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1.
PURPOSE: The purpose of this study was to determine pressure changes in the pulp space during tooth preparation with either diamond or tungsten carbide burs in a high-speed dental handpiece in the laboratory. MATERIALS AND METHODS: Twenty premolar teeth were collected and randomly assigned to two groups: group 1 received preparation with diamond burs and group 2 with tungsten carbide burs. The teeth were mounted on a pressure transducer and the pulp chambers were filled with saline. A 0.1-mm thickness of tooth tissue was removed from the proximal surface of each tooth, alternating dry and wet cutting, until the pulp chamber was exposed. Pressure and temperature changes were recorded during tooth preparation. RESULTS: At 0 to 1 mm of remaining dentin depth dry cutting with diamond and tungsten carbide burs generated a mean positive pulpal pressure of 12 kPa and 6 kPa, respectively. Wet cutting under the same conditions produced 0.6 kPa and 0.15 kPa, respectively. The difference between wet and dry cutting was highly significant (P < 0.001). Diamond burs produced significantly higher pressure increases than carbide burs at all levels for both wet and dry techniques (P < 0.05). When cutting farther than 2 mm from the pulp, tooth preparation created a mean 0.09-kPa pressure increase, which was not influenced by either coolant use or bur type. The temperature change was minimal during wet cutting and only minor temperature increases were recorded during dry cutting. CONCLUSION: From this laboratory study it is concluded that significant pressure changes occur in the pulp chamber during tooth preparation of extracted teeth when the remaining dentin thickness is less than 2 mm.  相似文献   

2.
Heat generated by grinding during removal of ceramic brackets   总被引:2,自引:0,他引:2  
When ceramic brackets fracture during treatment or at the time of debonding, it may become necessary to remove residual fragments by grinding with a handpiece. However, the grinding of ceramic surfaces may generate temperatures high enough to have detrimental effects on dental pulp. Intrapulpal temperature measurements were made on extracted teeth during bracket grinding with a small thermocouple probe fixed to the pulpal wall subjacent to the bracket position. These measurements were then compared with established threshold temperatures that have been reported to cause pulpal pathosis. We removed 122 ceramic brackets (A-Company Starfire, GAC Allure, and Unitek Transcend) from eight extracted teeth by grinding with high-speed diamond burs or low-speed green stones, both with and without air or water coolant. It was determined that low-speed grinding without coolant resulted in a significant (p less than 0.001) increase in pulp chamber temperature for all three types of brackets. Neither high-speed nor low-speed grinding during bracket removal caused a rise in pulp chamber temperature when combined with air or water coolant.  相似文献   

3.
OBJECTIVE: The aim of these experiments was to compare the cutting dynamics of high-speed high-torque (speed-increasing) and high-speed low-torque (air-turbine) handpieces and evaluate the effect of handpiece torque and bur type on sub-surface enamel cracking. Temperature changes were also recorded in teeth during cavity preparation with high and low torque handpieces with diamond and tungsten carbide (TC) burs. The null hypothesis of this study was that high torque handpieces cause more damage to tooth structure during cutting and lead to a rise in temperature within the pulp-chamber. MATERIALS AND METHODS: Images of the dynamic interactions between burs and enamel were recorded at video rate using a confocal microscope. Central incisors were mounted on a specially made servomotor driven stage for cutting with a type 57 TC bur. The two handpiece types were used with simultaneous recording of cutting load and rate. Sub-surface enamel cracking caused by the use of diamond and TC burs with high and low torque was also examined. Lower third molars were sectioned horizontally to remove the cusp tips and then the two remaining crowns cemented together with cyanoacrylate adhesive, by their flat surfaces. Axial surfaces of the crowns were then prepared with the burs and handpieces. The teeth were then separated and the original sectioned surface examined for any cracks using a confocal microscope. Heat generation was measured using thermocouples placed into the pulp chambers of extracted premolars, with diamond and TC burs/high-low torque handpiece variables, when cutting occlusal and cervical cavities. RESULTS: When lightly loaded the two handpiece types performed similarly. However, marked differences in cutting mechanisms were noted when increased forces were applied to the handpieces with, generally, an increase in cutting rate. The air turbine could not cope with steady heavy loads, tending to stall. 'Rippling' was seen in the interface as this stall developed, coinciding with the bur 'clearing' itself. No differences were noted between different handpieces and burs, in terms of sub-surface enamel cracking. Similarly, no differences were recorded for temperature rise during cavity preparation. CONCLUSIONS: Differences in cutting mechanisms were seen between handpieces with high and low torque, especially when the loads and cutting rates were increased. The speed increasing handpiece was better able to cope with increased loading. Nevertheless, there was no evidence of increased tooth cracking or heating with this type handpiece, indicating that these do not have any deleterious effects on the tooth.  相似文献   

