Home parenteral nutrition is beneficial in systemic sclerosis patients with gastrointestinal dysfunction.

OBJECTIVES: To assess 12-month changes in nutritional status and quality of life (QoL) in systemic sclerosis (SSc) patients requiring home parenteral nutrition (HPN). METHOD: We conducted a retrospective, single-centre database analysis of SSc patients regarding a 12-month period of HPN at an interdisciplinary University Unit/team for nutrition and rheumatic diseases. Nutritional status was analysed by nutritional risk screening (NRS) and body mass index (BMI). QoL was evaluated using Short-Form Health Survey (SF-36) questionnaires. RESULTS: Between 2008 and 2013, daily nocturnal HPN was initiated in five consecutive SSc patients (four females and one male, mean age 62.2 years) suffering severe malnutrition due to gastrointestinal tract (GIT) involvement. After 12 months of HPN, the mean NRS score decreased from 4.4 (range 4-5) to 1.4 (range 1-2), the mean BMI increased from 19.1 (range 17.4-20.3) to 21.0 kg/m2 (range 18.3-23.4). QoL improved in all patients, reflected by the summary of physical components with 33.92 points before vs. 67.72 points after 12 months of HPN, and the summary of mental components with 49.66 points before vs. 89.27 points after 12 months of HPN. Two patients suffered one catheter-related infection each with subsequent surgical removal and reinsertion. CONCLUSIONS: HPN is a feasible method for improving anthropometric parameters and QoL in SSc patients severely affected by GIT dysfunction. We recommend HPN in malnourished, catabolic SSc patients unable to otherwise maintain or improve their nutritional status.

Quantitative measurement of volume changes induced by oral plastic surgery: validation of an optical method using different geometrically-formed specimens.

The purpose of this research was to study the validity and variability of a projection Moiré system, measuring volume differences of geometrically different formed specimens mimicking localized alveolar ridge defects. Nine pairs of specimens were fabricated, each of which simulated a preoperative ridge defect and a corresponding surgically-corrected postoperative ridge defect. All specimen pairs had a mathematically defined form which allowed the accurate assessment of their volume differences by a mechanical 3-D coordinate measuring machine or by a software-controlled milling machine. Measurements achieved with these methods were used as the references for comparison. Six specimen pairs, A1 to A6, possessed a simple rectangular geometrical form which facilitated their fabrication. Three specimen pairs, B1 to B3, were milled and consisted of geometrically more complex 3-D sculptured surfaces, which came closest to a true imitation of a localized ridge defect. An optical measurement system in the form of the projection Moiré was utilized, applying a 4-phase shift technique, and results obtained with this device were regarded as test volumes. The absolute variability of the test volume measurements differed between 0.397 mm3 to 15.872 mm3, corresponding to a relative variability of 0.83% to 2.83%. The mean of the relative variability was within 1.68% for the "A" specimens and 2.15% for the "B" specimens. However, the difference was not significant, probably due to the limited number of "B" specimens. The systematic error of the Moiré measurements in relation to the reference methods was surprisingly low, ranging from -0.12 mm3 to 7.67 mm3. The relative systematic error, expressed as a percentage of reference volume, ranged between 0.06% and -2.23%. The mean of the relative error for the more complex "B" specimens was 1.37%, which was less accurate in comparison to the more simply formed "A" specimens with a relative systematic error of 0.35%. Therefore, in this in vitro model it was possible to measure volume differences of geometrically different formed specimens, mimicking localized alveolar ridge defects, with a validity within 2.2% and with a variability of less than 2.8%.

Immediate occlusal loading of Brånemark implants applied in various jawbone regions: a prospective, 1-year clinical study.

