A five-year clinical evaluation of direct nanofilled and indirect composite resin restorations in posterior teeth.

AIM: To assess the clinical efficacy of posterior composite resin restorations placed directly and indirectly in posterior teeth after five years. MATERIALS AND METHODS: A total of 108 cavities in 54 patients were restored with three direct composite resins (Filtek SupremeXT [FSXT], Tetric Evo Ceram [TEC], AELITE Aesthetic [AA]) and two indirect composite resins (Estenia [E] and Tescera ATL [TATL]). All restorations were evaluated by two examiners using the United States Public Health Service criteria at baseline and five years after placement. Statistical analysis was completed with Fisher exact and McNemar χ(2) tests. RESULTS: At baseline, 4% (five) of the restored teeth presented postoperative sensitivity; however, only one of them (a member of the E group) required canal treatment and replacement after two years. At the five-year evaluation, all restorations were retained, with Alpha ratings at 100%. Only one tooth (in the TEC group) required replacement after three years due to secondary caries. Color match, surface texture, and marginal integrity were predominantly scored as Alpha after five years for all groups. After that time, marginal discoloration was scored as Alpha in 64% of AE restorations, 70% of TATL restorations, 73% of E restorations, and 87% of FSXT restorations. There were no Charlie scores recorded for any of the restorative systems. CONCLUSIONS: Under controlled clinical conditions, indirect composite resin inlays and direct composite resin restorations exhibited an annual failure rate of 2.5% and 1.6%, respectively, after five years. Therefore, the investigated materials showed acceptable clinical performance, and no significant differences were found among them.

Effect of Er,Cr:YSGG laser on the microtensile bond strength of two different adhesives to the sound and caries-affected dentin.

OBJECTIVE: This study examined the effect of Er,Cr:YSGG laser irradiation on the microtensile bond strength (microTBS) of a three-step etch-and-rinse and a two-step self-etch adhesive to sound and caries-affected dentin. METHODS: Sixteen freshly extracted human molars with occlusal dentin caries were used. The caries lesion was removed by one of the following methods: conventional treatment with burs or Er,Cr:YSGG laser (Waterlase MD, Biolase). The adhesive systems (AdheSE, Ivoclar Vivadent and Scotchbond Multi Purpose, 3M ESPE) were applied to the entire tooth surface according to the manufacturers' instructions. Resin composites were applied to the adhesive-treated dentin surfaces and light-cured. Each tooth was sectioned into multiple beams with the "non-trimming" version of the microtensile test. The specimens were subjected to microtensile forces (BISCO Microtensile Tester, BISCO). The data was analyzed by three-way ANOVA and independent t-tests (p=0.05). RESULTS: Er,Cr:YSGG laser irradiation exhibited similar microTBS values compared to that of conventional bur treatment, regardless of the adhesive system and type of treated dentin. The self-etch system revealed lower microTBS values, both with conventional and laser treatment techniques, compared to the etch-and-rinse adhesive in sound and caries-affected dentin (p<0.05). CONCLUSION: Er,Cr:YSGG laser irradiation did not negatively affect the bonding performance of adhesive systems to sound and caries-affected dentin.

Macular involvement in secondary systemic amyloidosis.

PURPOSE: A patient with subretinal and preretinal hemorrhage after secondary systemic amyloidosis due to familial Mediterranean fever is presented. METHODS: Case presentation. RESULTS: A 30-year-old woman with secondary systemic amyloidosis secondary to familial Mediterranean fever presented with painless visual loss in the right eye. The examination demonstrated multiple subretinal and preretinal hemorrhages, massive deposits which may represent amyloid material at the left macular region. After 6 months, the hemorrhages disappeared, but deposits persisted. CONCLUSIONS: The macular deposition and hemorrhage is an uncommon manifestation of secondary systemic amyloidosis secondary to familial Mediterranean fever. Further evidence is necessary to understand the nature of these deposits and their relevance to secondary systemic amyloidosis and/or familial Mediterranean fever.

A case of retinal detachment in retinitis pigmentosa.

