Chair Time Research Articles

Biocompatibility and biofilm formation on conventional and CAD/CAM provisional implant restorations

Dental implant treatment is a complex and sophisticated process, and implant provisional restorations play a vital role in ensuring its success. The advent of computer-aided design and computer-aided manufacturing (CAD/CAM) technology has revolutionized the field of implant restorations by providing improved precision leading to a reduction in chair time and more predictable treatment outcomes. This technology offers a promising solution to the drawbacks of conventional methods and has the potential to transform the way implant procedures are approached. Despite the clear advantages of CAD/CAM over conventional provisional implant restorations including higher accuracy of fit and superior mechanical properties, little research has been conducted on the biological aspect of these novel restorations. This study aims to fill that gap, comprehensively assessing the biocompatibility, gingival tissue attachment and biofilm formation of a range of provisional implant restorations using CAD/CAM technology through milling and 3-D printing processes compared to conventional fabrication. The biocompatibility of the tested restorations was assessed by MTT assay, Calcein-AM assay as well as SEM analysis. The surface roughness of the tested samples was evaluated, alongside the attachment of Human Gingival Fibroblasts (HGF) cells as well as biofilm formation, and estimated Porphyromonas gingivalis (P. gingivalis) cell count from DNA detection.The results showed all tested provisional implant restorations were non-toxic and good HGF cell attachment but differed in their quantity of biofilm formation, with surface texture influenced by the material and fabrication technique, playing a role. Within the limitation of this study, the findings suggest that CAD/CAM-fabricated provisional implant restorations using a milling technique may be the most favourable among tested groups in terms of biocompatibility and periodontal-related biofilm formation.

Framework for fiscal impact analysis of managing initial caries lesions with noninvasive therapies

BackgroundEvidence-based noninvasive caries therapies for initial caries lesions are available in the United States. Fundamental differences between noninvasive therapies and the traditional surgical dental approach warrant a study of the financial scalability. MethodsThe financial costs and benefits of fee-for-service clinics and payors were compared across 11 scenarios simulating the treatment of 1,000 initial caries lesions during a 3-year period. The scenarios included varying combinations of noninvasive therapies (that is, silver diamine fluoride, self-assembling peptide P11-4, and glass ionomer therapeutic sealants), no treatment, and various rates of 1- through 3-surface restorations to an estimated 2022 practice model. We used a decision tree microsimulation model for deterministic and probabilistic sensitivity analyses. We derived assumptions from an initial lesion and noninvasive therapy–focused cohort study with operations data from 16 sites accepting Medicaid in Alabama as a case study and clinical data from all 92 sites. ResultsIn comparison with the 2022 practice model assumed for this study, scenarios that produce mutually beneficial results for payors’ savings and clinics’ net profits and profit margins include self-assembling peptide P11-4, silver diamine fluoride on nonesthetic surfaces, and a mix of 3 noninvasive therapies. When considering the limited resources of chair and clinician time, the same scenarios, as well as silver diamine fluoride with restorations, emerged with substantially higher clinic net profit. ConclusionsHypothetical scenarios that include noninvasive therapies and minimize restorations achieve improved outcomes for all parties. Practical ImplicationsPayors and clinicians should explore and implement noninvasive caries therapies to improve oral health for all. This study was registered at ClinicalTrials.gov. The registration number is NCT04933331.

Enamel Matrix Derivative (EMD) as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review.

If left untreated, periodontitis is a chronic, irreversible disease that can contribute to tooth loss. The primary objective of periodontal treatment is to arrest the progression of the disease and restore the supporting structures of the tooth. Scaling and root planing (SRP) is a common non-surgical periodontal therapy (NSPT) used to reduce inflammation, pocket depth, and clinical attachment loss. However, NSPT has limitations, notably in difficult-to-access deep pockets and molar furcations. Deep pockets (greater than 4 mm) frequently retain calculus following NSPT. To attain direct access, surgical periodontal therapy (SPT) is recommended, particularly for pockets deeper than 5 mm. Enamel matrix derivative (EMD) has emerged in recent years as a tool for periodontal regeneration when used in conjunction with NSP for infrabony defects. EMD may also have advantageous effects when combined with NSPT. The purpose of this review is to provide a thorough understanding of the effects of EMD as an adjunct to NSPT. The databases Scopus, PubMed/MEDLINE, Google Scholar, Cochrane, and Embase were systematically searched to identify relevant studies on the benefits of EMD and its use as an adjunct to NSPT. Incorporating EMD into NSPT reduces chair time, and 60% of studies demonstrated considerable benefits compared to SRP alone, according to the findings. On the basis of research, it can be concluded that EMD can be used as an adjunct to NSPT, thereby reducing the amount of time spent in the operating chair. In some cases, it can, therefore, be regarded as an alternative to surgical treatment.