BACKGROUND: The original protocol for dental implant treatment ad modum Brånemark was based on submerged healing prior to loading. For patients, immediate implant function could reduce cost and increase attractiveness of implant treatment. PURPOSE: The goal of this study was to evaluate the short-term success rate of immediately loaded implants placed in various regions of the jaws. MATERIALS AND METHODS: Forty-one patients received a total of 127 immediately loaded implants (76 maxillary and 51 mandibular). Seventy-one percent of the patients received their prosthetic restoration the same day and the others within 11 days. All prosthetic constructions were in full contact in centric occlusion. Clinical follow-up examinations were performed at 1 week, 2 weeks, and at 1, 2, 3, 6, and 12 months after implant loading. The study was completed 1 year after loading. RESULTS: Twenty-two implants were lost in 13 patients (including 7 maxillary implants lost in 1 patient). The cumulative success rate of the implants was 82.7% after 1 year of prosthetic loading. All sites with implant losses were re-implanted, using a two-stage technique, with no further complications reported. Ninety-one percent of implants placed in regions other than the posterior maxilla were successful compared with 66% of implants placed in the posterior maxilla. Implants in patients with a parafunctional habit (bruxers) were lost more frequently than those placed in patients with no parafunction (41% vs. 12%). Implants subjected to guided bone regeneration were more successful compared with those not subjected to regeneration procedures (90% vs. 67%). CONCLUSIONS: The immediate loading concept is a realistic treatment alternative in various jawbone regions except for the posterior part of the maxilla. High occlusal loads should be considered a risk factor. On the other hand, implants in combination with bone defects frequently are penetrating cortical layers to a higher extent, thereby contributing to implant stability during the healing phase and consequently do not inevitably jeopardize the treatment result. However, further controlled clinical studies with larger sample sizes need to be performed to evaluate the influence of different parameters on treatment outcome.

Resorbable versus nonresorbable membranes in combination with Bio-Oss for guided bone regeneration.

The purpose of this clinical investigation was to compare the new resorbable collagen membrane, Bio-Gide, to the conventional expanded polytetrafluoroethylene material (Gore-Tex) for guided bone regeneration in situations involving exposed implant surfaces. Over a 2-year period, 25 split-mouth patients were treated randomly: one defect site was treated with Bio-Gide and the other defect site with Gore-Tex; all 84 defects were filled with Bio-Oss and covered with the respective membrane. The defect types, their dimensions, and their morphology were measured in detail initially and at re-entry to allow for calculation of the exposed implant surface. Changes in defect surface for both types of membranes were statistically significant (P < .0001); however, no statistical significance (P > .94) could be detected between the two membranes. The mean average percentage of bone fill was 92% for Bio-Gide and 78% for Gore-Tex sites. In the latter group, 44% wound dehiscences and/or premature membrane removal occurred. The resorbable membrane, Bio-Gide, in combination with a bone graft, can be a useful alternative to the well-established expanded polytetrafluoroethylene membranes.

Long-term results of implants treated with guided bone regeneration: a 5-year prospective study.

The aim of this prospective 5-year longitudinal study was to follow endosteal implants in which guided bone regeneration (GBR) was applied during implant placement. In 75 patients, defects around implants (Branemark System) were treated with Bio-Oss and Bio-Gide (112 implants). In split-mouth patients in this group, Bio-Oss and Gore-Tex were used in the second defect site (41 implants). All 75 patients had at least 1 implant that was entirely surrounded by bone and served as the control (112 implants). After placement of the definitive prostheses (single-tooth, fixed, or removable implant prostheses), patients were recalled after 6 months and then every 12 months during a 5-year observation period. The following variables were investigated: implant survival, marginal bone level (MBL), presence of plaque, peri-implant mucosal conditions, height of keratinized mucosa (KM), and marginal soft tissue level (MSTL). The cumulative implant survival rate after 5 years varied between 93% and 97% for implants treated with or without GBR. The mean MBL after 60 months was 1.83 mm for sites treated with Bio-Oss and Bio-Gide, 2.21 mm for sites treated with Bio-Oss and Gore-Tex, and 1.73 mm for the control sites. The MBL values were found to increase significantly with time and differed significantly among the treatment groups. During the observation period, KM varied between 3.16 and 3.02 mm. A slight recession of 0.1 mm was observed, and plaque was found in 15% of all sites and was associated with inflammatory symptoms of the peri-implant mucosa. It was observed that such symptoms and recession correlated more strongly with the type of restoration than with the type of treatment. This study demonstrated that implants placed with or without GBR techniques had similar survival rates after 5 years, but that bone resorption was more pronounced in sites with GBR treatment. It was assumed that the use of GBR is indeed indicated when the initial defect size is larger than 2 mm in the vertical dimension.

Factors influencing metal-resin tensile bond strength to filled composites.