PURPOSE: To report case of retinitis pigmentosa in association with rhegmatogenous retinal detachment. METHODS: An eight year old boy complained of a sudden visual loss. The patient had night blindness, bone spicule-like hyperpigmentation, pale optic disc in both eyes, and the retina was totally detached in the right eye. RESULTS: He was initially treated with conventional scleral buckling surgery, then pars plana vitrectomy with silicone tamponade was performed and retinal reattachment was established. After the phacoemulsification combined with silicone oil removal the final visual acuity of counting fingers was obtained. CONCLUSIONS: The association of retinitis pigmentosa and rhegmatogenous retinal detachment is uncommon in young patients.

Antibacterial activities of MDPB and fluoride in dentin bonding agents.

The aim of this study was to compare in vitro antibacterial activity of MDPB containing bonding system ABF with activities of three Fluoride containing bonding systems (Fuji Bond LC (FBLC), Prime&Bond NT (PBNT), and FluoroBond (FLB). Two bacterial strains were tested: Streptococcus mutans and Lactobacillus acidophilus. The study was performed on Muller Hinton Agar by Agar Well Technique. The bacterial agar was evenly distributed over the surface of petri dishes. Standard wells were punched into the agar. The test materials were placed in the wells of Muller Hinton agar plates, inoculated with Streptococcus mutans NCTC10449 and Lactobacillus acidophilus. The diameters of inhibition zones produced around the materials were measured after 24 h of incubation at 37 +/- 1 degrees C. For statistical analysis, Duncan's multiple range test was used. The primers of bonding agents were highly effective against to Streptococcus mutans. The MDPB containing primer of ABF Bond produced the greatest inhibition zones against to Lactobacillus acidophilus. It was followed by FLB primer. Lactobacillus acidophilus was resistant to FBLC primer and bonding, ABF, PBNT and FLB bonding agents. The results of this study indicated that, incorporation of MDPB in primer of self-etch system increased its antibacterial activity especially against to Lactobacillus acidophilus. However, all bonding systems except for bonding agent of ABF showed some antibacterial activity against to Streptococcus mutans.

Comparison of antibacterial activity of two dentin bonding systems using agar well technique and tooth cavity model.

OBJECTIVE: This study compared the antibacterial activities of two dentin bonding systems (ABF, Kuraray and Reactmer Bond, Shofu) by a conventional agar well technique and a newly designed in vitro test using tooth model. METHODS: In the agar well technique, the test materials were filled in the wells of Muller Hinton agar plates inoculated with Streptococcus mutans NCTC10449, and the diameters of inhibition zones produced around the materials were measured after 24h of incubation. For the tooth model test, three cavities (diameter 1mm, depth 2mm) were prepared in the flat occlusal dentin of human extracted molar. After sterilization, the teeth were left in broth culture of 1.56 x 10(8)CFU/ml of S. mutans at 37 degrees C for 72h for allowing bacteria to invade the cavity. The dentin bonding systems were applied separately to each of the two infected cavities, and the third cavity was left unapplied for control. After sealing the occlusal surfaces, the teeth were kept in physiologic saline solution at 37 degrees C for 72h. The standardized amounts of dentin chips (120+/-5mg) were obtained from the cavity walls and the number of bacteria recovered was determined. The results were analyzed by One Way ANOVA, Kruskal Wallis and Mann-Whitney's U tests. RESULTS: The primer of ABF and Reactmer Bond produced inhibition zones with similar sizes (p>0.05), but the bonding resin of ABF did not produce any inhibition. When tested by the model cavity method, the application of ABF resulted in significantly less bacterial recovery than Reactmer Bond (p<0.05), demonstrating substantial antibacterial effects. CONCLUSIONS: The tooth model method used in this study was effective for evaluating the substantial antibacterial effects of dentin bonding agents, and the experimental dentin bonding system ABF was demonstrated to be able to inactivate the bacteria in the cavity effectively in comparison with little antibacterial activity shown by Reactmer Bond.

