Performance of two different digital evaluation systems used for assessing pre-clinical dental students' prosthodontic technical skills.

INTRODUCTION: Proper integration of newly emerging digital assessment tools is a central issue in dental education in an effort to provide more accurate and objective feedback to students. The study examined how the outcomes of students' tooth preparation were correlated when evaluated using traditional faculty assessment and two types of digital assessment approaches. Specifically, incorporation of the Romexis Compare 2.0 (Compare) and Sirona prepCheck 1.1 (prepCheck) systems was evaluated. Additionally, satisfaction of students based on the type of software was evaluated through a survey. MATERIAL AND METHODS: Students in a second-year pre-clinical prosthodontics course were allocated to either Compare (n = 42) or prepCheck (n = 37) systems. All students received conventional instruction and used their assigned digital system as an additional evaluation tool to aid in assessing their work. Examinations assessed crown preparations of the maxillary right central incisor (#8) and the mandibular left first molar (#19). All submissions were graded by faculty, Compare and prepCheck. RESULTS: Technical scores did not differ between student groups for any of the assessment approaches. Compare and prepCheck had modest, statistically significant correlations with faculty scores with a minimum correlation of 0.3944 (P = 0.0011) and strong, statistically significant correlations with each other with a minimum correlation of 0.8203 (P < 0.0001). A post-course student survey found that 55.26% of the students felt unfavourably about learning the digital evaluation protocols. A total of 62.31% felt favourably about the integration of these digital tools into the curriculum. CONCLUSIONS: Comparison of Compare and prepCheck showed no evidence of significant difference in students' prosthodontics technical performance and perception.

The treatment of moderate to severe psoriasis with a new anti-CD11a monoclonal antibody.

BACKGROUND: Anti-CD11a (hu1124) is a humanized monoclonal antibody directed against the CD11a subunit of LFA-1. This study investigated whether treatment with anti-CD11a antibody provides clinical benefit to patients with moderate to severe plaque psoriasis. METHODS: This was a double-blind, placebo-controlled, phase II, multicenter study. In total, 145 patients with minimum Psoriasis Area and Severity Index scores of 12 and affected body surface area of 10% or more were sequentially enrolled into low-dose (0.1 mg/kg, n = 22) or high-dose (0.3 mg/kg, n = 75) groups. Within groups, patients were randomized to treatment or placebo (n = 48) in a 2:1 ratio. Drug was administered intravenously at weekly intervals for 8 weeks. RESULTS: The percentage of subjects achieving more than 50% improvement in physician's global assessment at day 56 (1 week after final dose) was 15% and 48% for placebo and 0.3 mg/kg of drug, respectively (P =.002). A physician's global assessment of excellent (>75% improvement) was greater in the 0.3 mg/kg group versus placebo (25% vs 2%, P =.0003). Average Psoriasis Area and Severity Index scores at day 56 were 13.9 +/- 7.5 (placebo) and 10.9 +/- 8.4 (0.3 mg/kg) (P <.0001). Epidermal thickness was reduced in the 0.3 mg/kg group compared with the placebo group (37% vs 19%, P =.004). Treatment was well tolerated; mild to moderate flu-like complaints were the most common adverse events. White blood cell counts and lymphocyte counts transiently increased. Depletion of circulating lymphocytes did not occur. CONCLUSIONS: Anti-CD11a antibody administered intravenously in 8 weekly doses of 0.3 mg/kg was well tolerated and induced clinical and histologic improvements in psoriasis.

Dynamic fatigue properties of the dental implant-abutment interface: joint opening in wide-diameter versus standard-diameter hex-type implants.

STATEMENT OF PROBLEM: The clinical long-term success of single-tooth implant restorations depends, in part, on a stable connection between the prosthetic restoration and the implant body. PURPOSE: The purpose of this experiment was to investigate the fatigue life of UCLA-style abutment screws in wide-diameter versus conventionally sized dental implant restorations. MATERIAL AND METHODS: Five 3.75 x 15-mm and five 6.0 x 15-mm hexed dental implants were used. Ten frameworks were fabricated, 5 with a single UCLA-style, 3.75-mm hexed gold alloy cylinder, and 5 with a single UCLA-style, 6.0-mm hexed gold alloy cylinder. To simulate a common laboratory procedure, 2 abutment interfaces were relieved with a one-quarter round bur for both diameters. The 3.75-mm implant used a Gold-Tite central abutment screw torqued to 32 Ncm, and the 6.0-mm implant used a titanium central abutment screw torqued to 25 Ncm. Frameworks were dynamically loaded ( approximately 10 Hz) with a 120 +/- 10-N, 4-mm off-axis force. Liquid metal strain gauges were used to measure joint opening. Measurements were made at intervals of 10(3), 10(4), 10(5), and 5x10(5) cycles. Gauge output data were converted to displacement with a conversion factor determined by calibration. Linear regression analysis then was performed. RESULTS: Two observations were made in this study. Two of three 3.75-mm nonadjusted specimens and all three 6.0-mm nonadjusted specimens maintained joint closure (range of opening 0-20 microm) while measured under dynamic loading. The median joint opening at 5x10(5) cycles for 3.75-mm nonadjusted specimens was 14 +/- 7 microm; for 6.0-mm specimens, it was 11 +/- 10 microm. Both 3.75-mm adjusted specimens and 1 nonadjusted specimen failed to maintain joint closure (excess joint opening >50 microm). One of the 3.75-mm adjusted specimens had abutment screw fracture. One of two 6.0-mm adjusted specimens failed to maintain joint closure because of screw fracture. CONCLUSION: The dental implant-abutment interface of 3.75-mm and 6.0-mm externally hexed implants experienced similar joint opening after periods of dynamic loading. Laboratory adjustment of the interface significantly decreased the service life of the abutment screw joint.