This study evaluated the effect of metal surface conditioning, application of a silicon layer, water storage, and resin filling on tensile bond strength of a metal-resin system using three experimental composites (un-, micro-, and macrofilled) having the same self-curing resin composed of Bis-GMA and TEGDMA (2:1 wt%). Test specimens were prepared by bonding the resin between pairs of Ni-Cr-Be alloy cast disks (diameter, 8 mm) previously subjected to heat treatments simulating porcelain firing procedures. A specially constructed apparatus facilitated the absolutely parallel alignment and orientation of the disk faces to each other, maintaining a constant resin thickness of 100 microns. Before being bonded, the sand-blasted metal surfaces were either electrolytically etched and/or silicoated. Prior to being tested, assemblies were stored in water at 37 degrees C for one and 30 days. Thereafter, the specimens were processed in a universal testing machine at a cross-head speed of 2 mm/min until failure. Bond strengths ranged from 4.2 to 20.5 MPa. Data were analyzed by ANOVA with a factorial design (conf. level = 99%). The results showed that: (i) bond strength was increased when the metal was silicoated, (ii) the combination of sandblasting/silicoating produced the best values, and (iii) the 30-day water storage combined with silicoating enhanced the strength of the bond. The resin filling had no significant effect, indicating that neither its presence nor type affects bonding strengths to metal.

Evaluation of the interface between one-bottle bonding agents and dentin by cryopreparation and low-temperature scanning electron microscopy (LTSEM). A pilot study on perfused dentinal samples.

OBJECTIVES: Dentin bonding samples are generally observed in the high vacuum chamber of an electron microscope only after completion of the bonding procedure fixation, dehydration and drying of the specimens. The purpose of this study was to observe the effect of each step in the application of various one-bottle dentin bonding agents (DBA) using cryopreparation followed by low-temperature scanning electron microscopy (LTSEM). METHODS: Prime&Bond 2.1 (P&B 2.1), Coltène Experimental (Exp.) and Syntac Single Component (Syntac SC) were applied onto perfused dentin of extracted, human third permanent molar teeth. After acid-etching, rinsing and drying, and following the application of the respective resins, the teeth were fractured at random and plunge-frozen in liquid nitrogen before examination under LTSEM. As this method preserves the state of the treated surface at the moment when it is frozen, each step of the application of the DBA can be observed as if it were a 'real-time' procedure. RESULTS: Acid-etching the dentin resulted in the removal of the smear layer for all materials tested. Those one-bottle DBAs which recommend the application of two consecutive resin layers (P&B 2.1 and Syntac SC) showed incomplete saturation of the dentinal surface after application of the first layer. With Syntac SC the incomplete saturation was more pronounced than with P&B 2.1. The use of Exp. resulted in a much more homogeneous coverage of the dentin despite only one layer of resin having been applied. CONCLUSION: It is concluded that cryo-preparation followed by LTSEM appears to be a method which allows each stage of the application of DBA to be evaluated.

Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches.

OBJECTIVES: The purpose of this study was to compare three different methods for sinus elevation: (1) the lateral antrostomy as a two-step procedure, (2) the lateral antrostomy as a one-step procedure, and (3) the osteotome technique with a crestal approach. Indication criteria were defined, based on the residual bone height measured from computed tomography scans, for the sake of applying the appropriate technique. STUDY: In 30 patients designated for implant treatment in the resorbed posterior maxilla, 79 implants were placed in combination with a bone-grafting material for sinus augmentation. The final bone heights were measured from panoramic radiographs or post-operative computed tomography scans. RESULTS: The success rate for the osteotome technique was 95% during the 30-month study period; no failures occurred in any site treated with a lateral antrostomy. The gain in bone height was comparable for the one-step (median = 10 mm) and two-step (median = 12.7 mm) lateral antrostomies. These sites exhibited a significantly greater increase in bone height (p < 0.001) than did the sites in which the osteotome technique was applied (mean = 3.5 mm). The histologic sections showed both bone apposition in intimate contact with the bone-grafting material particles and initial signs of its remodeling. CONCLUSIONS: The results indicate that the osteotome technique can be recommended when more than 6 mm of residual bone height is present and an increase of about 3 to 4 mm is expected. In cases of more advanced resorption a one-step or two-step lateral antrostomy has to be performed.

The dual bonding technique: a modified method to improve adhesive luting procedures.