Scleral permeability to hydrocortisone and mannitol in the albino rabbit eye.

To further explore barrier properties of the sclera, the diffusion of 3H-hydrocortisone and 14C-mannitol was measured across isolated rabbit scleral membrane. In vitro permeability studies were performed using side by side diffusion cells. Bicarbonated Ringer Solution with oxidized glutathione (GBR) at pH 7.4 was the perfusion medium, and the temperature was kept at 37 degrees C. Diffusion of hydrocortisone through the cornea was also measured to compare scleral and corneal permeation. Scleral permeability was found to be five times greater than corneal permeability. Drug analyses were performed by radionuclide counting (LSC), and permeability coefficients were obtained. In vitro metabolism of hydrocortisone was examined by incubation of tissue in hydrocortisone solution in GBR for 5 hours and 37 degrees C. Permeability coefficients of hydrocortisone diffusion through the sclera were also obtained at 25 degrees C, 15 degrees C, and 5 degrees C. Activation energy of scleral transport of hydrocortisone was calculated from an Arrhenius plot. The low activation energy suggests an aqueous pore pathway unlike permeation of the drug across the cornea which uses a transcellular pathway.

Bonding strength to two different surfaces of dentin under simulated pulpal pressure.

PURPOSE: The purpose of this in vitro study was to measure and compare the in vitro shear bond strengths (SBS) of the following dentin bonding systems to different dentin surfaces under simulated pulpal pressure: Liner Bond 2 (self-etching) (LB2), Liner Bond 2V (self-etching) (LB2V), Opti Bond Solo (single component) (OBS), Fuji Bond LC (filled) (FBLC), Prime & Bond 2-1 (single component) (P&B2-1), and Solid Bond (total etching) (SB). MATERIALS AND METHODS: Occlusal and buccal surfaces of 60 extracted human molars were prepared to expose the dentin bonding surface. After being wet ground with 600-grit abrasive papers, teeth were randomly assigned to 6 equal groups of 10 each. The dentin surfaces were treated with the bonding systems mentioned above, and resin composite cylinders (Clearfil AP-X) were built up under simulated pulpal pressure when diluted bovine serum was used as the pulpal fluid. After one day of storage in 37 degrees C water, the specimens were shear tested to failure on an Instron machine. RESULTS: The data were statistically analyzed with the Student's t-test and a post hoc Tukey test. Comparing buccal surfaces, the post hoc Tukey test indicated no significant differences among all the test groups (p > 0.05). On occlusal surfaces, the post hoc Tukey test indicated significant differences among the tested groups (p < 0.05). The Student's t test revealed significant differences between the occlusal and buccal shear bond strength values in LB 2, LB2V, and SB groups (p < 0.05). CONCLUSION: The strength of adhesion to dentin depends upon both the adhesive system used - with self-etching systems tending to show higher bond strengths than the other materials tested - and the location of the dentin, with significantly higher SBS being found on buccal surfaces in 3 of the 7 tested bonding systems.

Evaluation of retinoic acid ophthalmic emulsion in dry eye.

PURPOSE: An oil in water emulsion of 0.01% all-trans-retinoic acid (tretinoin) was prepared and clinically evaluated in dry eye patients. METHODS: The ophthalmic emulsion consisted of 10% of arachis oil and 90% of the hydrogel of Carbopol 940. To evaluate retinoic acid emulsion clinically, a placebo-controlled, open-labeled, randomized study was performed with 22 dry-eye patients. Symptoms were recorded before and after the treatments. The Schirmer I test, measurement of tear film break-up time (BUT), rose Bengal and fluorescein staining of cornea and conjunctiva, and mucus fern test were done. RESULTS: Retinoic acid did not improve the dryness, photophobia and foreign body sensation more than placebo. Schirmer test and BUT were significantly improved by retinoic acid treatment. Corneal and conjunctival epithelium maintained their characteristics during the use of retinoic acid, as indicated by rose Bengal and fluorescein staining. CONCLUSIONS: Ophthalmic emulsion of retinoic acid can be suggested as a promising approach for the treatment of dry eye.

