Margin Contour Research Articles

Ultrasound morphology of invasive lobular breast cancer is different compared with other types of breast cancer

The aim of this study was to evaluate the ultrasound (US) morphology of invasive lobular breast carcinomas (ILC) in comparison to that of invasive tumors of other histologic differentiation (TOD). Images of 406 breast lesions were included in this retrospective study. A total of 10 US criteria (shape, orientation, echogenicity, echo pattern, calcifications, margin, margin contour, lesion boundary, surrounding tissue and posterior acoustic features) were defined and determined. Tumors were stratified into ILC ( n = 69) vs. TOD ( n = 337). The correlation between the sonographically and pathologically measured size of the tumors was analyzed. Irregular shape was found in 88% of ILC vs. 67% of TOD ( p < 0.001). Margins were indistinct in 94% of ILC compared to 76% of TOD ( p = 0.001). Posterior shadowing was observed in 84% of ILC and 58% of TOD ( p = 0.001). Irregular margin contour, hyper- or isoechoic pattern and architectural distortion were more frequent in ILC. Underestimation of tumor size by US was significantly more frequent in ILC (5.4 ± 12.2 mm) than in TOD (1.4 ± 12.0 mm) ( p = 0.015). In summary, we found that histologic differentiation significantly influences ultrasonographic appearance of breast cancer. The underestimation of tumor size of ILC might compromise the operative strategy. (E-mail: watermann@frk.ukl.uni-freiburg.de)

Ultrasound criteria for ductal invasive breast cancer are modified by age, tumor size, and axillary lymph node status

To evaluate the influence of distinct clinicopathological parameters on ultrasound criteria for ductal invasive breast cancer. The hardcopy prints of 337 ductal invasive breast cancers were analyzed. Ten ultrasound criteria (shape, orientation, echogenicity, echo pattern, calcifications, margin, margin contour, lesion boundary, surrounding tissue, and posterior acoustic features) were defined and correlated to age, tumor size, axillary lymph node status, and histological grading in a multivariate analysis. Tumors in women < or = 50 years displayed more often an indistinct margin (p = 0.003) and an enhanced/indifferent posterior ultrasound transmission (p = 0.008). Tumors in an advanced T-stage showed more frequently an irregular shape ( p = 0.006), an orientation parallel to the skin ( p = 0.01), hypoechogenicity ( p < 0.0001), and less often calcifications ( p = 0.002). A positive axillary lymph node status was significantly correlated to oval/round shape ( p = 0.004), hyper-/isoechogenicity ( p = 0.001), and a homogeneous echo pattern ( p = 0.002). Grading showed no correlation to the examined ultrasound criteria. Breast ultrasound criteria, which are used to differentiate benign from malignant breast lesions, are influenced by age, size and lymph node status. These clinical conditions should be considered in the ultrasound diagnosis of breast lesions.

Upper Quaternary deposits on the Sao Tomé deep-sea channel levee system (South Brazilian Basin): major turbidite versus contourite processes

This paper is an attempt to show how one may discriminate turbiditic and contouritic processes in the deposition of deep-sea accumulations. The case study is the Sao Tomé deep-sea ‘channel levee’ system in the South Brazilian Basin. This system is elongated parallel to the margin contour, and was first interpreted as being controlled by contour current activity. Detailed analyses of 3.5-kHz profiles and piston cores allowed to demonstrate that the Upper Quaternary sediments are predominantly deposited by turbidite and hemipelagic–pelagic sedimentation processes. On the levee and the transitional area towards the deeper rise, frequent fine-grained turbidites, accounting for 25–45% of the entire depositional series, are interbedded with the hemipelagic–pelagic muds. In the channel, thicker and coarser turbidites (15%) are associated with debris-flows (20%). Deposit deformation in the form of slides, slumps and diapir-like structures largely affect the distal transitional area. Slight evidence of contour current activity only consists of some sediment wave fields and manganiferous-rich layers or some top-truncated sequences and foraminiferal sandy layers.

Domestic and Foreign Sales When Prices in Both Markets are Uncertain

This paper obtains comparative static results for a firm that sells a single output domestically and abroad when prices in both markets are uncertain. Results are obtained for both constant absolute risk aversion and for Ross decreasing absolute risk aversion, using a diagrammatic analysis which exploits the properties of expected marginal utility contours. The results depend crucially on whether foreign and domestic sales are net substitutes or complements. The model is more complex and yields fewer unambiguous results – particularly in the case of substitutes – than when there is price uncertainty in only one market.

Composite veneered acrylic resin provisional restorations for complete veneer crowns

Restorations that are remade to improve esthetics, teeth with pronounced gingival-to-incisal color contrast, or high-value translucent teeth can limit the capability of shaded acrylic resin provisional restorations to satisfy the esthetic demands of certain patients. This article describes a procedure to incorporate a composite veneer in an acrylic resin provisional restoration. Improved optical properties of microfilled composite are combined with the excellent marginal seal and contour of acrylic resin. Precise control of color, translucency, and surface texture provide excellent interim esthetics and a better guide for the definitive prosthesis. (J Prosthet Dent 1999;82:515-7.)