4.
PURPOSE: The aim of this study was to examine the clinical and radiographic success of the treatment of maxillary anterior primary incisors with composite resin strip crowns placed in a private practice setting. METHODS: This was a retrospective, clinical study of patients who had strip crowns (SC) placed on maxillary primary incisors, returned for at least 1, 6-month recall examination, and whose parents consented to participate in the study. Radiographic and photographic examinations were used for evaluation. Two evaluators rated the images independently. When ratings were not in agreement, the 2 examiners reviewed the photograph or radiograph together and reached a consensus rating. RESULTS: One hundred twelve restorations placed in 40 children were evaluated. The evaluations were performed after the crowns had been in place for an average of 18 months. None of the restorations were totally lost, and only 12% were rated as having lost some resin material, resulting in an 88% overall retention rate. There was no difference in restoration success if the crowns were placed 4 at a time, or if fewer crowns were placed in a single sitting; the failure rates were comparable. Teeth that had pulpal treatment were judged to have far more significant color match discrepancies than those teeth without pulpal treatment. Ninety-one percent of the teeth demonstrated healthy pulps. Eight percent had some pulpal changes but did not require immediate attention. Only 1 tooth showed radiographic evidence of pulpal necrosis. Only 11 teeth had pulpal treatment, but of these, 10 demonstrated clinical success. CONCLUSIONS: Composite resin strip crowns for restoring primary incisors with large or multisurface caries performed well. Color match of these crowns with adjacent teeth may be significantly reduced when placed upon teeth that have undergone pulpectomy treatment and have been obturated with an iodoform paste. However, based upon the results of this study, the strip crown may provide an esthetic and durable restoration for carious primary incisors.  相似文献   

5.
Purpose: The aim of this study was to analyze the survival rate and failure mode of IPS leucite‐reinforced ceramic onlays and partial veneer crowns regarding thickness under the following clinical conditions: vital versus nonvital teeth, tooth location, and type of opposing dentition. Materials and Methods: Teeth were prepared according to established guidelines for ceramic onlays and partial veneer crowns. Before cementation, the restorations were measured for occlusal thickness at the central fossa, mesial, and distal marginal ridges, and functional and nonfunctional cusps. A total of 210 ceramic restorations were cemented in 99 patients within a mean observation period of 2.9 ± 1.89 years. The mode of failure was classified and evaluated as (1) adhesive, (2) cohesive, (3) combined failure, (4) decementation, (5) tooth sensitivity, and (6) pulpal necrosis. Kaplan, log‐rank, and Cox regression tests were used for statistical analysis. Results: The failure rate was 3.33% (7/210). Increased material thickness produced less probability of failures. Vital teeth were less likely to fail than nonvital teeth. Second molars were five times more susceptible to failure than first molars. Tooth sensitivity postcementation and the type of opposing dentition were not statistically significant in this study. Conclusions: In this study, thickness of the restorations, tooth vitality, and location of teeth in the dental arch influenced restoration failures.  相似文献   

6.
PURPOSE: The objectives of the present study were to determine the prevalence of residual extrusion, pulpal necrosis, and resorption for extruded permanent teeth and to establish the effect of presentation and treatment factors. METHODS: Seventy-two traumatically extruded permanent incisors were studied at the Departments of Paediatric Dentistry in Belfast, Newcastle upon Tyne, and Glasgow. The mean age of the patients was 10.1 years (range=6 to 18 years). Clinical and radiographic outcomes were analyzed and related to presenting and treatment factors. RESULTS: The initial degree of extrusion was moderate for 46 teeth (64%), and the median delay prior to repositioning was 3 hours (range=1 to 168 hours). Pulp necrosis occurred in 31 teeth (43%), residual extrusion was present in 16 teeth (23%), and inflammatory resorption occurred in 11 teeth (15%). Residual extrusion was significantly associated with a delay in repositioning the tooth, pulpal necrosis was significantly more common in teeth with closed apices and in severely extruded teeth, and inflammatory resorption was more common after pulpal necrosis. CONCLUSIONS: Residual extrusion could be minimized by earlier presentation and repositioning. The risk of pulpal necrosis is greatest for severely extruded teeth and for those with closed apices.  相似文献   