Fleck dystrophy of the cornea; a report of cases from three generations of a family.

Fleck dystrophy of the cornea is characterized by numerous, tiny, small opacities scattered throughout the entire corneal stroma. The mode of inheritance is autosomal dominant, and this dystrophy is considered to be bilaterally symmetric. This report describes five members from three-generations of the same family with corneal fleck dystrophy. Their clinical features and genetic inheritance pattern are discussed. Visual acuity in all patients was normal and the density of opacities were similar except for two patients with less density. Except for one who presented with mild photophobia all patients were asymptomatic. The inheritance pattern appeared as autosomal dominant with variable expression.

Calculation of intraocular lens power with the SRK II formula for axial high myopia.

AIM: The SRK II formula has been widely used for intraocular lens (IOL) power calculations. The predictability of this formula is evaluated in axial myopic patients. METHODS: Planned extracapsular cataract extraction and posterior chamber IOL implantation (PECCE + IOL) were performed on 98 eyes of 98 patients with axial length > 24.5 mm. Cases had no preoperative complications and postoperative visual acuity was at least 0.5 (Snellen). Corneal refractive power and axial length were measured preoperatively and emmetropic IOL power calculations were made using the SRK II formula. Long-term (mean 4.7 months) visual acuities and refractions were noted postoperatively. RESULTS: The absolute refractive error was < 1.00 Diopters (D) in 57 eyes (58.2%) and < 2.00 D in 83 eyes (84.7%). The mean absolute error of the SRK II formula in axial myopia was 1.16 D +/- 0.78 SD. CONCLUSIONS: The SRK II formula is not very accurate in axial myopic patients.

Surgical management of retinal detachment with choroidal coloboma.

PURPOSE: To verify the functional and anatomical results of retinal detachments related to choroidal coloboma. METHODS: Seven eyes with retinal detachment secondary to retinal breaks at the margin of or within a choroidal coloboma were analysed retrospectively. RESULTS: Scleral buckling was performed in five of the seven eyes; two needed additional pars plana vitrectomy (PPV) with internal tamponade using silicone oil to reattach the retina. In two eyes PPV with internal tamponade using silicone oil or gas was used as a primary procedure. All seven eyes were reattached. Five eyes (71.4%) showed improvement or had visual acuity of 20/400 or better after surgery, but two remained unchanged. CONCLUSIONS: Retinal detachment secondary to choroidal coloboma can be treated successfully by scleral buckling or PPV with internal tamponade.

The management of giant retinal tears with silicone oil.

PURPOSE: To report the surgical success of vitrectomy with silicone oil tamponade in the treatment of retinal detachment associated with giant retinal tears due to various factors. METHODS: We retrospectively evaluated 21 eyes of 21 patients with retinal tears 90 degrees or greater that underwent vitrectomy, with injection of perfluorocarbon liquids and silicone oil tamponade. Eight eyes (38.1%) had previous ocular surgery (4 aphakia-pseudophakia, 4 pars plana vitrectomy), 4 eyes (19.0%) had a history of trauma (blunt injuries in 2 and penetrating injury in 2), 3 (14.3%) had high myopia. Six eyes (28.6%) had no known condition predisposing to development of giant retinal tear. RESULTS: Retinal attachment was obtained in 17 (80.5%) of 21 eyes, with a mean follow-up of 12.5 months. Visual acuity improved in 15 eyes (71.4%). CONCLUSIONS: Pars plana vitrectomy with silicone oil tamponade proved highly effective in giant retinal tears in terms of anatomical and functional results.

Role of the vitreous in age-related macular degeneration.