Improving Utilization of the Chemotherapy Unit through Implementing the Medication Early Release Project.

The outpatient oncology infusion unit is very busy, serving 60 to 70 patients per day. Due to a limited number of nurses, treatment chairs, only one pharmacy hood for bio-hazardous drug preparation, and other factors, patients wait a long time before starting their treatment, which affects the patient experience negatively. We conducted a quality improvement project to reduce the waiting time before starting the treatment, improve the patients' experience, and allow the unit to work more effectively through better resource utilization and accommodating more patients. A committee was formed with representatives from oncology nursing and the quality specialist, chemotherapy pharmacy supervisor, data manager, and a medical consultant (team leader). We studied baseline data of patient waiting times from January to March 2019 and the factors that contributed to delays before starting the treatment. The charge nurse identified patients who could safely have their medication released early in the morning at 7 am, enabling the pharmacy to dispense at 8 am without their actual presence being required in the infusion suite (i.e., medication early release program or MERP). Multiple plan-do-study-act (PDSA) cycles were implemented to achieve a wait time from check-in to medication administration of less than 60 minutes. Data collected included check-in time, chair time, vital signs time, administration time, and discharge time. Additionally, reasons for drug wastage were assessed for patients who did not receive the prepared medication. A patient satisfaction survey was conducted with the patients before and after being enrolled in the program. At baseline, average waiting time for patients receiving similar medications in the MERP was 2 hours and 27 minutes. After the first intervention, average waiting time was reduced to 1 hour and 24 minutes, and small improvements were observed after each PDSA cycl. A major breakthrough occurred after an intensive patient education program and enforcement of strict compliance with the criteria in selecting the patients appropriate for theMERP. Average waiting time wasreduced to ≤ 60 minutes, and in November 2022, it was 30 minutes on average. Drug wastage was identified as a balancing measure. We were successful in reducing drug wastage by implementing several changes and patient education measures and achieved zero wastage. The patient satisfaction survey showed better satisfaction with the new changes. A positive impact was achieved in this quality improvement project, with a significant reduction in the average waiting time for patients to start receiving chemotherapy. The outcome of this project has been maintained for 4 years and is still ongoing.

CAD-CAM and analog occlusal splints comparison based on the amount of occlusal adjustments. 3D analysis of the volumetric changes: A pilot study.

To evaluate the volumetric changes on occlusal surface of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices fabricated following a fully digital workflow after occlusal adjustment, compared to those fabricated with an analog workflow. Eight participants were included in this clinical pilot study, receiving two different occlusal devices fabricated with two different workflows, fully analog and fully digital. Every occlusal device was scanned before and after the occlusal adjustments to compare the volumetric changes using a reverse engineering software program. Moreover, three independent evaluators assessed a semi-quantitative and qualitative comparison using visual analog scale and dichotomous evaluation. The Shapiro-Wilk test was performed to validate normal distribution assumption, and a dependent t-Student test for paired variables was used to determine statistically significant differences (p-value < 0.05). The root mean square value was extracted from the 3-Dimensional (3D) analysis of the occlusal devices. The average values of the root mean square were higher for the analogic technique (0.23 ± 0.10 mm) than the digital technique (0.14 ± 0.07 mm) but the differences were not statistically significant (paired t-Student test; p = 0.106) between the two fabrication techniques. The semiquantitative visual analog scale values between the impression for the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) technique were significant (p < 0.001), and statistically significant differences values were assessed for evaluator 3 compared to the other evaluators (p < 0.05). However, the three evaluators agreed on the qualitative dichotomous evaluation in 62% of the cases, and at least two evaluators agreed in 100% of the evaluations. Occlusal devices fabricated following a fully digital workflow resulted in fewer occlusal adjustments, as they could be a valid alternative to those fabricated following an analog workflow. Fabricated occlusal devices following a fully digital workflow could have some advantages over analog workflow such reduce occlusal adjustments at delivery appointment, which can result in reduced chair time and therefore increased comfort for the patient and clinician.

