Effects of dentin bonding agents and silanization on bond strength between 3D printed resin and composite resin.

This study aimed to evaluate the effects of dentin bonding agents and silanization on the bond strength between 3D printed resin and composite resin and compare it with a conventional composite resin. 3D printed resin cylinders (PCB) and composite resin substrates (Z250) were prepared and divided into eight subgroups based on the bonding agents used (n=12). The shear bond strength was measured using a universal testing machine, and the failure modes were evaluated. The bond strength was found to vary significantly among the bonding agents and substrate types. Silane application did not significantly improve the bond strength. Among the bonding agents, the universal adhesives exhibited the highest bond strengths for both substrates. Compared to PCB, Z250 demonstrated stronger bonds and exhibited more cohesive failures. Further research is needed to optimize the surface treatments and resin formulations for enhanced bond strength and durability between 3D printed and composite resins.

Management of Recurrent Giant Cell Tumor of Distal Tibia With Intramedullary Hindfoot Fusion Nail and Trabecular Metal Implant Construct.

Reconstruction options for giant cell tumors (GCTs) of bone are limited and challenging due to the amount of structural compromise and the high recurrence rates. This is especially true for GCTs of the foot and ankle, as the area is vital for weight bearing and function. The typical treatment for GCTs is currently excision, curettage, and cementation, although that is not always effective. A 36-year-old otherwise healthy female presented with an original diagnosis of a large aneurysmal bone cyst (ABC) of the distal tibia that had recurred despite two previous attempts at treatment with resection and cementation. She was treated with surgical resection of the lesion, reconstruction, and ankle and subtalar joint arthrodesis with a tibiotalocalcaneal intramedullary nail in combination with a trabecular metal cone. The final pathology of the intraoperative samples was consistent with GCT. Postoperatively, she recovered well, and her imaging was consistent with a successful fusion. This case report provides evidence that tibiotalocalcaneal fusion with a unique combination of hindfoot nail and trabecular metal cone construct in a single procedure is a successful option for the treatment of large, recurrent GCT lesions in the distal tibia.

Food impaction on three-dimensional printed models with periodontal ligament simulation.

OBJECTIVE: This study aims to evaluate food impaction on three-dimensional (3D) printed models with periodontal ligament simulation. MATERIALS AND METHODS: Based on a commercial typodont pair, 3D maxillary and mandibular models were created with no teeth and with tooth sockets that were 1 mm wider than the original ones from 24 to 27 or 34 to 37 for periodontal ligament simulation with vinyl polysiloxane impression material. In total, 35 pairs of 7 combinations, including maxillary/mandibular typodonts in occlusion with maxillary/mandibular 3D models with/without a distal gap of canines on 3D models (tooth 23 or 33) were mounted on hinge articulators and divided into seven groups (n = 5). Each sample experienced the same manual chewing simulation on a customized device. The proximal surfaces were photographed to measure the percentage of food impaction area using ImageJ software. RESULTS: Group with fixed maxillary and mandibular teeth showed more food impaction than other groups with significant differences in the average of maxilla and the average of all proximal areas. CONCLUSION: The flexibility of the periodontal ligament and the degree of freedom of the teeth in their sockets may contribute to the extent of food impaction in proximal spaces.

Trueness, physical properties, and surface characteristics of additive-manufactured zirconia crown.

OBJECTIVE: This study aimed to conduct a comparison of trueness and physical and surface properties among five distinct types of additive manufactured (AM) zirconia crowns and zirconia crowns produced using the subtractive manufacturing (SM). MATERIAL AND METHODS: Zirconia crowns were fabricated using five distinct techniques, each varying in the method of slurry transfer and photocuring source. Each experimental group utilized either one of the four digital light processing (DLP)-based techniques (DLP spreading, DLP spreading gradation, DLP vat and DLP circular spreading) or the stereolithography (SLA)-based technique (SLA spreading). The control (CON) group employed SM. To assess accuracy, trueness was measured between the scan and reference data. To analyze the physical properties, voids were examined using high-energy spiral micro-computed tomography scans, and the crystal structure analysis was performed using X-ray diffraction (XRD). Surface roughness was assessed through laser scanning microscopy. RESULTS: Differences in the trueness of internal surfaces of crowns were found among the groups (P < 0.05). Trueness varied across the measurement surfaces (occlusal, lateral, and marginal) in all the groups except for the DLP spreading gradation group (P < 0.05). Voids were observed in all AM groups. All groups showed similar XRD patterns. All AM groups showed significantly greater surface roughness compared to the CON group (P < 0.001). CONCLUSION: The AM zirconia crowns showed bubbles and a rougher surface compared to the SM crowns. All groups exhibited typical zirconia traits and trueness levels within clinically acceptable limits, suggesting that current zirconia AM techniques could be suitable for dental applications.

