps, or other defects that lead to clinical failure. Utilization of materials ranked more radiopaque than enamel would enable clinicians to distinguish the restorative material from tooth structure.

Effect of two abrasive systems on resin bonding to laboratory-processed indirect resin composite restorations.

PURPOSE: This study compared two methods of surface roughening or preparation, with or without the use of proprietary surface wetting agents, to evaluate their effect on resin cement adhesion to the following laboratory-processed, indirect restorations: Artglass (AG), belleGlass HP (BG), Concept (C), and Targis (T). Methods of surface roughening or preparation included microetching with aluminum oxide (AO): 50 microns at 34 psi and silanized silica coating, CoJet-Sand (CJ): 30 microns at 34 psi. Artglass and Concept were tested with and without the use of their respective surface wetting agents: Artglass Liquid (AGL) and Special Bond II (SB). MATERIALS AND METHODS: One hundred twenty specimens, each consisting of a pair of cylinders (7.0 x 3 mm and 4.3 x 3 mm) were fabricated. The larger cylinder or base was embedded in self-curing resin in a phenolic ring, and bonding surfaces were finished with 320-grit silicon carbide paper. Specimen pairs for each restorative material were randomly assigned to treatment groups (n = 10) and received the following surface treatments prior to cementation: group 1 (AG/AO/+AGL), group 2 (AG/AO/-AGL), group 3 (AG/CJ/+AGL), group 4 (AG/CJ/-AGL), group 5 (BG/AO), group 6 (BG/CJ), group 7 (C/AO/+SB), group 8 (C/AO/-SB), group 9 (C/CJ/+SB), group 10 (C/CJ/-SB), group 11 (T/AO), and group 12 (T/CJ). Specimen pairs were cemented with a dual-cure resin cement (Dual) and a standardized force of 1 MPa. Specimens were light-cured 40 seconds per side (80 s total), then thermocycled 300 times at between 5 degrees and 55 degrees C. Shear bond strengths (MPa) were determined using a Zwick Materials Testing Machine at a crosshead speed of 5 mm per minute. RESULTS: One-way analysis of variance (ANOVA) and Duncan's multiple range test (alpha = 0.05) by restoration type indicated no significant differences in shear bond strength between BG group 5 (29.8 +/- 5.8), BG group 6 (28.3 +/- 4.3), T group 11 (29.3 +/- 4.9), and T group 12 (29.0 +/- 4.4). Shear bond strength in AG group 3 (35.9 +/- 3.4) was significantly higher than in AG group 4 (32.4 +/- 4.0) and equal to that in AG group 2 (31.9 +/- 3.9) and AG group 1 (30.0 +/- 3.6). Shear bond strength in C group 10 (24.8 +/- 5.7) was equal to that in C group 9 (21.5 +/- 2.9), but was higher than in C groups 7 (19.4 +/- 3.1) and 8 (19.3 +/- 3.4). CLINICAL SIGNIFICANCE: Under the conditions of this study, the combination of CoJet-Sand and Artglass Liquid resulted in the highest bond strength for Artglass restorations. Microetching with CoJet-Sand or aluminum oxide followed by wetting with an unfilled adhesive was an effective surface pretreatment for dual-cure resin cementation of the four proprietary indirect resin-ceromer restorations tested.

Amalgam shear bond strength to dentin using single-bottle primer/adhesive systems.

PURPOSE: To evaluate the in vitro shear bond strengths (SBS) of a spherical amalgam alloy (Tytin) to dentin using several single-bottle primer/adhesive systems both alone: Single Bond (SB), OptiBond Solo (Sol), Prime & Bond 2.1 (PB), One-Step (OS) and in combination with the manufacturer's supplemental amalgam bonding agent: Single Bond w/3M RelyX ARC (SBX) and Prime & Bond 2.1 w/Amalgam Bonding Accessory Kit (PBA). Two, three-component adhesive systems, Scotchbond Multi-Purpose (SBMP) and Scotchbond Multi-Purpose Plus w/light curing (S + V) and w/o light curing (S+) were used for comparison. MATERIALS AND METHODS: One hundred eight extracted human third molars were mounted lengthwise in phenolic rings with acrylic resin. The proximal surfaces were ground to expose a flat dentin surface, then polished to 600 grit silicon carbide paper. The teeth were randomly assigned to 9 groups (n = 12), and dentin surfaces in each group were treated with an adhesive system according to the manufacturer's instructions, except for S + V specimens, where the adhesive was light cured for 10 s before placing the amalgam. Specimens were then secured in a split Teflon mold, having a 3 mm diameter opening and amalgam was triturated and condensed onto the treated dentin surfaces. Twenty minutes after condensation, the split mold was separated. Specimens were placed in distilled water for 24 hrs, then thermocycled (300 cycles, between 5 degrees C and 55 degrees C, with 12 s dwell time). All specimens were stored in 37 degrees C distilled water for 7 days, prior to shear strength testing using a Zwick Universal Testing Machine at a cross-head speed of 0.5 mm/min. RESULTS: The highest to the lowest mean dentin shear bond strength values (MPa) for the adhesive systems tested were: S + V (10.3 +/- 2.3), SBX (10.2 +/- 3.5), PBA, (6.4 +/- 3.6), SOL (5.8 +/- 2.5), SBMP (5.7 +/- 1.8), S+ (4.8 +/- 2.3), PB (2.7 +/- 2.6), SB (2.7 +/- 1.1) and OS (2.5 +/- 1.8). One-way ANOVA and Duncan's Multiple Range Test indicated significant differences among groups. SBX and S + V produced significantly higher amalgam to dentin shear bond strengths than all other adhesive systems. Bond strengths of amalgam to dentin for the single-bottle adhesives, SOL and PBA were comparable to the three-component systems, SBMP and S+ and were significantly greater than OS, SB and PB (P < 0.05).