Effect of selective enamel etching on clinical performance of CAD/CAM partial ceramic crowns luted with a self-adhesive resin cement

Objectives

This study was conducted to evaluate a self-adhesive resin luting cement [RelyX Unicem 3MESPE–RXU] for luting partial ceramic crowns (PCCs) with and without selective enamel etching in a prospective, randomized clinical trial.

Materials and methods

Thirty-four patients had received the intended treatment. Two PCCs (Vita Mark II; Cerec 3D; Sirona) had been placed in a split-mouth design: one with RXU without enamel etching (RXU), the other with RXU with selective enamel etching (RXU?+?E). Restorations were evaluated at baseline (BL) and after 12, 24, and 36 months (USPHS criteria). For statistical analysis, the Chi-square test was applied (α?=?0.05). Clinical survival of all restorations (n?=?68) after 3 years was determined using Kaplan–Meier analysis.

Results

Twenty three patients (12 male/11 female) were available for clinical evaluation after 3 years. 19 RXU-PCCs were placed in molars, four in premolars, 18 RXU?+?E–PCCs in molars, five in premolars. Concerning clinical changes, no significant differences were found between luting strategies RXU/RXU?+?E at all recalls. Statistically significant changes over time were observed for marginal adaptation and marginal discoloration between BL and 36 m for RXU and RXU?+?E. For RXU?+?E, postoperative hypersensitivities decreased significantly from BL (n?=?6) to 36 m (n?=?0). Of the 68 restorations originally included, eight RXU and four RXU?+?E restorations failed. At 3 years, Kaplan–Meier survival of RXU was 72.9 %, that of RXU?+?E 87.6 %. Survival rates were not statistically significant different.

Conclusions

Although clinical survival of RXU?+?E is slightly better at 3 years, restorations of both groups perform similar with respect to clinical changes over time as evaluated by modified USPHS criteria.

Clinical relevance

The self-adhesive resin cement RXU can be used in conjunction with selective enamel etching, because survival rates of PCCs in the RXU?+?E group were not lower but, as a trend, even better than without enamel etching.     

Sirolimus-Eluting Versus Bare-Metal Stents for the Reduction of Coronary Restenosis

PURPOSE: The GERSHWIN study (German Stent Health Outcome and Economics Within Normal Practice) was designed to evaluate long-term effects of treatment of coronary artery disease (CAD) with sirolimus-eluting stents (SES), as compared to bare-metal stents (BMS). PATIENTS AND METHODS: Within a multicenter, prospective intervention study in 35 hospitals throughout Germany, CAD patients with coronary stenosis and elective percutaneous coronary intervention (PCI) indication were treated either with SES or BMS (sequential control design with a case-to-control ratio of 2 : 1). Standardized questionnaires were completed by patients and their physicians at baseline, 3, 6, 12, and 18 months following PCI to document re-PCI for restenosis, myocardial infarction (MI), coronary bypass surgery (CABG), and death. Angiographic PCI documentation was evaluated by an independent expert. RESULTS: From April 2003 until June 2005, 658 patients were treated with SES (mean age 63 +/- 9 years, 87% male) and 294 patients with BMS (mean age 64 +/- 10 years, 79% male). Significant baseline differences were found by age, gender, household status, three vessel disease, and number of implanted stents. After 18 months, 8% of the SES versus 17% of the BMS group had undergone target vessel revascularization (p adjusted < 0.0001). There were no significant differences between BMS and SES regarding MI, CABG, or death. Re-PCI of target and new non-target vessel lesions was performed at a significantly lower degree of stenosis in SES than in BMS. CONCLUSION: Compared to patients with BMS, patients with implantation of SES experienced considerably fewer target vessel revascularizations. The threshold to perform re-PCI appeared lower in SES than in BMS. An extended evaluation of the effects of SES will be available from the 3-year follow-up of the GERSHWIN study.     