A Phase II, Open-Label Study of an Accelerated Infusion Rate of Daratumumab in Patients With Relapsed and Refractory Multiple Myeloma.

Daratumumab is an anti-CD38 monoclonal antibody initially approved as a single agent for the treatment of relapsed and refractory multiple myeloma. The infusion-related reactions (IRRs) commonly seen with intravenous daratumumab have been managed by prolonging the first infusion, temporarily stopping/slowing the rate if reactions occur and using adequate pre- and post-infusion medications. Several retrospective studies have evaluated shorter infusions after ≥ 2 prior doses administered at the standard rates. Although the shorter infusions were well-tolerated, patients in these reports were given heterogeneous daratumumab regimens and had often already received multiple doses at the longer standard rates. CMRG-009 is a prospective study designed to demonstrate the safety of accelerated daratumumab infusions commencing with the second dose. After an initial dose on Cycle 1 Day consisting of 8 mg/kg over 4 hours, all subsequent doses were given over 90 minutes. No grade 3 IRRs were observed with the 90-minutes infusions. Both the safety profile and anti-myeloma effects were otherwise similar to those observed with other single agent daratumumab studies using longer infusion times. This is the first formal prospective trial using infusion times shorter than the standard schedule directly after an initial 4-hours dose. This rapid infusion protocol has resulted in more efficient resource utilization and has become the standard protocol for the use in all intravenous daratumumab regimens in Canada. This approach has been particularly helpful in shortening chair time during the COVID-19 pandemic and providing a useful alternative in jurisdictions without access to subcutaneous daratumumab.

Practice efficiency of treatment with epcoritamab versus glofitamab in relapsed/refractory diffuse large B-cell lymphoma.

e18919 Background: Bispecific antibodies are an emerging class of immunotherapies with demonstrated efficacy in the treatment of relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). Since epcoritamab is administered subcutaneously, it provides an opportunity for reduced healthcare provider (HCP) and patient burden compared to intravenous (IV) glofitamab. This study assessed HCP and chair time saved treating R/R DLBCL patients with epcoritamab versus glofitamab. Methods: An efficiency model was developed to comprehensively capture time and resources utilized in the administration of epcoritamab and glofitamab from the perspective of institutional decision makers in the United States. The model was informed by the administration process and dosing schedules outlined in the pivotal publications as well as published literature examining HCP’s tasks and the time required to complete these tasks. A 6-month time horizon as was adopted as the base case due to its relevance in the Enhancing Oncology Model, and scenario analyses were performed examining various time horizons. Results: Treating patients with SC epcoritamab compared to IV glofitamab was estimated to reduce HCP time by 29% (45.4 hours for 19 doses of epcoritamab vs. 63.9 hours for 10 doses of glofitamab) and chair time by 38% (55.8 vs. 90.6 hours) per patient over a 6-month time horizon. Time saved for epcoritamab was mainly driven by glofitamab’s infusion time and required pre-treatment with obinutuzumab. For 100 hypothetical patients treated with SC epcoritamab vs. IV glofitamab, a savings of 3,478 chair hours was generated, which could free up capacity to treat 62 additional patients. In the scenario analyses examining different time horizons, the capacity savings advantage of epcoritamab over glofitamab remained. Conclusions: In this model, the use of SC epcoritamab improved practice efficiency compared to IV glofitamab. For institutional decision makers, reduced chair time may increase the total number of treated patients and lead to reduced waiting lists.

Evaluation of the Flash-Free Adhesive System for a 6-month Period: A Split-Mouth Trial.