Micromotion and dynamic fatigue properties of the dental implant-abutment interface.

STATEMENT OF PROBLEM: Clinical loading may result in micromotion and metal fatigue in apparently stable implant screw joints. This micromotion may contribute to tissue inflammation and prosthesis failure. PURPOSE: This study investigated dental implant screw joint micromotion and dynamic fatigue as a function of varied preload torque applied to abutment screws when tested under simulated clinical loading. MATERIAL AND METHODS: Fifteen noble alloy single-tooth implant restorations, each containing a hexed UCLA-style gold cylinder, were randomly assigned to 3 preload groups (16, 32, and 48 N.cm). Each group consisted of 5 implants (each 3.75 x 15 mm) and 5 square gold alloy abutment screws. A mechanical testing machine applied a compressive cyclic sine wave load between 20 and 130 N at 6 Hz to a contact point on each implant crown. A liquid metal strain gauge recorded the micromotion of the screw joint interface after 100, 500, 1,000, 5,000, 10,000, 50,000, and 100,000 cycles. Baseline data at 0 N.cm were collected before the application of the specified preload torque. RESULTS: The 16 N.cm group exhibited greater micromotion (P<.001) than both the 32 and 48 N.cm groups at all cycle intervals (2-way ANOVA, Tukey HSD). Micromotion of the implant-abutment interface remained constant (P=.99) for each of the preload groups through 105 cycles. CONCLUSION: Under the loading parameters of this study, no measurable fatigue of the implant-abutment interface occurred. However, dental implant screw joints tightened to lower preload values exhibited significantly greater micromotion at the implant-abutment interface.

Oral terbinafine in the treatment of toenail onychomycosis: North American multicenter trial.

BACKGROUND: Onychomycosis is an increasing problem with limited therapeutic options. OBJECTIVE: We evaluated the safety and efficacy, of oral terbinafine, a new fungicidal antimycotic, in patients with toenail onychomycosis. METHODS: A North American multicenter, double-blind, placebo-controlled study evaluated the mycologic and clinical efficacy of oral terbinafine 250 mg/day for 12 or 24 weeks in 358 patients with toenail onychomycosis. RESULTS: A total of 74% of patients treated with 12 or 24 weeks of terbinafine achieved a successful clinical outcome. Approximately 11% of terbinafine responders showed evidence of relapse 18 of 21 months after cessation of treatment. Terbinafine was well tolerated; most adverse events were transient and mild to moderate in severity. CONCLUSION: The results of this study confirm that oral terbinafine is a safe and effective therapy for the treatment of onychomycosis.

Information from time-varying vibrotactile stimuli.

Experiments have been carried out to investigate the information transfer available via a single vibrator on the fingertip. In a first experiment, for stimuli with durations 80 to 320 ms, discrimination of a one-octave step change in frequency at the halfway point was investigated. Results were similar for three stimulus types--sinewave, monophasic pulse and tetraphasic pulse--suggesting temporal cues are more important than spectral cues in this task. In a second experiment, subjects were required to perceive changes in a sequence of stimulus elements. A presentation rate of 6.25 elements s-1 was found to give better results than a rate of 12.5 elements s-1. In the former case, the potential information transfer per element was estimated to be approximately 1.0 bits, corresponding to an information transfer rate of around 6 bits s-1. Implications for the design of a tactile aid to lipreading are discussed.

Ultimate tensile strength of five interchangeable prosthetic retaining screws.