Intima-media thickness predicts stroke risk in the Heinz Nixdorf Recall study in association with vascular risk factors, age and gender

Background and purposeIndividual risk stratification requires reliable information on preexisting vascular disease. The intima-media thickness of the common carotid artery (CIMT) is a non-invasively accessible marker of atherosclerosis, which can be used for risk evaluation.MethodsIn a sample of 3669 initially stroke-free subjects aged 45–75 years belonging to the population-based Heinz Nixdorf Recall cohort, the predictive value of CIMT for incident stroke was evaluated over 85.3 ± 17.4 months in addition to established risk factors.ResultsIn a multivariable Cox regression analysis with traditional cardiovascular risk factors including age, gender, systolic blood pressure, LDL and HDL, diabetes, body mass index, smoking and CIMT, CIMT was a moderate stroke predictor (hazard ratio = 1.20 per 0.1 mm, 95% confidence interval = 1.01–1.44; p = 0.043), additional to e.g. age (1.46 per 5 years, 1.21–1.75; p < 0.001), systolic blood pressure (1.16 per 10 mm Hg, 1.04–1.30; p = 0.008) and current smoking (1.93, 1.12–3.31; p = 0.014). CIMT was associated with stroke risk in subjects above but not below 65 years. CIMT predicted stroke events in men, but not women. CIMT discriminated stroke incidence specifically in subjects belonging to the highest Framingham risk score tercile.ConclusionsCIMT is a moderate independent stroke predictor, which discriminates stroke incidence in subjects at high vascular risk.     

The significance of postprocedural aortic regurgitation after transcatheter aortic valve implantation on postprocedural prognosis

Transcatheter aortic valve implantation (TAVI) is becoming a more and more important treatment for aortic valve stenosis in high-risk surgical patients. Furthermore, there currently is a discussion for the expansion of TAVI to intermediate-risk patients. In the past, surgical aortic valve replacement was the standard treatment, with excellent results in hemodynamic, as well as echocardiographic parameters and survival rates. However, the results of the Partner A and Partner B trials, as well as the ADVANCE study demonstrate the promise of establishing TAVI as a real alternative treatment option for aortic valve stenosis. One of the risks of a TAVI procedure is the occurrence of aortic regurgitation (AR) post-TAVI. Mild AR is a common finding after TAVI and seems not to be a clinical problem; however, occurrence of significant postprocedural AR after TAVI is still a problem. There is a clear association between significant postprocedural AR and clinical outcomes. Therefore, this review focuses on the occurrence, reasons, diagnostics, clinical impact and treatment options of AR post-TAVI.     

Radiographic Bone Loss and Its Relation to Patient-Specific Risk Factors,LDL Cholesterol,and Vitamin D: A Cross-Sectional Study

The influence of patient-specific factors such as medical conditions, low-density lipoprotein cholesterol (LDL-C) or levels of 25-hydroxyvitamin D (25OHD) on periodontal diseases is frequently discussed in the literature. Therefore, the aim of this retrospective cross-sectional study was to evaluate potential associations between radiographic bone loss (RBL) and patient-specific risk factors, particularly LDL-C and 25OHD levels. Patients from a dental practice, who received full-mouth cone beam CTs (CBCTs) and blood-sampling in the course of implant treatment planning, were included in this study. RBL was determined at six sites per tooth from CBCT data. LDL-C and 25OHD levels were measured from venous blood samples. Other patient-specific risk factors were assessed based on anamnesis and dental charts. Statistical analysis was performed applying non-parametric procedures (Mann–Whitney U tests, error rates method). Data from 163 patients could be included in the analysis. RBL was significantly higher in male patients, older age groups, smokers, patients with high DMFT (decayed/missing/filled teeth) score, lower number of teeth, and high LDL-C levels (≥160 mg/dL). Furthermore, patients with high 25OHD levels (≥40 ng/mL) exhibited significantly less RBL. In summary, RBL was found to be associated with known patient-specific markers, particularly with age and high LDL-C levels.