To compare the adhesive pre-coated (APC) flash-free (FF) appliance system (3M Unitek) with an operator-coated (OC) system (Transbond XT Light Cure Adhesive Paste; 3M Unitek) in terms of bond failure, bracket survival, and chair time. This single-center study was planned with 30 non-extraction patients, 22 females and 8 males with an average age of 17 years and 5 months. A split-mouth design was used, and bonding time, failed brackets, reasons for failure, and adhesive remnant index (ARI) scores were noted. The data were analyzed with the chi-square, Kaplan-Meier, log-rank, and Mann-Whitney U tests. OC and FF adhesive-coated brackets demonstrated bond failure rates of 0.7% and 3.0%, respectively. Failure rates and survival rates presented a statistically significant difference (p=0.033). Although higher bond failure for the lower arch along with higher bond failure for the incisor teeth compared with the premolar teeth were found, these findings were not statistically significant (p=0.128; p=0.261, respectively). The effect of gender on the bond failure rate (p=0.463) and survival rate (p=0.473) was not statistically significant. A significant difference was obtained for the ARI scores (p=0.011). The bonding time for each bracket type (64.43 seconds for FF versus 98.97 seconds for OC) demonstrated a significant difference (p=0.174). The bond failure rate was higher for the FF APC brackets, but the chair time reduction during bonding was recorded. Therefore, it seems that FF APC brackets are promising. Trial registration: ISRCTNand ISRCTN26731749. Registered October 7, 2020-Retrospectively registered, https://doi.org/10.1186/ISRCTN26731749.

Subcutaneous versus endovenous trastuzumab: Real world data from a reference cancer center in Peru.

e12527 Background: HER2 receptor amplification/overexpression is identified in approximately 20% of invasive breast neoplasms; it is characterized by biologically aggressive behavior and worse prognosis compared to HER2-negative tumors. Trastuzumab, a humanized monoclonal antibody, was approved for therapeutic use in HER2-positive breast cancer. The objective of this study is to compare the acquisition costs, costs, and preparation and application times of trastuzumab presentations. Methods: Descriptive and retrospective study in female patients aged 18 years and older with a diagnosis of HER 2 positive early breast cancer who received subcutaneous or intravenous trastuzumab during the years 2019-2021. The study setting was the National Institute of Neoplastic Diseases (INEN)- Lima/Peru. We created a simple spreadsheet model to evaluate costs (expressed in soles). The analysis included the calculation of patient time in the chemotherapy chair, preparation time and treatment administration time. Results: The cost of the subcutaneous presentation was S/4212 and S/4348 for the intravenous presentation. The cost of the complete treatment was S/75816 for the subcutaneous presentation and S/82612 for the intravenous presentation. The cost of the supplies used in the preparation of 18 cycles of treatment for the subcutaneous presentation was S/ 20.7 and for the intravenous presentation S/ 399.96; likewise, the cost of the supplies used in the administration of 18 cycles of treatment for subcutaneous trastuzumab was S/ 34.02 and for the intravenous presentation was S/ 1094.4. The cost of using a chemotherapy chair for 18 cycles for subcutaneous presentation was S/36 and for intravenous presentation S/663. The time used in the application of 1 cycle of subcutaneous presentation was 30 minutes for the first application and 15 minutes for subsequent applications; the time used in the application of each cycle for endovenous presentation was 6 hours for the first application and 2 hours for subsequent applications. The administration of 18 cycles for subcutaneous presentation was S/ 732.45 and for intravenous presentation S/ 6168. The trastuzumab formulation for subcutaneous application is a ready-to-use solution, so it did not generate preparation costs. The preparation time for one cycle of intravenous presentation was 15 minutes and meant an investment of S/693.90 for the preparation of 18 cycles (cost of preparation personnel time). Conclusions: The use of subcutaneous trastuzumab generates less costs associated with an overall savings of 16.36%, its use implies less time for preparation and application, as well as a reduction in patient chair time. These time reductions translate into economic savings, a more efficient use of resources and a reduction in waiting time for appointments in the chemotherapy service and a greater capacity of the oncology service to treat a greater number of patients.

More Than Meets the Eye Evaluating Non-Organic Vision Loss

Non-organic vision loss (NOVL), referred to as “functional vision loss” in the literature, is defined as a decrease in either visual acuity or field of vision without an identifiable underlying organic etiology.1,2 Suspected NOVL requires extensive chair time, increased hands-on care, and reassurance with the patient. NOVL has been found to accompany other organic causes in about 15% of cases.3, 4 A diagnosis of NOVL should be made only after other organic causes of visual loss are ruled out. This may require multiple tests of each part of the visual pathway – many of which are subjective based on patient responses and may therefore yield inconclusive or conflicting results.