Post-polymerization of three-dimensional printing resin using a dental light curing unit.

Background/Purpose: In vat photopolymerization, post-polymerization of the three-dimensional (3D) printing resin is necessary to ensure the optimum physical properties of the printed objects. This study aimed to evaluate the potential use of a handheld polywave light-emitting diode (LED) dental light-curing unit (LCU) for post-polymerizing 3D printed resins by measuring the microhardness and biaxial flexural strength of the post-polymerized resin. Material and methods: 3D printed 1- and 2-mm-thick disks were irradiated with a dental LCU at 3200 mW/cm2. Post-polymerization was repeated either on one side from the top surface: two cycles (T2), four cycles (T4), and eight cycles (T8), or on both sides from the top and bottom surfaces: one cycle (T1B1), two cycles (T2B2), and four cycles (T4B4) for each side. The microhardness and biaxial strength of the disks were compared to those post-polymerized by a conventional desktop polymerizing unit (PC) and those without post-polymerization (NC). Results: Microhardness of the disks varied between the top and bottom surfaces of the 1-mm and 2-mm-thick disks, depending on the post-polymerization methods. T8 and T4B4 produced comparable microhardness on the top surface to PC for both thicknesses. In contrast, PC, T2B2, and T4B4 exhibited the highest microhardness on the bottom surface. Except for NC, the 1-mm-thick disks had a higher biaxial flexural strength than the 2-mm-thick disks. T4B4 resulted in the highest biaxial flexural strength for both thicknesses, which was comparable to that of the desktop polymerizing unit. Conclusion: The microhardness and biaxial flexural strengths of the post-polymerized 3D-printed disks increase with polymerization time. With sufficient polymerization from both sides, the polywave LCU has the potential to be a viable alternative to desktop polymerization units.

Determinants of Dentist-Patient Relationships: A Scoping Review.

OBJECTIVES: The dentist-patient relationship (DPR) is considered to be a key element in dental clinical settings. This scoping review aimed to examine the extent of previous research on DPR, focussing on its determinants for the reification of the construct. METHODS: This research was directed by the guidance for systematic scoping reviews from the Joanna Briggs Institute. The inclusion/exclusion criteria were based on participants of general adults and dentists, the concept of determinants of DPR, and the context of dental health care encounters. A literature search was performed in 6 major electronic databases in July 2023. Key information from included articles was extracted to chart the results, mainly to identify the determinants of DPR. Each determinant of DPR was classified according to the conceptual model of DPR. RESULTS: A total of 1727 records were initially identified, and 16 articles were included in the review. Nine studies used a quantitative method and 7 were nonempirical articles. All but 2 articles were from the perspective of patients. Factors were grouped into 6 main domains: dentist, patient, society/environment, clinical structure, clinical process, and outcome. Amongst the 6 domains of DPR, most determining factors were related to the clinical process. "Communication" was most frequently counted, at 8 times, followed by "trust" (frequency, 6). At the patient level, "dental fear/anxiety" was frequently used to measure DPR. CONCLUSIONS: Previous literature about DPR indicated a few common and dentistry-specific determinants from the patient perspective. Further studies are encouraged to develop a more comprehensive framework and evaluation scale of DPR.

Impaired sleep is associated with tau deposition on 18F-flortaucipir PET and accelerated cognitive decline, accounting for medications that affect sleep.