7.
BACKGROUND: The authors tested the clinical longevity of disposable diamond burs. They cut a series of five preparations and assessed the leakage after restoring the tooth. METHODS: The authors prepared 10 teeth for Class V restorations, and used a new disposable diamond bur for each tooth. The burs were used to cut preparations in extra teeth before being used to prepare a second series of 10 teeth (third use). The authors then cut preparations in extra teeth before preparing a third set of 10 teeth (fifth use). They removed existing restorations in a second group of 30 teeth and extended the preparations using the same regimen of one, three and five bur uses. All preparations were etched and conditioned, and the teeth were restored with resin-based composite. Using a 20-volt direct-current power source and a stainless-steel counter electrode, the authors measured the leakage electrochemically in 1.0 percent sodium chloride for 30 days. RESULTS: Freshly prepared and restored teeth leaked less than reprepared teeth. Leakage was similar for the first and third uses of the bur, but was far greater for the fifth use (P < .01). The previously restored teeth that were cut with the first- and third-use burs behaved the same, but the third-use bur caused more leakage than the fifth-use bur (P < .01). CONCLUSIONS: Reuse of disposable burs can affect leakage behavior. With new preparations, use of a disposable bur to cut more than three preparations increased leakage. For teeth that were reprepared and restored, greater leakage occurred than it did with new preparations, although repeated use of a bur may reduce leakage. CLINICAL IMPLICATIONS: Disposable diamond burs may cut preparations in up to three teeth before adversely affecting leakage behavior. Restoration removal and repreparation of teeth results in greater leakage than that with freshly prepared teeth.  相似文献   

8.
Fate of vital pulps beneath a metal-ceramic crown or a bridge retainer   总被引:1,自引:0,他引:1  
AIM: To investigate the incidence of and factors associated with pulpal necrosis in vital teeth restored with metal-ceramic crowns (CMCs) or crowned as part of a fixed-fixed bridge. METHODOLOGY: Patients who had a CMC or bridge retainer (BR) placed on a tooth with no previous history of root canal treatment from 1981 to 1989 were retrieved from computer records. The collated patients were randomly selected and their clinical records examined. Those who satisfied the inclusion criteria were contacted and offered a review. After clinical examination, long-cone paralleling periapical radiographs were taken of the selected teeth, which were then assessed by two precalibrated operators to ascertain the pulpal status. Factors that might contribute to loss of pulp vitality and the tooth type were also recorded. The collected data were analysed statistically using the chi-square test and subject to Bonferroni adjustment where indicated. RESULTS: The numbers of preoperatively vital teeth in the CMC and BR groups were 122 and 77, and the mean observation periods were 169 +/- 25 (SD) and 187 +/- 23 months, respectively. In the CMC group, 19 failed cases (15.6%) were due to an endodontic reason; total number of failures was 34. In the BR group, 25 (32.5%) showed signs of pulpal necrosis; a significant association with maxillary anterior teeth was noted. The survival rates for pulp vitality were 84.4% (CMC) and 70.8% (BR) after 10 years, and 81.2% (SC) and 66.2% (BR) after 15 years. The difference between the two groups was significant. CONCLUSION: The survival of the vital pulp in teeth restored with a single-unit CMC was significantly higher than those serving as an abutment of a fixed-fixed bridge. Maxillary anterior teeth used as bridge abutments had a higher rate of pulpal necrosis than any other tooth types.  相似文献   