One-Step Surface-Treatment Reagent (35% 3-O-Ethyl-l-ascorbic Acid Plus 50% Citric Acid Solution) Restores the Shear Bond Strength of Metal Brackets Bonded to Bleached Human Enamel: An In Vitro Study.

This study investigates how a new substance, composed of ethyl ascorbic acid and citric acid, affects the shear bond strength (SBS) of metal brackets when bonded to bleached teeth. Forty maxillary premolar teeth were used and randomly placed into four groups (n = 10): the control group did not undergo bleaching; the remaining groups underwent bleached using 35% hydrogen peroxide. In group A, 37% phosphoric acid was applied after bleaching. In group B, 10% sodium ascorbate was used for ten minutes before 37% phosphoric acid. In group C, 35%3-O-ethyl-l-ascorbic acid plus 50% citric acid solution (35EA/50CA) was applied for 5 min. The subgroups were bonded immediately after bleaching. The SBS was determined with a universal testing machine and analyzed using one-way ANOVA and then Tukey's HSD tests. Adhesive remnant index (ARI) scores were determined with a stereomicroscope and analyzed with a chi-squared test. The significance level was 0.05. Group C demonstrated significantly higher SBS values than group A (p < 0.001), but was not significantly different than the control group or group C (p > 0.05). The ARI scores were significantly different among the groups (p < 0.001). In conclusion, enamel surface treatment using 35EA/50CA improved the reduced SBS to an acceptable clinical level and reduced the clinical chair time.

Guide and tools for comprehensive toric soft contact lens fitting

Contact lens options for astigmatic patients include commercially available toric soft contact lenses, custom soft contact lenses, rigid corneal and scleral contact lenses. Wide range of parameters and modalities of modern soft toric lenses covers more than 90 % of patients with astigmatism. It makes toric soft contact lenses most available and convenient option for eyecare specialists.Purpose of this publication is to review main steps of toric lens fitting and remind ECP about useful tools and services designed to reduce chair time.

Clinician perspectives on implementation of digitally fabricated complete dentures: A national survey of prosthodontists

Statement of problemResearch on implementation factors for digitally fabricated complete dentures is sparse. PurposeThe purpose of this survey of prosthodontists was to explore the current usage of conventionally and digitally fabricated complete dentures and to identify factors that may impact their use. Material and methodsA confidential cross-sectional survey consisting of 20 questions was conducted in 2019 using the Qualtrics Research Suite. The survey was distributed via electronic mail to all 1820 members of the American College of Prosthodontics. Frequency distributions, chi-squared tests, and Fisher exact tests were used to analyze the data and compare subgroups (α=.05). ResultsThe response rate was 16.8% (N=305). A total of 31.5% of respondents were implementing digitally fabricated complete dentures, 36.6% were interested in learning and/or incorporating them, 37.7% reported that they had not tried them, and 12.7% had tried them but were not interested in using them again. When asked which factors were important when considering the implementation of digitally fabricated complete dentures, 55.8% indicated laboratory costs, 72.1% total chair time spent, and 81.9% patient satisfaction. Prosthodontists who graduated from dental school after about 1991 were more interested in learning about and incorporating digitally fabricated complete dentures than earlier graduates (P=.02). ConclusionsThe survey results indicate that prosthodontists are implementing digitally fabricated complete dentures in clinical practice but not at the rate that might be expected of a technology that has been available for nearly a decade. Factors reported to matter in the decision to implement this technology were decreased time, overall cost, and improved patient satisfaction.

Patient-reported outcome measures (PROMs) of leucocyte and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial.

