Rheumatoid arthritis and myasthenia gravis: a case-based review of the therapeutic options

Clinical Rheumatology - Myasthenia gravis is an autoimmune disease affecting the neuromuscular junction, often associated with other autoimmune diseases, including rheumatoid arthritis. Patients...     

Do collagen cross-linkers improve dentin’s bonding receptiveness?

Objectives

Dentin biomodification using collagen cross-linkers has been proposed as one of the strategies to improve bond durability of adhesives to dentin. However, literature is not very consistent regarding their benefit, in particular when cross-linkers are applied in clinically realistic application times. This study investigated the effect of three cross-linkers on the mini-interfacial fracture toughness (mini-iFT) of four adhesives bonded to dentin following either etch&rinse (E&R) or self-etch (SE) modes.

Light irradiance through novel CAD–CAM block materials and degree of conversion of composite cements

Objective

To assess light irradiance (LI) delivered by two light-curing units (LCU’s) and to measure the degree of conversion (DC) of three composite cements, when cured through different thicknesses of two novel CAD–CAM block materials.

<Emphasis Type="Bold">S</Emphasis>hort fibre-reinforced composite for extensive direct restorations: a laboratory and computational assessment

Objectives

The objective of the study was to evaluate the effectiveness of a short fibre-reinforced composite (FRC) applied in combination with a conventional filler composite (CFC) on the fatigue resistance, fracture strength, failure mode and stress distribution, for restorations of premolars under two loading angles.

Material and methods

Thirty-two inferior premolars received extensive cavities with removal of the lingual cusp. Teeth were restored directly using ‘FRC (EverX Posterior, GC) + CFC (G-aenial, GC)’ or ‘CFC only’ and received two fatigue/fracture loadings at two different angles (0°/45°) (n = 8). Data were submitted to two-way ANOVA (α = 5 %) and Tukey test. Failure mode was analysed using SEM. Four 3D finite element (FE) models were constructed and static, linear and elastic analyses were performed. Maximum principal and von Mises stresses were evaluated.

Results

All specimens survived the mechanical fatigue simulation. No statistical difference in fracture resistance was recorded between FRC + CFC and CFC only, considering both loading angles (p = 0.115). However, the 0° loading showed a statistical significant higher strength than the 45° loading (p = 0.000). Failure mode analysis revealed more repairable fractures upon 0° loading, versus more root fractures (unrepairable) upon 45° loading. FE revealed a higher amount of stress upon 45° loading, with tensile stress being imposed to the lingual cervical area.

Conclusion

The fracture strength was not increased using the FRC. Loading at a 45° decreased significantly the fracture resistance.

Clinical relevance

The restoration of extensive cavities in posterior tooth is a challenge for the clinicians and the choice of the material that increases the fracture strength of tooth-restoration complex is required.

     

Effects of metabolic syndrome on kidney transplantation outcomes: a systematic review and meta‐analysis

Metabolic syndrome (MS) has been associated with proteinuria and reduced glomerular filtration rate. Immunosuppressive agents increase the incidence of traditional risk factors for cardiovascular disease (CVD) and have known effects on MS components after kidney transplantation. The purpose of this meta‐analysis was to evaluate the impact of MS on relevant outcomes after kidney transplantation. MEDLINE, EMBASE, and Cochrane Library were searched up to November 7, 2015. Papers that compared patients with and without MS and assessed one of the following outcomes, graft loss, death by cardiovascular disease, and all‐cause mortality, were included. Of 585 studies identified, five studies including 1269 patients were evaluated. MS was identified as a risk factor for graft loss [relative risk, 3.06; 95% confidence interval (CI), 2.17, 4.32; I² = 0%; P heterogeneity = 0.72] and death by CVD (relative risk, 3.53; 95% CI, 1.27, 9.85; I² = 0%; P heterogeneity = 0.40). Results on the association between MS and all‐cause mortality were inconclusive (relative risk, 2.61; 95% CI, 0.70, 9.81; I² = 58%; P heterogeneity = 0.09). Graft loss and death by CVD were associated with the presence of MS after transplantation. Randomized clinical trials should be conducted to define whether interventions on each MS component would result in better outcomes after transplantation.     

Esthetic Rehabilitation of Retained Primary Teeth—A Conservative Approach

With the advancement in ceramic restorations bonded to tooth structure, the treatment has become a feasible and conservative option to restore teeth with alteration in shape when owing to high demand in esthetics, with or without minimum tooth preparation. This article describes a report of a 32‐year‐old woman who was dissatisfied with her smile. The patient reported that she still had deciduous teeth, and that the maxillary lateral incisors had been restored with direct resin composite to correct the teeth shape. After discussing the restorative possibilities, a decision was made to place all‐ceramic crowns (lithium disilicate glass‐ceramic) with minimal tooth preparation, which figures as a conservative full‐coverage approach. An esthetic outcome resembling a natural‐looking smile resulted in the patient's satisfaction. Bonding of all‐ceramic crowns onto minimally prepared deciduous teeth figures as a conservative treatment in case of partial anodontia, which decreases the chance of root resorption induced by trauma and benefits from good adhesion to enamel.     

Randomized clinical trial of 2 nonvital tooth bleaching techniques: A 1-year follow-up

Statement of problem

Controlled clinical trials comparing the effectiveness of the walking bleaching (WB) technique and the inside-outside (I-O) technique used in a short daily regimen are lacking.