9.
The statistics for prosthetic restorations used for missing teeth at the Prosthetic Department of Asahi University Hospital from April 1986 to March 1987 were compared with those obtained for an earlier period (April 1983 to March 1984). Fixed bridges and removable partial dentures constituted the majority of the prosthetic restorations for posterior teeth. Fixed bridges were twice more frequently used for anterior teeth during this period than during the previous period. For a single missing tooth, fixed bridges amounted to 90% and removable partial dentures to 10%, as they did in the previous period. For two or more missing teeth, the use of fixed bridges was some what increased compared to the previous period. As in the previous report, the use of so-called one-tooth denture was most frequent for missing lower first molar. For bridges, the average number of missing teeth and that of abutment teeth were 1.3 and 2.4 respectively. Bridges for one missing tooth with two abutment teeth were most frequently used. For removable partial dentures, the average number of missing teeth and that of abutment teeth were 6.1 and 2.8 respectively. Removable partial dentures for two missing teeth with two abutment teeth were most frequently used. Full cast crowns were most frequently used for bridge retainers, followed by facing crowns. Facing crowns were used more than twice as frequently during this period as they were during the previous period.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

10.
OBJECTIVE: The purpose of this study was to determine the influence of the applied load on the handpiece, type of cooling agent, and type of tooth on surgical tooth dissection with a tapered crosscut fissure bur. STUDY DESIGN: Cutting studies were performed at handpiece loadings of 295 and 590 g through use of an oral surgery straight handpiece, tapered crosscut fissure burs, and an established cutting regimen. Extracted molars were dissected under irrigation with water, 0.9% saline solution, and lactated Ringer's solution at constant flow rates of 15 and 25 mL/min. Cutting efficiencies were analyzed by 1-way analysis of variance and Scheffé tests. RESULTS: No difference in cutting efficiency was found at low loads under irrigation with water or saline solution, but under irrigation with lactated Ringer's solution, a higher cutting efficiency was found (P < .05). There was no difference in cutting efficiency for lactated Ringer's solution and saline solution at high loads, but both cut more efficiently than water (P < .01). CONCLUSIONS: Saline solution is a useful coolant/irrigant for the dissection of teeth under most conditions, but lactated Ringer's solution might be beneficial with respect to cutting efficiency when lower handpiece loads are required.  相似文献   

11.
This article reviews the literature dealing with the combination implant-to-natural-tooth-supported fixed partial denture. The restoration of masticatory function with a combination implant-to-natural-tooth fixed partial denture is associated with a variety of undesirable clinical sequelae, including the breakage of implant components, damage to the abutment teeth, or intrusion of the abutment teeth. Theories regarding intrusion of abutment teeth combined with implants for fixed partial dentures are only speculative. Several theories are presented to explain the intrusion of natural teeth in association with implant-to-natural-tooth fixed partial dentures. One of the first theories was based on the idea that a lack of normal stimulation of the periodontal ligament produces atrophy of the periodontal ligament and intrusion of the tooth. The remaining theories relate to excessive forces being placed on the natural tooth, resulting in movement of the tooth to a less stressful position. These forces are placed on the tooth by differential energy dissipation, mandibular flexion and torsion, flexion of the fixed partial denture framework, impaired rebound memory, debris impaction or microjamming, or ratchet effect related to the use of precision attachments. Based a review of the literature, a philosophy for treating combination implant-to-natural-tooth restorations is presented.  相似文献   

12.
PURPOSE: The aim of this study was to examine the photographic and radiographic success of the treatment of maxillary anterior primary incisors with composite resin strip crowns (SCs) placed in a private-practice setting after a minimum of 18 months. METHODS: This was a retrospective, clinical study of patients who had SCs placed on primary maxillary incisors, returned for at least one 18-month recall examination, and whose parents consented to participate in the study. Radiographic and photographic examinations were used for evaluation. Two evaluators rated the images independently. RESULTS: One hundred forty-five restorations, placed in 52 children, were evaluated. The evaluations were performed after the crowns had been in place for an average of 31.3 months. None of the restorations were totally lost: 20% were rated as having lost some resin material, resulting in an 80% overall retention rate; 92% of the teeth demonstrated healthy pulps; 6% had some pulpal changes, but did not require immediate attention. Only 2 teeth showed radiographic evidence of pulpal pathology requiring treatment. CONCLUSIONS: SCs performed well for restoring primary incisors with large or multisurface caries for periods of over 3 years. This study suggests that SCs are likely to be successful and may be indicated as an excellent treatment choice for carious primary incisors with adequate tooth structure after caries removal, especially if esthetic concerns predominate.  相似文献   