The aim of this study was to evaluate the patient's morbidity and post-surgical complications after treatment of palatal donor sites after free gingival graft (FGG) harvesting using Leucocyte-and Platelet Rich Fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. Forty-two palatal donar sites after FGG haversting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at palatal area, while the secondary outcomes were post-operative discomfort, inability to chew, post-operative stress, surgical chair time, thickness of palatal fibromucosa and thickness of FGG. The PROMs were recorded after one week. After one week, a statistically significant difference was found between groups in terms of post operative stress (p=0.0083). No statistically significant differences in terms of postoperative pain (p=0.326), patient discomfort (p=0.509), inability to chew (p=0.936), surgical chair time (p=0.932) were recorded between test and control group. No statistically significant differences were recorded in terms of thickness of palatal fibromucosa (p=0.647) and thickness of FGG (P=0.756) between groups. Post-surgical wound healing complications (i.e., necrosis or infections) were not observed in both groups. Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.

Clinical Administration Characteristics of Subcutaneous and Intravenous Administration of Daratumumab in Patients With Multiple Myeloma at Mayo Clinic Infusion Centers.

Median duration of daratumumab (DARA) administration for treatment of multiple myeloma is 3-7 hours for the intravenous formulation (DARA IV) and 3-5 minutes for the subcutaneous formulation (DARA SC). Here, we describe clinical administration characteristics of DARA using a novel method for data extraction from electronic health records. Time-based measurements were extracted using a scheduling/pharmacy software program that tracked patient movement through appointments for patients initiating DARA in Mayo Clinic infusion centers from April 5, 2017, to October 14, 2021. Cohorts included patients who received DARA IV or DARA SC, or converted from DARA IV to DARA SC. The DARA SC cohort was further analyzed before (DARA SC initial) and after (DARA SC shortened) a reduction in the postadministration observation time mandated by the treatment plan. Events associated with administration-related reactions (ARRs) were also identified. Median total clinic times were 2.7-3.0 hours shorter for DARA SC versus DARA IV. Median clinic times were highest at dose 1 and decreased with subsequent doses. Median total chair times were 2.7-2.8 hours shorter for DARA SC versus DARA IV. Incidences of ARR-related events with DARA SC were low across doses. Reduced clinic times were observed with DARA SC, indicating that use of DARA SC as a treatment option results in time savings that may free clinic resources. Furthermore, novel methods of electronic health record data extraction can provide insights that may help inform clinic resource optimization.

Semi-permanent Restorations Just Temporary or Long-lasting Use?: A Review of the Literature

In some clinical situations, using a provisional fixed restoration for an extended period of time is unavoidable. However, traditional materials are unable to withstand this, resulting in restoration fracture, which leads to repair and/or replacement as well as increased chair time and treatment costs. Many practitioners have been developing their protocols to improve physical properties and longevities of these restorations. Currently, many manufacturers have launched novel products and several fabrication techniques; some are claimed to be “semi-permanent restoration” with improved strength and survivability. The purpose of this review article is to assist clinicians to decide the most appropriate provisional restorative materials for long-term usage in complex treatment procedures, including fabrication and cementation techniques.

A literature review of clinical efficiency, patient satisfaction, and future preference of Isolite and DryShield dental isolation systems among pediatric patients.

This review aims to summarize and analyze previous studies that evaluated the clinical efficiency, patient satisfaction, and future preference of Isolite System Isolation (ISI) and DryShield System Isolation (DSI) and compare them to other forms of isolation during dental treatment in children. Both authors independently searched engines using the keywords "Isolite", "Vacuum", "DryShield" and their combinations in March 2022. The inclusion criteria included peer-reviewed articles written in English and clinical trials that assessed the clinical efficiency, patient satisfaction, and future preference of ISI or DSI during dental treatment on healthy unaffected children and compared it to other isolation systems such as rubber dam and cotton roll. A total of five articles were included, and data were extracted by both authors independently and compiled into one single table.Five clinical trials were identified. The use of both ISI and DSI systems is associated with more noise, requires less chair time, is more comfortable, and is preferred by more children than rubber dam or cotton ball isolation.The review reports promising results in clinical efficiency, patient satisfaction, and future preference for both Isolite and DryShield isolation systems. Both systems require less chair time and were preferred by pediatric patients for future dental treatment when compared to both rubber dam and cotton roll isolation systems. Less fluid leaking and gagging reflex were reported when compared to cotton roll isolation. When compared to rubber dam isolation, they were associated with less discomfort.