PURPOSE: To investigate the relationship between posterior vitreous detachment (PVD) and age-related macular degeneration (AMD). METHODS: The condition of the vitreous was examined by slit-lamp funduscopy and ultrasonography in 93 eyes of 50 patients with AMD (exudative or dry) and 100 eyes of 50 controls. RESULTS: There was complete PVD in 31 of the 93 eyes (33.3%) of 50 patients with AMD and the posterior vitreous was attached in 62 of these eyes (66.6%). In the control group, in 50 eyes (50%) of 50 subjects there was posterior vitreous detachment. The prevalence of PVD in eyes with macular degeneration was significantly lower (P < .05). There was no statistically significant difference between the exudative and the nonexudative groups in respect to PVD. CONCLUSIONS: PVD may have a protective role against the development of AMD. Chronic vitreomacular traction and/or continuous exposure to free radicals and cytokines may possibly be one of the causes of AMD in eyes with attached vitreous.

Amalgam repair: evaluation of bond strength and microleakage.

This study evaluated the tensile bond strength of "repaired" amalgams and compared the degree of microleakage. Amalgam (Cavex avalloy) was condensed into plastic tubes (3 mm in diameter, 10 mm in height) to the half-length. After storage in water at 37 degrees C for two days, the remaining parts of tubes were filled with amalgam (A), cavity varnish (CV)+A, Liner Bond 2V (LB2V)+A, 3M Opal Luting Cement (3MOLC)+A, Panavia F(PF)+A, Metabond(MB)+A, Fuji BondLC(FB)+A, HytacOSB(HOSB)+Hytac Aplitip (H), Liner Bond2V+Clearfil AP-X(CAP). The bond strengths for 15 samples of each restoration group were determined. For the microleakage study, MOD cavities of 90 extracted human premolars were used. The distal half of cavities were filled with amalgam. After storage in water at 37 degrees C for two days, the mesial half of the cavities were filled to simulate a clinical repair. The "repair" was placed using the procedures applied in the bond strength study. The teeth were stained with basic fuchsine (0.5%), sectioned and evaluated for dye penetration. In both parts of study, the data were analyzed by ANOVA and Duncan's multiple range tests. Bond strength values (MPa) were: A+PF+A 3.84+/-1.08, A+LB2V+A 3.15+/-0.97, A+LB2V+CAP 3.05+/-0.53, A+MB+A 2.86+/-0.88, A+HOSB+H 2.58+/-0.51, A+3MOLC+A 2.11+/-0.75, A+FB+A 0.68+/-0.59. The repaired A+A and A+CV+A groups were separated before testing. The A+PF+A group showed the highest bond strength (p<0.05). Microleakage in the cervical margins of repaired restorations was lower in the amalgam groups than microleakage in the resin composite and compomer groups. PF, MB, 3MOLC and FB performed better at the amalgam "repair" interface. The A+LB2V+A group showed no microleakage at both the occlusal and gingival test regions.

Formulation of Carbopol 940 ophthalmic vehicles, and in vitro evaluation of the influence of simulated lacrimal fluid on their physico-chemical properties.

Carbopol 940 ophthalmic vehicles were prepared in order to investigate the interaction between the simulated lacrimal fluid and the polymer, and to examine the influence of sodium fluorescein - a tracer for the fluorophotometric studies - on the physico-chemical properties of the polymer vehicles. Four kinds of vehicles containing mannitol (5%), sodium fluorescein (0.05%) and disodium edetate (0.01%) were formulated. Physicochemical properties of the preparations including pH, osmolality, surface tension and viscosity were measured after neutralization and sterilization, and also after 1 and 2 weeks, 1, 2 and 3 months of storage at 4 degrees C. The viscosity significantly decreased by adding sodium fluorescein and disodium edetate to Carbopol 940 vehicles. It was observed no significant effect of sterilization and storage on the viscosity, pH and osmolality. Significant change in the flow property of the vehicles was observed when the simulated lacrimal fluid was added. Three concentrations of Carbopol 940 vehicles (0.20%, 0.15% and 0.10%) both containing and not containing disodium edetate were proposed for in vivo evaluation.

[Formulation studies of the wetting solutions for hard contact lenses. 1. Microbiological studies]. / Sert kontakt lens islatma çözeltileri üzerinde formülasyon çalismalari. 1. Mikrobiyolojik çalismalar.

