Paraesophageal hernia repair with laparoscopic Toupet fundoplication: impact on pulmonary function,respiratory symptoms and quality of life

Hernia - Paraesophageal hiatal hernia (PEH) is characterized by protrusion of intra-abdominal organs into the posterior mediastinum. Respiratory symptoms and reduced pulmonary function have been...     

Effect of silica coating and laser treatment on the flexural strength,surface characteristics,and bond strength of a dental zirconia

This study investigated the effect of irradiation with an erbium‐doped yttrium aluminium garnet (Er:YAG) laser and coating with silica on the surface characteristics, bond strength, and flexural strength of dental zirconia. Three hundred and forty‐three standard zirconia specimens were created, and 49 were assigned to each of seven surface treatment groups: (i) no treatment; Er:YAG laser (80 mJ/2 Hz) with pulse widths of 50 μs (ii), 100 μs (iii), 300 μs (iv), or 600 μs (v); or tribochemical silica coating at the partially sintered stage (vi) or after sintering was complete (vii). All specimens were sintered after the surface treatments, except for the group in which specimens were sintered before treatment. The study outcomes were roughness, surface loss, microshear bond strength (μSBS), and biaxial flexural strength (BFS). Mean roughness and surface loss values were significantly higher in specimens from irradiated groups than in those from silica‐coated groups. Regarding μSBS, after aging, specimens from all experimental groups presented very low and similar μSBS values, irrespective of the surface treatment. Silica coating after sintering yielded the highest BFS (1149.5 ± 167.6 MPa), while coating partially sintered specimens with silica resulted a BFS (826.9 ± 60.9 MPa) similar to that of the untreated control group (794.9 ± 101.7 MPa). Laser treatments, irrespective of pulse width used, significantly decreased the BFS. In the group treated with laser at 300 μs pulse width, specimens exhibited the lowest BFS value (514.1 ± 71.5 MPa). Adhesion to zirconia was not stable after aging, regardless of the surface treatment implemented.     

Microstructural characterization and fracture behavior of a microhybrid and a nanofill composite

OBJECTIVES: To characterize the microstructure and composition of two different composites, and to determine their influence on the physical properties and fracture behavior. METHODS: The microstructure and composition of a microhybrid (Filtek Z250-Z2) and a nanofill (Filtek Supreme-SU) composite were analyzed using scanning electron microscopy (SEM) and electron dispersive spectroscopy (EDS). Filler wt% was determined by thermogravimetric analysis. Hardness (H) and degree of conversion (DC) were evaluated at top and bottom surfaces of 2-mm thick specimens, and the dynamic elastic modulus (E) was determined with ultrasonic waves. Bar specimens (n=30) were subjected to flexure loading and flexural strength (sigmaf) was calculated (MPa). Fractographic analysis (FA) was performed to determine the fracture origin (c) for calculation of fracture toughness (KIc), and these results were compared to those from the single edge notch beam (SENB) method. Results were statistically analyzed using two-way ANOVA, Student's t-test and Weibull analysis (alpha=0.05). RESULTS: Z2 had higher filler wt%, H, E and DC at 2-mm depth as compared with SU. The fracture behavior (sigmaf and KIc) and the structural reliability (m) of the composites were similar. Results of KIc tested by SENB or calculated from fracture surfaces from flexure testing were similar. SIGNIFICANCE: The microstructural organization of the composites determines their physical properties, in spite of the similar filler content. In contrast, the microstructure did not influence the fracture behavior and the structural reliability of these highly filled composites. FA was shown to be a reliable method for determining the KIc of composites.     