Effect of Surface Treatments on Adhesion of Milled Polyetheretherketone Post to Different Composite Resin Core Build-Up Materials.

To evaluate the effect of surface treatments on adhesion of milled PEEK post to two different composite resin core-build up materials. Six PEEK posts were divided into the following groups: G1: no treatment+ Grandio core material, G2: no treatment+ Bulk-fill core material, G3: 98% sulfuric acid for 60 seconds+ Grandio core material, G4: 98% sulfuric acid for 60 seconds+ Bulk-fill core material, G5: 50 μm airborne particle abraded + Grandio core material, G6: 50 μm airborne particle abraded + bulk fill core material. The adhesion of the post to core build-up materials was tested using micro push-out bond strength. Data were analyzed using ANOVA and Tukey's test. There was a significant effect for the surface treatment (p<.001), a non-significant effect for the core build-up materials (p<.289), and a significant effect for their interaction (p<.001) on the bond strength values. Within the limitation of this study, sulfuric acid etching group significantly increased the bond strength compared to other groups. Bulk-fill core material could be a feasible option when restoring ETT in terms of saving chair time and the treatment procedure simplicity. Key words:Bond Strength, Core material, PEEK, Surface Treatment.

Comparison of the morphology of the primary first molars and the forms of stainless steel crowns used in clinical practice.

This study aimed to assess the difference in the mesiodistal (MD) and buccolingual (BL) dimensions of primary first molars between Taiwanese boys and girls using a three-dimensional (3D) scanner (Microscribe G2 digitizer), record the coordinates in the 3D systems of Graph-R Project and reconstruct 3D images for subsequent analysis. We also determined whether the differences in these parameters between primary first molars and stainless steel crowns (SSC, 3M ESPE, No. 2-7) could be used as a reference for selecting a suitably-sized SSC and performing adjustments during restoration. The results indicated a statistically significant difference in the mesiodistal distance of lower primary first molar crowns between boys (7.75 ± 0.38 mm) and girls (7.41 ± 0.41 mm) (p < 0.05) but no differences in the mesiodistal distance of upper primary first molars between the two sexes. The mean mesiodistal distances of the upper and lower primary first molars of boys were close to SSC size 4 and 3, respectively, while those of girls were close to size 3 in both arches. Overall, the buccolingual distance between the first maxillary and mandibular molars of Taiwanese children was greater than the buccolingual distance between the 3M ESPE SSC. Reducing the buccolingual length of the abutment teeth might quickly help achieve a better fit, reduce chair time, and minimize patient discomfort. In addition, trimming the mesial and distal metal margins of SSCs might help reduce microleakage from the crown margins and improve its retention and survival rate. In conclusion, the 3D scanning and analysis method used in this study can serve as a reference for fabricating SSC to achieve better crown adaptation and improve dental procedures.

ENDOCROWN: A SUBSTITUTE APPROACH TO POST AND CORE FOR REHABILITATION OF ENDODONTICALLY TREATED TOOTH

Restoration of endodontically treated teeth (ETT) is distinct from root canal treatment although they are mutually dependent in planning, treatment and prognosis. The fabrication of full coverage crowns with or without the use of posts remains the long-established means of restoration of endodontically treated teeth. Despite all the clinical success achieved with intraradicular posts, they have been criticized for removal of sound tissue and risk of root perforation. With the amelioration of adhesive techniques and invention of newer materials, the concept of endocrown has been considered as an alternative and viable method for restoration of root canal treated molars. It is an indirect monoblock restoration aimed to achieve a bonded biomimetic reconstruction. The preparation is simple following minimally invasive principles of adhesive dentistry compared to conventional crowns with post and core. They have the advantage of removing lower amounts of sound tissue compared to other techniques, and with much lower chair time needed. Also, the masticatory stresses received at the tooth/ restoration interface are more properly dissipated along the overall restored tooth structure when endocrowns are placed. The rationale of the preparation was to use surface area available in the pulp chamber to gain stability and retention through adhesive cementation. The supragingival positioning of restorative margins prevents interferences with periodontal tissues. This article highlights a case report where a porcelain fused to metal endocrown is fabricated to effectively manage a grossly mutilated endodontically treated tooth and was followed up for one year.