Indirect restorative procedures usually require temporary restorations for protection of the pulp and for restoring the patients esthetic and functional needs. The use of temporary cements, either with or without eugenol, however, considerably decreases the adhesion of the bond on dentin if--according to the conventional technique--such dentin bonding systems are applied once at the moment of final cementation. With a dual application of the dentin bonding agents a considerable increase in bond strength values was discovered. This article presents a modified luting procedure called the "dual bonding technique."

The new In-Ceram Spinell system--a case report.

The final color of all-ceramic restorations is mainly dependent on the light-transmission characteristics of the different components of the ceramic material. This article is a report on the improvement in light reflection and light transmission possible with the new In-Ceram Spinell crown system, which provides a natural-looking appearance.

A new all-ceramic post and core system: clinical, technical, and in vitro results.

Root-filled teeth with fractured or discolored coronal aspects invariably need to be restored by crowns. The prepared abutment tooth is usually reinforced by a metallic post and core system. The grayish discoloration of the root, and consequently of the gingiva, caused by the metal color may be an enormous esthetic disadvantage in the anterior teeth. In 1993 ceramic posts made of zirconia were introduced by the authors, allowing a new all-ceramic concept for nonvital abutment teeth. A new ceramic post and core system has now been developed with the idea of further improving esthetic appearance. In this system the core material is heat pressed directly onto the zirconia post. This article describes the material and the fabrication procedures (chairside and in the laboratory) of the system. Clinical results are presented. The retention of the core material is evaluated by in vitro tests.

Light transmission of composite luting resins.

The final color of all-ceramic restorations is dependent on the surrounding structures and on the ceramic itself. The degree that the layer of the composite luting agent contributes to this final color formation can only be estimated. Based on general optical physics, this paper reports on transmissivity of some commercially available composite luting resins and discusses how these theoretical results apply to clinical situations.

Alveolar ridge augmentation with Bio-Oss: a histologic study in humans.

The aim of the present study was to investigate the healing of alveolar ridge defects augmented with cancellous bovine bone mineral. In six partially edentulous patients, bone augmentation was necessary prior to implant placement because of severe alveolar ridge resorption. The defect sites, all located in the maxilla, were filled with Bio-Oss and covered with the resorbable collagen membrane Bio-Gide. Biopsies were obtained from the defect sites 6 to 7 months following grafting and were processed for ground sectioning. The histologic analysis revealed that the Bio-Oss particles occupied 31% of the total biopsy area. An intimate contact between woven bone and Bio-Oss was detected along 37% of the particle surfaces. A mixed type of bone was found; it contained woven bone and parallel-fibered bone, which demonstrates features of remodeling activity. Signs of resorption of the grafting material were observed in the histologic sections, which indicates that the material takes part in the remodeling process. It is suggested that Bio-Oss may be a very suitable material for staged localized ridge augmentation in humans.

Bond strength of one-bottle dentin bonding agents on human dentin.

PURPOSE: To evaluate the shear bond strength of one-bottle dentin bonding agents (DBA's) (Prime & Bond 2.1, ART Experimental, Syntac Single Component) on pressurized human dentin. MATERIALS AND METHODS: Freshly prepared dentin specimens of human teeth were perfused with horse serum which was diluted 1:5 in physiologic saline. Three different types of surface treatment were evaluated on the freshly prepared dentin. Group 1: One of the three one-bottle DBA's was applied onto freshly prepared dentin together with a cylinder of composite luting resin and cured. Group 2: A provisional cement (Freegenol, without eugenol, or Temp Bond, containing eugenol) was applied first on the dentin surface for 24 h. Only then was one of the three the one-bottle DBA's added onto the dentin together with a cylinder of composite luting resin after cleaning the dentin surface with pumice. Group 3: One of the three one-bottle DBA's was applied first on the dentin surface and light-cured. Then a provisional cement (Freegenol, without eugenol, or Temp Bond, containing eugenol) was added for 24 h. After cleaning with pumice, the respective one-bottle DBA was applied for a second time onto the dentin together with a cylinder of composite luting resin and light-cured. As control for Group 1 (freshly prepared dentin), the two- or three-step DBA's ART Bond and Syntac were used in a similar way. As control for Group 2 (single application of the DBA's after contamination of the dentin with a provisional cement) and Group 3 (dual application of the DBA's with intermediate contamination of the dentin with a provisional cement) the two-step DBA ART Bond was used. After 1500 thermal cycles with constant imitation of intrapulpal pressure, shear bond strengths were measured. Resulting shear bond strength values were displayed by means of a box plot and they were analyzed statistically by Student's t-Test or one-way ANOVA. RESULTS: Lowest and highest mean shear bond strength values were 0.26 +/- 0.47 MPa (single use of ART Bond with prior application of Temp Bond) and 16.34 +/- 5.02 MPa (dual use of ART Bond with intermediate application of Temp Bond). With respect to the surface treatment significant differences between the DBA's could be found in all groups.