EFFECT OF ACID ETCHING OF GLASS IONOMER CEMENT SURFACE ON THE MICROLEAKAGE OF SANDWICH RESTORATIONS

The purposes of this study were to evaluate the sealing ability of different glass ionomer cements (GICs) used for sandwich restorations and to assess the effect of acid etching of GIC on microleakage at GIC-resin composite interface. Forty cavities were prepared on the proximal surfaces of 20 permanent human premolars (2 cavities per tooth), assigned to 4 groups (n=10) and restored as follows: Group CIE – conventional GIC (CI) was applied onto the axial and cervical cavity walls, allowed setting for 5 min and acid etched (E) along the cavity margins with 35% phosphoric acid for 15 s, washed for 30 s and water was blotted; the adhesive system was applied and light cured for 10 s, completing the restoration with composite resin light cured for 40 s; Group CIN – same as Group CIE, except for acid etching of the CI surface; Group RME – same as CIE, but using a resin modified GIC (RMGIC); Group RMN – same as Group RME, except for acid etching of the RMGIC surface. Specimens were soaked in 1% methylene blue dye solution at 24°C for 24 h, rinsed under running water for 1 h, bisected longitudinally and dye penetration was measured following the ISO/TS 11405-2003 standard. Results were statistically analyzed by Kruskal-Wallis and chi-square tests (α=0.05). Dye penetration scores were as follow: CIE – 2.5; CIN – 2.5; RME – 0.9; and RMN – 0.6. The results suggest that phosphoric acid etching of GIC prior to the placement of composite resin does not improve the sealing ability of sandwich restorations. The RMGIC was more effective in preventing dye penetration at the GIC-resin composite- dentin interfaces than CI.     

The effect of ceramic surface treatment on bonding to densely sintered alumina ceramic

STATEMENT OF PROBLEM: Ceramic surface treatment is crucial for bonding to resin. High crystalline ceramics are poorly conditioned using traditional procedures. PURPOSE: The purpose of this study was to evaluate the effect of silica coating on a densely sintered alumina ceramic relative to its bond strength to composite, using a resin luting agent. Material and methods Blocks (6 x 6 x 5 mm) of ceramic and composite were made. The ceramic (Procera AllCeram) surfaces were polished, and the blocks were divided into 3 groups (n = 5): SB, airborne-particle abrasion with 110-microm Al 2 O 3 ; RS, silica coating using Rocatec System; and CS, silica coating using CoJet System. The treated ceramic blocks were luted to the composite (W3D Master) blocks using a resin luting agent (Panavia F). Specimens were stored in distilled water at 37 degrees C for 7 days and then cut in 2 axes, x and y, to obtain specimens with a bonding area of approximately 0.6 mm 2 (n = 30). The specimens were loaded to failure in tension in a universal testing machine, and data were statistically analyzed using a randomized complete block design analysis of variance and Tukey's test (alpha=.05). Fractured surfaces were examined using light microscopy and scanning electron microscopy to determine the type of failure. Energy-dispersive spectroscopy was used for surface compositional analysis. RESULTS: Mean bond strength values (MPa) of Groups RS (17.1 +/- 3.9) ( P =.00015) and CS (18.5 +/- 4.7) ( P =.00012) were significantly higher than the values of Group SB (12.7 +/- 2.6). There was no statistical difference between Groups RS and CS. All failures occurred at the adhesive zone. CONCLUSION: Tribochemical silica coating systems increased the tensile bond strength values between Panavia F and Procera AllCeram ceramic.     

Failure analysis of resin composite bonded to ceramic.

OBJECTIVE: To use fractographic principles to classify the mode of failure of resin composite bonded to ceramic specimens after microtensile testing. METHODS: A leucite-based ceramic (IPS Empress)-E1) and a lithia disilicate-based ceramic (IPS Empress2)-E2) were selected for the study. Fifteen blocks of E1 and E2 were polished through 1 microm alumina abrasive. The following ceramic surface treatments were applied to three blocks of each ceramic: (1) 9.5% hydrofluoric acid (HF) for 2 min; (2) 4% acidulated phosphate fluoride (APF) for 2 min; (3) Silane coating (S); (4) HF+S; (5) APF+S. An adhesive resin and a resin composite were applied to all treated surfaces and light cured. Twenty bar specimens for each group were prepared from the composite-ceramic blocks and stored in 37 degrees C distilled water for 30 days before loading to failure under tension in an Instron testing machine. Fracture surfaces were examined using scanning electron microscopy and X-ray dot mapping. Statistical analysis was performed using one-way ANOVA, Duncan's multiple range test, and Weibull analyses. RESULTS: Similar surface treatments were associated with significantly different bond strengths and modes of failures for E1 and E2. All fractures occurred within the adhesion zone. The microstructural difference between etched E1 and E2 ceramics was a major controlling factor on adhesion. SIGNIFICANCE: The quality of the bond should not be assessed based on bond strength data alone. Mode of failure and fractographic analyses should provide important information leading to predictions of clinical performance limits.     