BACKGROUND: Impaired sleep is commonly associated with Alzheimer's disease (AD), although the underlying mechanisms remain unclear. Furthermore, the moderating effects of sleep-affecting medications, which have been linked to AD pathology, are incompletely characterized. Using data from the Alzheimer's Disease Neuroimaging Initiative, we investigated whether a medical history of impaired sleep, informant-reported nighttime behaviors, and sleep-affecting medications are associated with beta-amyloid and tau deposition on PET and cognitive change, cross-sectionally and longitudinally. METHODS: We included 964 subjects with 18F-florbetapir PET scans. Measures of sleep impairment and medication use were obtained from medical histories and the Neuropsychiatric Inventory Questionnaire. Multivariate models, adjusted for covariates, were used to assess associations among sleep-related features, beta-amyloid and tau, and cognition. Cortical tau deposition, categorized by Braak stage, was assessed using the standardized uptake value peak alignment (SUVP) method on 18F-flortaucipir PET. RESULTS: Medical history of sleep impairment was associated with greater baseline tau in the meta-temporal, Braak 1, and Braak 4 regions (p = 0.04, p < 0.001, p = 0.025, respectively). Abnormal nighttime behaviors were also associated with greater baseline tau in the meta-temporal region (p = 0.024), and greater cognitive impairment, cross-sectionally (p = 0.007) and longitudinally (p < 0.001). Impaired sleep was not associated with baseline beta-amyloid (p > 0.05). Short-term use of selective serotonin reuptake inhibitors and benzodiazepines slightly weakened the sleep-tau relationship. CONCLUSIONS: Sleep impairment was associated with tauopathy and cognitive decline, which could be linked to increased tau secretion from neuronal hyperactivity. Clinically, our results help identify high-risk individuals who could benefit from sleep-related interventions aimed to delay cognitive decline and AD.

Shear bond strength of dual-cured resin cements on zirconia: The light-blocking effect of a zirconia crown.

Abstract Background/purpose: The presence of restorative material between resin cement and the light-curing unit can reduce light transmission. This study aimed to evaluate the effect of the light-blocking effect of zirconia crown on shear bond strength (SBS) between three dual-cured resin cements and the zirconia surface. Materials and methods: Sixty zirconia specimens were prepared and divided into three groups according to the type of resin cement [RXU (RelyX Ultimate); SC2 (SmartCem2); MEC (Maxcem Elite Chroma)]. Each group was further divided into two subgroups, with or without a 1-mm-thick zirconia crown (n = 10). The specimens were light-cured from five different directions for 20 s each. All specimens were thermocycled 5000 times and subjected to SBS testing, followed by scanning electron microscope examination. Results: The presence of a 1-mm-thick zirconia crown had no significant effect on the SBS in all resin cements. However, the SBS was significantly affected by type of resin cement. RXU showed the highest SBS (8.35 MPa with crown; 8.57 MPa without crown), followed by SC2 (5.48 MPa with crown; 5.57 without crown) and then MEC (3.37 MPa with crown; 4.04 MPa without crown. Fractured surfaces exhibited varying degrees of mixed failure patterns. Conclusion: A 1-mm-thick zirconia crown material between the light source and the dual-cured resin cement did not significantly influence the SBS of the resin cements on the zirconia substrates. RXU exhibited the highest SBS regardless of zirconia crown coverage. With sufficient light-curing, dual-cured resin cements can be a good choice for zirconia crown cementation.

Investigating the role of chlorogenic acids and coffee type in coffee-induced teeth discoloration.

OBJECTIVE: Coffee is one of the most popular beverages in the world, with millions of people consuming it every day. The effect of coffee on teeth discoloration has long been a concern for both coffee drinkers and dental professionals. To address this concern, this study aimed to investigate the role of chlorogenic acids (CGAs) and the type of coffee in coffee-induced teeth discoloration. MATERIALS AND METHODS: High-performance liquid chromatography with a photodiode array detector was used to determine the CGA contents of instant coffee produced by five manufacturers (Starbucks, Dunkin' Donuts, Kanu, Ediya, Coffee Bean). A total of 180 bovine tooth specimens were immersed in the coffee samples for varying durations (3, 9, 24, 48, and 72 h), and the discoloration levels were measured using a spectrophotometer. A linear mixed-effects model analysis was used to determine the significance of L*, a*, and b* values in relation to the duration of coffee immersion and coffee type. RESULTS: Both immersion time and coffee type had significant effects on tooth discoloration (p < 0.001), with some types of coffee being more strongly associated with tooth discoloration than others. The amount of CGAs present in coffee was found to be positively correlated with the degree of discoloration (p = 0.030). CONCLUSIONS: Prolonged exposure to coffee can exacerbate teeth staining, and different types of coffee can cause varying degrees of discoloration. Furthermore, coffee with higher levels of CGAs may lead to greater tooth discoloration.