Dentin bond strength of Dyract Cem.

PURPOSE: To evaluate the influence of provisional cements and of a dentin bonding agent on the adhesion of a self-curing polyacid-modified resin composite (Dyract Cem) on pressurized human dentin. MATERIALS AND METHODS: Freshly prepared dentin specimens of human teeth were perfused with physiologic saline. Three different types of surface treatment were evaluated. (1) Dyract Cem was applied to freshly prepared dentin without (Group 1.1) or with (Group 1.2) the respective dentin bonding agent (Prime & Bond 2.0) and cured. (2) Freegenol (Groups 2.1 and 2.2) or Temp Bond (Groups 2.3 and 2.4) were applied first on the dentin surface for 24 hours. Only then was Dyract Cem (with or without Prime & Bond 2.0) added onto the dentin after cleaning the dentin surface with pumice. 3) Prime & Bond 2.0 was applied first on the dentin surface and cured. Then Freegenol (Group 3.1) or Temp Bond (Group 3.2) were added for 24 hours. After cleaning with pumice, Prime & Bond 2.0 was applied for a second time on the dentin (= dual application) and finally Dyract Cem was added. As control, a conventional glass ionomer cement (Ketac-Cem Maxicap; Groups 4.1-4.3) was used in a similar way. After 1,500 thermal cycles with constant imitation of intrapulpal pressure, shear bond strengths were measured. Resulting shear bond strength values were displayed by means of a box plot and they were analyzed statistically by Mann-Whitney, Kruskal-Wallis or one way ANOVA tests. RESULTS: Lowest and highest mean shear bond strength values were 0.27 +/- 0.42 MPa (Group 2.4; single use of Prime & Bond 2.0 with prior application of TempBond) and 5.84 +/- 3.36 MPa (Group 3.1; dual use of Prime & Bond 2.0 with intermediate application of Freegenol). A clearly significant difference between groups could only be found when a single or dual use of the dentin bonding agent Prime & Bond 2.0 were combined with either Freegenol (Groups 2.1, 2.2 and 3.1; Kruskal-Wallis: P < 0.01) or Temp Bond (Groups 2.3, 2.4 and 3.2; Kruskal-Wallis: P < 0.001) as additional dentin surface treatment.

Dual application of dentin bonding agents: effect on bond strength.

PURPOSE: To evaluate the effect of a dual application of dentin bonding agents (DBA) on their shear bond strength on dentin with intermediate application of a provisional cement. MATERIALS AND METHODS: Freshly prepared flat dentin surfaces of human teeth were coated with a first layer of one of various dentin bonding agents (All-Bond 2, ART Bond, Syntac or an experimental DBA called P-Bond). After curing the DBA, a provisional cement (Temp Bond, Freegenol or Fermit, a soft provisional diacrylate) was applied to the bonded dentin surface. After 24 hours, the provisional cement was removed and the dentin surface scrubbed with pumice. A second application of the same DBA together with a composite cylinder followed. After curing and 1,500 thermal cycles with constant imitation of intrapulpal pressure, shear bond strengths were measured. RESULTS: Compared to a single application of dentin bonding agents following Temp Bond treatment (SBS in MPa: Syntac: 0.86 +/- 1.75, ART Bond: 0.26 +/- 0.47, P-Bond: 14.90 +/- 4.51) application of DBAs prior to use of Temp Bond as well as after its removal seems to be very beneficial to shear bond strength values (SBS in MPa: Syntac:13.36 +/- 4.70, ART Bond: 16.34 +/- 5.02, P-Bond: 19.04 +/- 2.01). Independent from the provisional cement, the values after serial application of P-Bond provided consistently high bond values which were not statistically different (Kruskal-Wallis, P > 0.05) from values of P-Bond on fresh dentin (18.19 +/- 2.29 MPa). The only exception from these findings in the present study was All-Bond 2. Regardless of the provisional materials used, the bond strength values of All-Bond 2 remained low (maximum SBS with Fermit as intermediate provisional cement: 4.63 +/- 2.91 MPa).