Implant prosthetic retaining screws have been reported to serve as built-in safety factors to protect against overload in the implant's "vertical stack," although loosening and fracture of retaining screws are often considered complications. Manufacturers have responded by introducing interchangeable prosthetic retaining screws, which can give the clinician the impression that interchanging screws will not have an adverse effect on the remainder of the implant complex and/or the integration of the implant itself. The objective of this investigation was to measure the ultimate tensile strength of four retaining screws from three manufacturers and two alloy types (gold and titanium) using the Nobelpharma gold prosthetic retaining screws as a standard for the comparisons. Five screws of each type were loaded in tension in an Instron Universal Testing Machine until fracture occurred. A Tukey-Kramer Test (significance level = .05) analysis of the data showed that all of the interchangeable prosthetic retaining screws were significantly different from the control screws in respect to ultimate tensile strength. The data suggest that interchanging prosthetic retaining screws will influence their built-in safety feature.

Geometric comparison of five interchangeable implant prosthetic retaining screws.

Eight geometric parameters of five interchangeable prosthetic retaining screws (#1-3i Implant Innovation-gold, #2-Impla-Med-gold, #3-Nobelpharma-gold, #4-3i Implant Innovation-titanium, and #5-Implant Support Systems-titanium) were recorded with an Amray 1000-B scanning electron microscope at x20 to x200 magnification. Five screws of each type were measured and eight parameters were evaluated: (A) diameter of head, (B) screw length, (C) thread pitch, (D) major diameter, (E) neck diameter (F) length of neck, (G) crest width, and (H) root width. The Nobelpharma-gold prosthetic retaining screws served as controls. The results revealed significant differences between the control and test screws in all parameters except parameters C and G (ANOVA, p < 0.05) and Duncan's multiple range test (significance level 0.05). On the basis of these differences, it was concluded that interchanging prosthetic retaining screws can introduce unknown variables in treating patients.

Comparison of "look-alike" implant prosthetic retaining screws.

PURPOSE: The maximum preload torque of implant prosthetic retaining screws from four manufacturers and of two alloy types was measured to determine one index of interchangeability of intersystem components. MATERIALS AND METHODS: Implant prosthetic retaining screws from four manufacturers (3i Implant Innovations Inc, West Palm Beach, FL; Impla-Med Inc, Sunrise, FL; Nobelpharma USA Inc, Chicago, IL; and Implant Support Systems Inc, Irvine, CA) and of two metal types (gold and titanium) were investigated using an in vitro simulation model. Five screws of each type were tightened down against a gold cylinder using a Tohnichi BTG-6 torque gauge (Tohnichi American Corporation, Northbrook, IL) until fracture occurred. RESULTS: The 3i Implant Innovations gold and the Nobelpharma gold were not significantly different. The 3i Implant Innovations titanium and the Impla-Med gold were able to withstand less preload torque than the 3i Implant Innovations gold and the Nobelpharma gold. The Implant Support Systems titanium was able to withstand significantly more preload torque than all of the other screws. CONCLUSIONS: Interchanging implant prosthetic retaining screws could introduce new and unknown variables that may affect the long-term survival of implant fixtures and/or the implant prostheses.

The performance of conventional, fixed bridgework, retained by partial coverage crowns.

A retrospective study was carried out on 248 partial coverage retained fixed bridges, in 211 patients. All were inserted at an undergraduate dental clinic and their length of service ranged from 1 to 19 years. In 211 prostheses, on which current information was available a total of 20 (9.5%) bridges had failed. The reasons for failure were loss of retention and, to a lesser extent, caries. Using a LIFE TABLE of survival, it was calculated that the percentage of short span, partial veneer retained prostheses that would survive TEN years was 76.5% +/- 5.99% (standard error). This figure is comparable to that quoted for resin-bonded bridges, and hence would militate against the use of conventional partial coverage fixed retainers on intact teeth. Where abutment teeth are heavily restored, full coverage retainers provide a more predictable, long term result.

Vibrotactile and electrotactile perception of time-varying pulse trains.

To establish the best strategy for transmitting speech-derived information via a single tactile channel, measurements were made on the perception of frequency- and/or amplitude-modulated pulse-train stimuli, with a comparison of the electrotactile and vibrotactile modalities. In one experiment, vibrotactile perception of 2-oct step changes in stimulus frequency was found to be significantly better than electrotactile on a time-scale appropriate for the transmission of speech features (e.g., with practiced subjects, information transfer of 69% with 200-ms vibrotactile stimuli, 32% with 200-ms electrotactile stimuli). Perception of step changes in stimulus amplitude was similar in the two modalities when changes in amplitude were tailored to match the different dynamic ranges available. In a second experiment, vibrotactile-perception of voice fundamental frequency with various codings was investigated. Both experiments showed information transfer for vibrotactile stimuli to be greater when frequency and amplitude modulation were used together rather than with one or the other in isolation (sentence-stress identification scores: 66% for FM stimuli, 69% for AM stimuli, 80% for FM/AM stimuli). It is concluded that frequency- and amplitude-modulated vibratory stimulation is a good choice in a practical device for the profoundly hearing impaired.