13.
PURPOSE: The aim of our study was to explore the effects of different loading positions on the movements of the abutment tooth and denture base of removable partial denture with unilaterally designed framework (RPD-U). MATERIALS AND METHODS: The experiment was carried out with a simulation model of a mandible without left molars. The movements of abutment tooth and denture base of the unilateral and bilateral designs were due to 30N vertical load on 12 loading positions determined with a strain gauge circuitry. The effects of loading positions on the movements of the abutment tooth and denture base were compared between two designs. RESULTS: During the loading on buccal, lingual positions, and the most disto-central position the movements of the abutment tooth and denture base of the unilateral design were significantly greater than those of the bilateral design (P < 0.01). During the loading on the three mesio-central positions the movements of the abutment tooth and denture base were equal between designs, and were significantly lower than during the loading on the other positions (P < 0.01). CONCLUSION: Ending the denture teeth at the mesial cusp of second molar and positioning the occlusal contacts over the ridge crest adequately stabilize the abutment tooth and denture base of RPD-U.  相似文献   

14.
分体桩在后牙固定桥修复中的应用   总被引:1,自引:0,他引:1  
目的 探讨分体桩在后牙固定桥修复中的应用及操作程序。方法 对21例牙列缺损患者进行后牙固定桥修复,一侧磨牙残根残冠进行分体桩修复作为基牙。沿磨牙根管方向进行预备,按临床修复常规完成固定桥基牙牙体预备,用硅橡胶结合注射器取模,分别制作后牙固定桥和分体桩。结果 随访6~23个月,25例患者均未出现基牙松动或牙根折裂。结论后牙固定桥基牙为磨牙残根、残冠,且患者颌间距离短时(小于3mm),可用分体桩修复取得理想的效果。  相似文献   

15.
A missing incisor or premolar tooth that requires a quick functional and esthetic repair, such as the case of tooth loss caused by trauma needs quick conservative treatment to maintain sound abutment teeth. The use of resin composite for direct fixed partial denture (FPD) can reduce problems associated with metal substructures, such as esthetic limitations and preparation of abutment teeth. However, mechanical failure of direct FPD often occurs because of design limitations and poor fabrication. This case report describes a direct resin composite FPD combined with an orthodontic wire framework. A small enamel dimple was prepared below the contact area, and a U-shaped wire was formed and positioned in the prepared enamel dimples and bonded with resin cements. An alloy primer was applied to the surface of the wire, which was coated with adhesive resin and veneered with resin composite. The finishing of the margins and final polishing were completed a week after insertion. The FPD was contoured using fine composite diamond finishing burs and polished with silicone points. The combination of the U-shaped wire and an enamel dimple below the contact area has shown good results over a period of more than 12 months in these two cases.  相似文献   

16.
The pulpal response to mechanical exposure and capping either immediately or after 24 hours was investigated in 64 teeth of four cynomolgus monkeys with the use of Dycal, VLC Dycal, or Prisma-Bond. All overlying amalgam restorations were surface-sealed with zinc oxide-eugenol cement. After 2 months the teeth were removed and prepared for histologic examination; dentine bridges were present in almost all teeth filled with Dycal or VLC Dycal, and pulpal inflammation was observed in only one tooth that showed evidence of infection. Dentine bridges were usually incomplete when Prisma-Bond was used, although pulpal inflammation was only observed in 2 of 22 teeth. The success rate of pulp capping delayed for 24 hours was as high as that for immediate capping.  相似文献   

17.
目的:分析研究老年人可摘局部义齿修复后对基牙的影响,探讨其原因及预防措施。方法:对95例牙列缺失后的老年人行冷弯卡环固位式可摘局部义齿修复,记录和比较戴可摘局部义齿后基牙和非基牙的龋坏率和缺失率,用χ2检验分析其结果有无差异,并对影响基牙的原因进行分析。结果:戴用可摘局部义齿5a后,基牙的患龋率(17.38%)显著高于非基牙(7.10%);因牙折、牙周病松动及龋坏无法保留而拔除的基牙缺失率(27.01%)也显著高于非基牙(7.79%)(P<0.01)。结论:冷弯卡环固位可摘局部义齿修复后在一定程度上可增加老年人基牙的患龋率和缺失率。  相似文献   