Assessing the efficacy of jet dispenser versus direct syringe injection for calcium hydroxide paste placement in artificial root canals.

This study aimed to evaluate the efficacy of a novel jet dispenser (JD) for filling simulated straight and curved canals with calcium hydroxide (Ca(OH)2) paste by comparing the level of intracanal medicament with traditional direct syringe delivery. The Ca(OH)2 paste was delivered into the canals using either a direct syringe with binding tip and unbinding tip or a JD. The analysis of the ratio of the canal filled area (RCFA) in the coronal, middle, and apical thirds was conducted using the Kruskal-Wallis and Mann-Whitney U tests (α = 0.05). The JD resulted in a significantly higher RCFA of 1.00 in the middle and apical thirds in both the straight and curved canals than the direct syringe method (p < 0.001). Voids were frequently observed in the direct syringe group, whereas JD showed no voids within the filled area. In the direct syringe groups, the apical area was more readily filled in both canal types when the tip was bound (p < 0.001). The JD was found to be more effective in filling the entire canal space than the binding and unbinding conditions of the direct injection method, particularly in the apical area.

Improving radiotherapy in immunosuppressive microenvironments by targeting complement receptor C5aR1.

An immunosuppressive microenvironment causes poor tumor T cell infiltration and is associated with reduced patient overall survival in colorectal cancer. How to improve treatment responses in these tumors is still a challenge. Using an integrated screening approach to identify cancer-specific vulnerabilities, we identified complement receptor C5aR1 as a druggable target, which when inhibited improved radiotherapy, even in tumors displaying immunosuppressive features and poor CD8+ T cell infiltration. While C5aR1 is well-known for its role in the immune compartment, we found that C5aR1 is also robustly expressed on malignant epithelial cells, highlighting potential tumor cell-specific functions. C5aR1 targeting resulted in increased NF-κB-dependent apoptosis specifically in tumors and not normal tissues, indicating that, in malignant cells, C5aR1 primarily regulated cell fate. Collectively, these data revealed that increased complement gene expression is part of the stress response mounted by irradiated tumors and that targeting C5aR1 could improve radiotherapy, even in tumors displaying immunosuppressive features.

Rare variants in long non-coding RNAs are associated with blood lipid levels in the TOPMed whole-genome sequencing study.

Long non-coding RNAs (lncRNAs) are known to perform important regulatory functions in lipid metabolism. Large-scale whole-genome sequencing (WGS) studies and new statistical methods for variant set tests now provide an opportunity to assess more associations between rare variants in lncRNA genes and complex traits across the genome. In this study, we used high-coverage WGS from 66,329 participants of diverse ancestries with measurement of blood lipids and lipoproteins (LDL-C, HDL-C, TC, and TG) in the National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) program to investigate the role of lncRNAs in lipid variability. We aggregated rare variants for 165,375 lncRNA genes based on their genomic locations and conducted rare-variant aggregate association tests using the STAAR (variant-set test for association using annotation information) framework. We performed STAAR conditional analysis adjusting for common variants in known lipid GWAS loci and rare-coding variants in nearby protein-coding genes. Our analyses revealed 83 rare lncRNA variant sets significantly associated with blood lipid levels, all of which were located in known lipid GWAS loci (in a ±500-kb window of a Global Lipids Genetics Consortium index variant). Notably, 61 out of 83 signals (73%) were conditionally independent of common regulatory variation and rare protein-coding variation at the same loci. We replicated 34 out of 61 (56%) conditionally independent associations using the independent UK Biobank WGS data. Our results expand the genetic architecture of blood lipids to rare variants in lncRNAs.

Malnutrition in heart failure with preserved ejection fraction.