Adjustment of localized alveolar ridge defects by soft tissue transplantation to improve mucogingival esthetics: a proposal for clinical classification and an evaluation of procedures.

Esthetically correct treatment of a localized alveolar ridge defect is a frequent prosthetic challenge. Such defects can be overcome not only by a variety of prosthetic means, but also by several periodontal surgical techniques, notably soft tissue augmentations. Preoperative classification of the localized alveolar ridge defect can be greatly useful in evaluating the prognosis and technical difficulties involved. A semiquantitative classification, dependent on the severity of vertical and horizontal dimensional loss, is proposed to supplement the recognized qualitative classification of a ridge defect. Various methods of soft tissue augmentation are evaluated, based on initial volumetric measurements. The roll flap technique is proposed when the problem is related to ridge quality (single-tooth defect with little horizontal and vertical loss). Larger defects in which a volumetric problem must be solved are corrected through the subepithelial connective tissue technique. Additional mucogingival problems (eg, insufficient gingival width, high frenum, gingival scarring, or tattoo) should not be corrected simultaneously with augmentation procedures. In these cases, the onlay transplant technique is favored.

Overdenture supported by osseointegrated fixtures: a case report.

The increasing use of oral endoprostheses has offered new alternatives for fixed and removable prosthesis design. However, the use of implants also requires the complex understanding and use of sound prosthodontic principles. The establishment of proper maxillomandibular relationships (vertical dimension, occlusal plane, curve of Spee, tooth arrangement), esthetics, and function are essential precursors to success. Although the usefulness of rehabilitation with overdentures supported by osseointegrated fixtures is sometimes underestimated, overdentures provide an adequate treatment alternative in indicated cases. A case is presented in which previous preprosthetic surgery had failed and subsequently an overdenture supported by osseointegrated fixtures was constructed.

Reliability and strength of all-ceramic dental restorations fabricated by direct ceramic machining (DCM).

All-ceramic dental bridges for the molar region are not yet available at reasonable costs. The novel direct ceramic machining (DCM) process allows an easy, reliable and rapid fabrication for all-ceramic dental restorations with high mechanical strength and good biocompatibility. In DCM, an enlarged framework is easily milled out of a pre-fabricated porous ceramic blank made of zirconia. After sintering to full density, no further time-consuming hard machining with diamond tools is needed. For individual esthetical requirements, the framework is coated with a veneer porcelain. Compared to the commercially available In-Ceram Alumina and IPS Empress2 restorations, the mechanical strength of zirconia frameworks is twice as high, allowing the restorations to bear the high mastication forces in the molar region. In terms of reliability, zirconia bridges fabricated by the DCM process are also superior to In-Ceram Alumina and IPS Empress2. A clinical study of three-unit dental bridges in the molar region found no problems after the first year of observation.

[The shear strength of dentin-bonding agents under intrapulpal pressure and temperature change. An in-vitro study]. / Scherfestigkeit von Dentinhaftmitteln unter intrapulpärem Druck und Temperaturwechsel. Eine In-vitro-Studie.

This in-vitro study reports on a modified method for testing shear bond strength of dentin bonding agents (DBA's). For a better imitation of the surface of vital human dentin, all DBA's used in this investigation (12 commercially available and one experimental) were tested with dentin under intrapulpal pressure (19.6 cm/36 cm H2O) and exposed to thermal cycling (x1500, 5 degrees C/55 degrees C). In group A the bonding agent was light cured before the application of the composite resin. In group B the bonding agent and the composite resin were light cured at the same time. The difference between the modified testing method and a commonly used method (application of the DBA onto a dry dentinal surface, water storage at 37 degrees C for 24 h) was significant (p < 0.001, ANOVA two way). The shear bond strengths recorded with our method were generally lower than formerly published results. A.R.T. Bond and Experimental had the best average results in both testing groups. Superbond C&B bond strength had to be interpreted separately.