Effect of preload torque on the ultimate tensile strength of implant prosthetic retaining screws.

The preload concept proposes that an optimal torque exists to which implant prosthetic retaining screws should be tightened. According to this theory, the preload prevents separation of implant components, thus protecting the screw from fracture. Recent research suggests that most implant-retained prostheses in function today were placed using improper preloads. The purpose of this investigation was to determine whether or not improper preloading of prosthetic implant-retaining screws would adversely affect their ultimate tensile strength. Fifteen Nobelpharma-slotted gold screws from one lot were tightened to 6, 10, and 15 N/cm with a torque gauge and ultimate tensile strength values determined. The procedure was duplicated using 15 Nobelpharma gold screws from another lot tightened to 0, 10, and 20 N/cm. Within each of the test groups, there was no significant difference in the ultimate tensile strength among the three preload torques. However, a paired t test (P = 0.005) determined that there was a significant difference between the two lots with respect to the ultimate tensile strength of the screws preloaded to 10 N/cm. Altering the preload torque applied to Nobelpharma gold-retaining screws does not affect their ultimate tensile strength. The ultimate tensile strength of the screws from the two lots differed, suggesting an unannounced change in component specifications.

Working time of synthetic elastomeric impression material.

This study will introduce a new method for measuring the working time of elastomeric impression materials, taking into account the perceived shortcomings of existing systems for evaluating these times. The working times of various commercially available polysulfide, addition reaction silicones and polyethers were determined at room temperature (20 degrees C), following storage in a refrigerator (6 degrees C), and at mouth temperature (35 degrees C). At room temperature, the polysulfides demonstrated the longest working times and the silicones the shortest. Both the polysulfides and the silicones had longer working times following storage at 6 degrees C for 24 hours. However, the polyethers were found to be unusable at this temperature. All the impression materials had shorter working times when placed into the testing apparatus, which had been heated to mouth temperature.

Providing optimum torque to implant prostheses: a pilot study.

Ten N/cm torque has been proposed as the optimum level for the tightening of implant retaining gold screws in order to preload the implant components to limit loosening and fracture. The purpose of this study was to determine the influence of instrumentation and operator experience on the torque generated during manual tightening of slotted gold screws. Sixteen subjects, divided into four groups based on experience, were instructed to tighten five screws into implant analogs with 20-mm and 37-mm slotted screwdrivers. The screws were then removed with a torque gauge. All of the groups of subjects were able to generate significantly greater torque with the 37-mm screwdriver. Dentists with no implant treatment experience generated significantly less torque than the other three groups. Of the 12 dentist subjects, only 3 generated the optimal amount of torque when using the 20-mm screwdriver. Operators who had little experience dealing with implant prostheses were not able to provide the recommended torque and experienced operators tended to generate more than the recommended amount. None of the subjects were able to generate consistent torque values.

Transvaginal sonography of normal pelvic anatomy.

The major structures of interest in the pelvis for sonography are the uterus and ovaries. TVS, with its superior imaging characteristics, provides better sonographic detail of this anatomy and improves our diagnostic capabilities. It is certainly reasonable to expect this approach to yield even greater improvements in the future as the refinements to the technology continue to evolve.

Comparative study of calcipotriol (MC 903) ointment and betamethasone 17-valerate ointment in patients with psoriasis vulgaris.

BACKGROUND: Topical vitamin D analogues have been reported to be an effective treatment in patients with psoriasis. Comparative studies with existing treatments are required. OBJECTIVE: Our purpose was to compare the effectiveness of calcipotriol (50 micrograms/gm) and betamethasone 17-valerate (1 mg/gm) ointments twice daily in the treatment of stable plaque psoriasis. METHODS: This study was a randomized, double-blind comparison over 6 weeks in 409 patients. Efficacy, as measured by the Psoriasis Area and Severity Index (PASI), and safety were assessed at 2, 4, and 6 weeks. RESULTS: Reduction of PASI was statistically significant at all time points for both treatments but there were no significant between-treatment differences. At the completion of 6 weeks of treatment, the mean PASI reduction was 5.50 for calcipotriol and 5.32 for betamethasone (95% confidence interval [CI] -0.40 to 0.78). Analysis of patient assessment at 6 weeks showed clearance or marked improvement in 61.2% of the calcipotriol patients and 50.5% with betamethasone (95% CI 1.4 to 20.8). Calcipotriol produced significantly more local side effects (19.5% compared with 3.9%, p less than 0.001); however, these were minimal leading to withdrawal in only 3 of 205 patients. CONCLUSION: Calcipotriol ointment was as effective as betamethasone 17-valerate ointment as measured by the PASI and superior as measured by self-assessment in patients with stable plaque psoriasis. Both treatments were well tolerated.