BACKGROUND: Malnutrition may be an important geriatric condition in adults with heart failure with preserved ejection fraction (HFpEF), but studies on its prevalence and associated clinical outcomes are limited. The aim of this study was to determine if malnutrition is associated with short-term morbidity and mortality in ambulatory patients with HFpEF. METHODS: We examined 231 patients with a clinical diagnosis of HFpEF seen at two dedicated academic HFpEF programs (Weill Cornell Medicine and Michigan Medicine) from June 2018 to April 2022. Malnutrition was defined by Mini-Nutritional Assessment Short Form (MNA-SF) scores ≤11. The primary endpoint was a 6-month composite of all-cause mortality and all-cause hospitalization. A Cox proportional-hazard models was used to examine the association between malnutrition and the primary endpoint, adjusting for race, prior hospitalization history, and the validated Meta-Analysis Global Group in Chronic (MAGGIC) heart failure prognostic risk score. RESULTS: The median age of the cohort was 73 years (interquartile range 64-81). The most common comorbid conditions included hypertension (prevalence 81%), atrial fibrillation (43%), and obesity (63%). The prevalence of malnutrition was 42% (n = 97), and MNA-SF scores did not significantly correlate with body mass index (R = -0.02, p = 0.71). At the 6-month follow-up, 62 patients (26.8%) were hospitalized and four patients died (1.7%). In a fully-adjusted analysis, malnutrition was independently associated with the composite outcome of all-cause mortality and all-cause hospitalization (HR 1.94 [95% CI: 1.17-3.20], p = 0.01). CONCLUSION: Despite a high prevalence of obesity, two out of five ambulatory adults with HFpEF are malnourished. Malnutrition was independently associated with adverse outcomes at 6 months. Future work is necessary to develop interventions that can address malnutrition.

Rare variants in long non-coding RNAs are associated with blood lipid levels in the TOPMed Whole Genome Sequencing Study.

Long non-coding RNAs (lncRNAs) are known to perform important regulatory functions. Large-scale whole genome sequencing (WGS) studies and new statistical methods for variant set tests now provide an opportunity to assess the associations between rare variants in lncRNA genes and complex traits across the genome. In this study, we used high-coverage WGS from 66,329 participants of diverse ancestries with blood lipid levels (LDL-C, HDL-C, TC, and TG) in the National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) program to investigate the role of lncRNAs in lipid variability. We aggregated rare variants for 165,375 lncRNA genes based on their genomic locations and conducted rare variant aggregate association tests using the STAAR (variant-Set Test for Association using Annotation infoRmation) framework. We performed STAAR conditional analysis adjusting for common variants in known lipid GWAS loci and rare coding variants in nearby protein coding genes. Our analyses revealed 83 rare lncRNA variant sets significantly associated with blood lipid levels, all of which were located in known lipid GWAS loci (in a ±500 kb window of a Global Lipids Genetics Consortium index variant). Notably, 61 out of 83 signals (73%) were conditionally independent of common regulatory variations and rare protein coding variations at the same loci. We replicated 34 out of 61 (56%) conditionally independent associations using the independent UK Biobank WGS data. Our results expand the genetic architecture of blood lipids to rare variants in lncRNA, implicating new therapeutic opportunities.

Direct Fabrication of Functional Shapes on 3D Surfaces Using Electrospinning.

In this work, we demonstrate the ability to simultaneously pattern fibers and fabricate functional 2D and 3D shapes (e.g., letters, mask-like structures with nose bridges and ear loops, aprons, hoods) using a single step electrospinning process. Using 2D and 3D mesh templates, electrospun fibers were preferentially attracted to the metal protrusions relative to the voids so that the pattern of the electrospun mat mimicked the woven mesh macroscopically. On a microscopic scale, the electrostatic lensing effect decreased fiber diameter and narrowed the fiber size distribution, e.g., the coefficient of variation of the fiber diameter for sample collected on a 0.6 mm mesh was 14% compared to 55% for the sample collected on foil). Functionally, the mesh did not affect the wettability of the fiber mats. Notably, the fiber patterning increased the rigidity of the fiber mat. There was a 2-fold increase in flexural rigidity using the 0.6 mm mesh compared to the sample collected on foil. Overall, we anticipate this approach will be a versatile tool for design and fabrication of 2D and 3D patterns with potential applications in personalized wound care and surgical meshes.

Trueness and surface characteristics of 3-dimensional printed casts made with different technologies.