Bond strength of a resin cement to high-alumina and zirconia-reinforced ceramics: the effect of surface conditioning

PURPOSE: The aim of this study was to evaluate the effect of two surface conditioning methods on the microtensile bond strength of a resin cement to three high-strength core ceramics: high alumina-based (In-Ceram Alumina, Procera AllCeram) and zirconia-reinforced alumina-based (In-Ceram Zirconia) ceramics. MATERIALS AND METHODS: Ten blocks (5 x 6 x 8 mm) of In-Ceram Alumina (AL), In-Ceram Zirconia (ZR), and Procera (PR) ceramics were fabricated according to each manufacturer's instructions and duplicated in composite. The specimens were assigned to one of the two following treatment conditions: (1) airborne particle abrasion with 110-microm Al2O3 particles + silanization, (2) silica coating with 30 microm SiOx particles (CoJet, 3M ESPE) + silanization. Each ceramic block was duplicated in composite resin (W3D-Master, Wilcos, Petrópolis, RJ, Brazil) using a mold made out of silicon impression material. Composite resin layers were incrementally condensed into the mold to fill up the mold and each layer was light polymerized for 40 s. The composite blocks were bonded to the surface-conditioned ceramic blocks using a resin cement system (Panavia F, Kuraray, Okayama, Japan). One composite resin block was fabricated for each ceramic block. The ceramic-composite was stored at 37 degrees C in distilled water for 7 days prior to bond tests. The blocks were cut under water cooling to produce bar specimens (n = 30) with a bonding area of approximately 0.6 mm2. The bond strength tests were performed in a universal testing machine (crosshead speed: 1 mm/min). Bond strength values were statistically analyzed using two-way ANOVA and Tukey's test (< or = 0.05). RESULTS: Silica coating with silanization increased the bond strength significantly for all three high-strength ceramics (18.5 to 31.2 MPa) compared to that of airborne particle abrasion with 110-microm Al2O3 (12.7-17.3 MPa) (ANOVA, p < 0.05). PR exhibited the lowest bond strengths after both Al2O3 and silica coating (12.7 and 18.5 MPa, respectively). CONCLUSION: Conditioning the high-strength ceramic surfaces with silica coating and silanization provided higher bond strengths of the resin cement than with airborne particle abrasion with 110-microm Al2O3 and silanization.     

Influence of thermal gradients on stress state of veneered restorations

Objectives

To assess transient and residual stresses within the porcelain of veneered restorations (zirconia and metal) as a result of cooling rate and porcelain thickness.

Methods

Porcelain-on-zirconia (PZ) and porcelain-fused-to-metal (PFM) crowns were fabricated with 1 or 2 mm of porcelain. Thermocouples were attached both internally and externally to the crowns to record transient temperatures. For fast cooling, the furnace was opened after the holding time and switched off. Slow cooling was accomplished by opening the furnace at 50 °C below the glass transition temperature (T_g) of the material. An axially symmetric FEA model simulated thermal stresses. Time-dependent temperature equations from thermocouple readings were set as boundary conditions. Framework materials and the porcelain below T_g were considered to behave elastically. Visco-elastic behavior was assumed for porcelain above the T_g modeling properties as dependent on cooling rate.

Results

Differences in residual stress were found for fast and slow cooled PZ and PFM crowns. Significant transient stress waves were observed within the porcelain when fast cooling through T_g. They are believed to be related to non-uniform volumetric changes originated from thermal gradients. Results were confirmed by modeling and physical testing of crowns containing a defect.

Significance

Residual stresses do not distinguish PZ from PFM. High magnitude transient stresses observed within the porcelain during fast cooling may explain clinical fractures involving internal defects. Stress waves may also originate internal micro-cracking which could grow under function. Therefore, slow cooling, especially for all-ceramic crowns with thick porcelain, is important to prevent thermal gradients and high-magnitude transient stresses.