The purpose of this study was to develop hard contact lens wetting solutions which would contain suitable and sufficient antimicrobial agents for preventing contamination. In the first part of the formulation studies, microbiological methods were employed to determine the adequate antibacterial concentrations of benzalkonium chloride and disodium EDTA.

Evaluation of the interfacial properties of a new potent antimicrobial surfactant C31G.

The surface activity of a new potent antimicrobial mixture (C31G) of alkyl betaines and alkyl amine oxides were evaluated in order to determine the relationship between its antimicrobial effectiveness and physical properties. Therefore the surface tension measurements were performed at different temperatures using an interfacial tensiometer. Critical micelle concentrations, interfacial and thermodynamic parameters of C31G were obtained from the surface tension data.

Emmetropization, visual acuity, and strabismus outcomes among hyperopic infants followed with partial hyperopic corrections given in accordance with dynamic retinoscopy.

OBJECT: To record emmetropization, visual acuity, and strabismus outcomes among hyperopic infants followed with partial hyperopic corrections given in accordance with dynamic retinoscopy (DR). METHODS: Infants (3.5-12 months of age) with ≥5 D hyperopia were followed without glasses or partial hyperopic corrections prescribed according to their near dynamic accommodative abilities determined by DR responses at the initial visit and follow-ups. Refraction and binocular accommodative ability assessments were made at 3-month intervals up to the age of 1 and at 6-month intervals afterwards for a mean 35.4±2.1 months; main outcome measures being the development of esotropia, emmetropization rate, and visual acuity level after emmetropization period. RESULTS: Among 211, 146 were normal accommodators initially (Group 1). These infants were followed without treatment and none presented with strabismus. Sixty-five infants were hypo-accommodators (Group 2) and received minimum DR-based corrections. Of the 65 infants 31 (48%) developed strabismus (Group 2B). The remaining 34 constituted Group 2A. Each of the three groups showed an overall reduction of hyperopia by 0.37±0.25 days per year, 0.50±0.28 days per year, and 0.60±0.20 days per year, respectively. Visual acuity assessments among Groups 1 and 2A revealed normal values (0.2-0.0 LogMAR); among Group 2B 19% were within normal range. CONCLUSIONS: Binocular accommodative behavior at the initial visit seems to be one of the indicators for pointing out infants at risk of developing strabismus and amblyopia. Prescription of DR-based corrections to hyperopic orthotropic infants does not impede emmetropization and result in normal visual acuities after emmetropization period.

Bond strength of self-etch adhesives after saliva contamination at different application steps.

This study evaluated and compared the effect of saliva contamination and possible decontamination methods on bond strengths of two self-etching adhesive systems (Clearfil SE Bond [CSE], Optibond Solo Plus SE [OSE]). Flat occlusal dentin surfaces were created on 180 extracted human molar teeth. The two bonding systems and corresponding composite resins (Clearfil AP-X, Kerr Point 4) were bonded to the dentin under six surface conditions (n=15/group): group 1 (control): primer/bonding/composite; group 2: saliva/drying/primer/bonding/composite; group 3: primer/saliva/rinsing/drying/primer/bonding/composite; group 4: primer/saliva/rinsing/drying/bonding/composite; group 5: primer/bonding (cured)/saliva/rinsing/drying/primer/bonding/composite; group 6: primer/bonding (cured)/saliva/removing contaminated layer with a bur/rinsing/drying/primer/bonding/composite. Shear bond strength was tested after specimens were stored in distilled water at 37°C for 24 hours. One-way analysis of variance and Tukey post hoc tests were used for statistical analyses. For CSE, groups 2, 3, and 4 and for OSE, groups 6, 2, and 4 showed significantly lower bond strengths than the control group (p<0.05). CSE groups 5 and 6 and OSE groups 3 and 5 revealed bond strengths similar to the control. When saliva contamination occurred after light polymerization of the bonding agent, repeating the bonding procedure recovered the bonding capacity of both self-etch adhesives. However, saliva contamination before or after primer application negatively affected their bond strength.