STATEMENT OF PROBLEM: Three-dimensional (3D) printers should be capable of fabricating products with high accuracy for potential use in a wide range of dental applications. The trueness and surface characteristics of 3D-printed casts made with different technologies remain unclear. PURPOSE: The purpose of this in vitro study was to evaluate the trueness and surface characteristics of 4 types of dental casts printed using 6 different 3D printers. MATERIAL AND METHODS: Four dental casts prepared for intracoronal and extracoronal restorations were printed using 6 different 3D printers-2 printers of each printing technology (FDM: Creator, Lugo; DLP: D2, ND5100; SLA: Form 2, Form 3). The printed casts were scanned to obtain standard tessellation language (STL) data sets that were superimposed onto the reference to evaluate their trueness (n=15). Trueness was measured based on overall deviations for each cast and for sectional deviations within the cavities. For qualitative evaluation, the surface characteristics of the 3D-printed casts were analyzed by using a digital camera, stereomicroscope, and scanning electron microscope. Statistical analyses were conducted using the Kruskal-Wallis test, followed by multiple Mann-Whitney U tests for pairwise comparisons among groups (α=.05). RESULTS: The overall median trueness values were lowest with the Form 3 (27.9 µm), followed by the ND5100 (30.0 µm), Lugo (37.1 µm), D2 (41.4 µm), Form 2 (46.9 µm), and Creator (83.3 µm) (P<.05). Sectional deviations within the cavity were generally greater than overall deviation. Macroscopic and microscopic images showed that the reproduced casts had the smoothest surface with the SLA, followed by the DLP and FDM printers. Horizontal layers were more discernible with the FDM printer. CONCLUSIONS: The trueness of the 3D-printed casts was influenced by the type of tooth preparation and was printer dependent. Among the tested 3D printers, the Form 3 produced the most accurate casts, while the Creator produced the least accurate casts.

Effect of vibration during bulk and incremental filling on adaptation of a bulk-fill composite resin.

This study evaluated the effect of vibration on adaptation of bulk-fill composite resin. A scanning laser doppler vibrometer measured the frequency and amplitude of a vibratory device (COMO; B&L Biotech) used for resin placement and visualized its effect on the resin according to depth. A bulk-fill composite resin (Filtek Bulk Fill; 3M ESPE) was placed in simulated cavities (4 mm diameter, 4 mm depth) by different layering methods (incremental filling with two 2-mm-thick layers vs. bulk filling with a single 4-mm-thick layer). The groups were further divided based on the application of vibration during restoration (no vibration vs. vibration). In addition to the surface void area at the cavity floor, the overall void volume and the void volumes of the bottom, middle, and top thirds were obtained for micro-computed tomography analysis. The frequency and amplitude of the COMO were approximately 149 Hz and between 26 and 51 µm, respectively. When vibration was not applied, incremental filling had a lower void volume in the bottom third of the cavity than did bulk filling (p < 0.05). Vibration applied with a 4-mm-thick bulk fill had no significant effect on the adaptation of composite resin (p > 0.05). In contrast, vibration reduced the amount of void formation in the bottom third of the cavity during incremental filling (p < 0.05). Application of vibration to resin with a 2-mm incremental-layering technique formed a smaller void at the interface between the cavity and resin and within the bulk-fill composite resin.

Outcomes and complications of primary reverse shoulder arthroplasty with minimum of 2 years' follow-up: a systematic review and meta-analysis.