18.
铸造多根桩修复磨牙大面积缺损的临床观察   总被引:3,自引:1,他引:2  
刘根娣  孙永瀛 《口腔医学》2004,24(3):159-160
目的 观察用铸造多根桩修复牙体大面积缺损或全缺损的磨牙临床效果。方法 对牙周组织健康、牙根形态正常、根管充填基本到位、牙体广泛缺损或全缺损的磨牙 ,按牙冠缺损的程度 ,用金刚砂车针制备根管 ,制作塑料根桩 ,预备核外型 ,取模、包埋 ,铸造桩核 ,制作全冠。结果 治疗 2 98例患者 ,共 331颗牙 ,通过 1~ 6年的临床随访观察 ,2 97颗牙修复体完好 ,咀嚼功能良好 ,治愈率达 98.8%。结论 以铸造多根桩修复大面积缺损或全缺损的磨牙 ,有利于恢复患者的咀嚼功能。  相似文献   

19.
The aim of the study was to make a direct comparison of the pulpal effects of laser and turbine preparations in subhuman primates. One female baboon (Papio Ursinus ursinus), weighing 15 kg, was used. General anaesthesia was administered (ketamine 100 mg/ml/kg body weight) and maintained with acepromazine (10 mg/ml/kg body weight). Class V cavities were prepared buccally in a total of 28 teeth (7 in each quadrant). Teeth in the upper right and lower left quadrants were prepared using a conventional 330 carbide bur in a high-speed fibre-optic handpiece with copious water spray. Teeth in the upper left and lower right quadrants were prepared using an Er:YAG laser drill (Fotona Twinlight, Llubljana, Slovenia) delivering 500 mJ at a pulse rate of 10 Hz and a wavelength of 2940 nm. The animal was sacrificed after 25 days. After general anaesthesia as described before, perfusion fixation of the head was accomplished with 10% neutral buffered formalin, pumped through a catheter inserted into the left carotid artery. The jaws were removed and, using a 330 carbide bur in a high speed handpiece, a continuous groove was cut through the bone and the roots at the level of the middle third of all the roots to promote thorough fixation of pulpal tissue. Decalcification and grading of the severity of the pulpal responses were conducted according to standard procedures. RESULTS: Owing to procedural errors seven teeth, FDI numbers 23, 24, 31, 34, 35, 44 and 45, had to be eliminated. The turbine-prepared teeth (N = 11) had a mean remaining dentine thickness (RDT) of 0.77 mm (SD = 0.42) and the laser-prepared teeth (N = 10) had a mean RDT of 0.81 mm (SD = 0.60). All pulps appeared normal except in one turbine-prepared tooth (12 with RDT = 0.20) and one laser-prepared tooth (27 with RDT = 0.30, where irreversible damage was caused. The only other deviations from normal were seen in the laser-treated 41 (RDT = 0.69) and the turbine-treated 36 (RDT = 0.77) where moderate hyperaemia was seen. Within the limitations of this study it can be concluded that there is no significant difference between dental pulp of teeth where Class V cavities were prepared with an Er:YAG laser drill compared with those prepared with a standard turbine drill.  相似文献   

20.
Occlusal force distribution in lower complete overdentures   总被引:1,自引:0,他引:1  
A space between the denture base and a root cap can effectively control the distribution ratio of occlusal force to abutment teeth and an alveolar ridge. The purpose of this study on abutments was to analyse the effect of variation in space (0 mm (no space), 0.3 mm and 0.6 mm) on the above ratio. Six subjects, 38-65 years of age, each with an edentulous maxilla and several teeth remaining in the mandible, were selected for this experiment. The lower experimental denture had embedded a transducer which could detect a change in the vertical force applied to the experimental tooth. This transducer was capable of changing the vertical space between a denture base and an experimental tooth. Each subject was asked to increase the occlusal force applied to the denture from zero to the maximum loading rate of 5 kgf s-1. The occlusal force and the force exerted on the experimental tooth were recorded in each space 1 month after insertion of new dentures. The following results were obtained: (i) when the occlusal force was applied to the artificial tooth just above the abutment tooth, the mean ratio in the 0 mm space was 60% of the force applied to the denture, the ratio in the 0.3 mm space was 50%, and the ratio in the 0.6 mm space was 30%; (ii) if the occlusal force was applied to the point 10 mm distant from the point just above the experimental tooth, the magnitude of the ratio was decreased by 60-80%.  相似文献   

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