BACKGROUND: Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy, irreparable rotator cuff tears, glenoid deformity, and other challenging clinical scenarios, including fracture sequelae and revision shoulder arthroplasty. There has been a wide range of reported outcomes and postoperative complication rates reported in the literature. The purpose of this systematic review and meta-analysis is to provide an updated review of the clinical outcomes and complication rates following primary rTSA. METHODS: A systematic review and meta-analysis was performed to evaluate outcomes and complications following primary rTSA according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Demographics, range of motion, patient-reported outcome measures (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant scores), number of complications, and revisions were extracted, recorded, and analyzed from the included articles. RESULTS: Of the 1415 studies screened, 52 studies met the inclusion criteria comprising a total of 5824 shoulders. The mean age at the time of surgery was 72 years (range: 34-93), and the mean follow-up was 3.9 years (range: 2-16). Patients demonstrated a mean improvement of 56° in active flexion, 50° in active abduction, and 14° in active external rotation. Regarding functional outcome scores, rTSA patients demonstrated a mean clinically significant improvement of 37 in Constant score (minimal clinically important difference [MCID] = 5.7) and ASES score (42.0; MCID = 13.6). The overall complication rate for rTSA was 9.4% and revision rate of 2.6%. Complications were further subdivided into major medical complications (0.07%), shoulder- or surgical-related complications (5.3%), and infections (1.2%). The most frequently reported shoulder- or surgical-related complications were scapular notching (14.4%), periprosthetic fracture (0.8%), glenoid loosening (0.7%), and prosthetic dislocation (0.7%). DISCUSSION: Primary rTSA is a safe and reliable procedure with low complication, revision, infection, and scapular notching rates. Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores.

Performance of Universal Adhesives in Composite Resin Repair.

Aim: The objective of this in vitro study was to evaluate the bond strength of universal adhesive systems in self-etch and etch-and-rinse modes at the repair interface between aged and new composite resins. Materials and Methods: Composite resin (Filtek Z250) was thermocycled to represent aged composite resin to be repaired. New composite resin was placed over the aged substrate after surface conditioning: NC (negative control, no surface treatment), A (adhesive only), SBM (Scotchbond Multi-Purpose in etch-and-rinse mode), CSE (Clearfil SE Bond in self-etch mode), SBU (Single Bond Universal), ABU (All Bond Universal), and TBU (Tetric N-Bond Universal). Universal adhesives (SBU, ABU, and TBU) were applied both in etch-and-rinse and self-etch modes. 1 mm × 1 mm × 8 mm beams were sectioned, and microtensile bond strength was measured after 24 hours of water storage and 10,000 thermocycling processes (n = 20/group). The fracture surfaces were observed with a scanning electron microscope to evaluate the failure pattern. Results: The repair bond strength between the old and new composite resins was material-dependent. Universal adhesives significantly improved the repair bond strength (p < 0.05), while no significant difference was observed between the etch modes (self-etch or etch-and-rinse) for each universal adhesive (p > 0.05). Thermocycling significantly reduced the bond strength in all groups (p < 0.05). Conclusion: Universal adhesives in both etch-and-rinse and self-etch modes outperformed the conventional 3-step etch-and-rinse and 2-step self-etch adhesive systems in terms of resin repair bond strength.

Two-year results for ranibizumab for radiation retinopathy (RRR): a randomized, prospective trial.

PURPOSE: To assess the efficacy of a treat-and-extend strategy with intravitreal ranibizumab for radiation-related macular edema. METHODS: Forty eyes with radiation-induced macular edema and decreased visual acuity were enrolled in the phase IIb, prospective clinical trial and randomized into 3 cohorts: (A) monthly ranibizumab, (B) monthly ranibizumab with targeted retinal photocoagulation (TRP), or (C) as-needed ranibizumab and TRP. In year 2, all subjects entered a treat-and-extend protocol for ranibizumab. The primary outcome measure was mean change in early treatment diabetic retinopathy study (ETDRS) best-corrected visual acuity (BCVA) from baseline. RESULTS: Through year 1, the mean change in ETDRS BCVA was significantly different between the three cohorts (p < 0.001); cohort A saw the largest gain with + 4.0 letters. Significant anatomic improvements were also seen in all cohorts. Comparatively, through year 2, cohorts A, B, and C had a mean change in ETDRS BCVA of - 1.9, - 3.9, and + 1.3 letters, respectively; additionally, no significant differences were found in absolute ETDRS BCVA across time (ANOVA, p = 0.123). Overall, 90% of eyes maintained VA 20/200 or better and 33.3% of subjects gained at least one line of vision. There were no significant differences in mean central macular thickness for any cohort compared to baseline (p = 0.09). The presence of retinal hemorrhage and intraretinal exudates stayed consistent from year 1 to year 2 for all cohorts. CONCLUSIONS: Among eyes with radiation-related macular edema, a treat-and-extend regimen with ranibizumab may not result in as many visual and anatomic improvements as monthly injections. However, treat-and-extend still may prevent serious visual complications compared to historical controls. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02222610.