Clinical evaluation of different adhesive systems for restoring teeth with erosion lesions

This investigation evaluated the performance of a resin-modified glass ionomer, a compomer, and a bonding system/composite combination for the restoration of cervical erosion lesions without cavity preparation. Forty-eight lesions (11 patients) were restored with a bonding agent/composite combination [Prime & Bond 2.1/PrismaTPH (P & B/TPH); DeTrey/Dentsply], a compomer (Dyract; DeTrey/Dentsply), or a light-curing glass ionomer (Fuji II LC; Fuji). The materials were randomly assigned to the patients in triplets. No cavity preparation was performed. The procedures strictly followed the manufacturers' instructions. The restorations were evaluated clinically, using modified USPHS criteria, and by quantitative scanning electron microscope (SEM) analysis, at baseline and 12 months. The clinical data were statistically evaluated with the Pearson chi-square test, the SEM data (criterion gap formation) were analyzed with the Mann-Whitney U-test and error rates method. Clinically, two restorations could not be evaluated. One Dyract restoration failed. With respect to marginal discoloration, recurrent caries and contour, no significant differences could be found between the materials. The surface texture of P & B/TPH and Dyract was significantly better than that of Fuji II LC at baseline and 12 months. Compared to P & B/TPH and Fuji II LC, Dyract revealed a significant decrease in marginal integrity between baseline and 12 months. In SEM analysis, gap formation was determined as follows: baseline, enamel interface: 4% Dyract= 4% Fuji >2% P & B/TPH and dentin interface: 11% Dyract >9% P & B/TPH >2% Fuji; 12 months, enamel interface: 15% Dyract >4% Fuji >3% P & B/TPH and dentin interface: 11% P & B/TPH >6% Fuji >5% Dyract. The error rates method revealed no significant differences, in general, between the three materials with regard to gap formation. In conclusion, the restorations of erosion lesions with different classes of adhesive materials were well retained after 12 months. None of the materials studied revealed superiority over the other materials. All materials revealed shortcomings with respect to either surface texture, marginal integrity or color stability clinically and for all materials gap formation was recorded in the SEM evaluation.

Dentin bonding system. Part I: Literature review

Currently, clinicians face choices of restoration including amalgams (mercury-based, gallium-based alloys, or mercury-free silver-based substitutes), composite resins, ceramics, and gold alloy. In order to choose an appropriate restorative material, many parameters are involved; they include preparation time requirements, finishing and polishing, marginal integrity, anatomy and contours, chipping and fracture, sensitivity, microleakage, wear resistance, and corrosion resistance. It is generally believed that amalgams are still evaluated as the best of all restorative materials as far as the aforementioned parameters are concerned. It is claimed that the amalgams exhibit in the range of 10 to 25 service years, while the composite resin exhibits ranging between 7 and 11 service years. When a composite resin requires a mass large enough for indirect fabrication, a bonding system is demanded with which this restoration should form an instantaneous, impervious, and stable bond to the tooth structure. Roughly a quarter century has passed since the research and development of a promising dentin bonding system was initiated. We are now in the fifth generation of the dentin bonding system, during the research and development of which various types of bonding agents as well as bonding models have been introduced. In this article, the history of development of the bonding agents and the understanding of the bonding mechanism will be reviewed.

Transconjunctival Lower Eyelid Blepharoplasty

Although transconjunctival lower eyelid blepharoplasty was described as far back as 1924 and it offers certain advantages over the skin-muscle flap, many surgeons continue to use the transcutaneous approach. This is likely due to unfamiliarity with the transconjunctival approach and general overestimation of the ability of skin excision to improve lower eyelid wrinkles. Transconjunctival lower eyelid blepharoplasty, however, continues to gain favor over the transcutaneous approach as more surgeons appreciate the absence of a visible scar and significantly lower incidence of postoperative lower eyelid retraction or change in lower eyelid margin contour, allowing a nonsurgical look.

カラーレスセラモメタルクラウンへの試作光重合型モノマーの応用 : マージン修正用ポーセレンの築盛

Collarless ceramo-metal crowns have been widely used because of their superior esthetics at the shoulder as well as the protection of the gingival margin from direct exposure to metal. There are, however, some difficulties in fabricating the crown with satisfactory marginal fit and/or correcting the contour of the loosely fitting porcelain shoulder. In order to overcome such problems in this study, the light-curing process was attempted for forming the porcelain with the experimental monomers. The monomers were composed of 1, 3-butanediol dimethacrylate monomer (BDMA) as a base monomer, glycidil methacrylate monomer (GMA) as a diluent, dl-camphor quinone as a photosensitizer, and N, N-dimethyl-p-toluidine as a reducing agent. Four monomers with different BDMA to GMA ratios were prepared : 1 : 0 0 (referred to as M_<1-0>), 1 : 1 (M_<1-1>), 1 : 1.5 (M_<1-1.5>), and 1 : 2 (M_<1-2>). Their performances were discussed by comparing with the porcelain formed with distilled water followed by firing at 900℃ as a control. The porcelain formed by the light-curing process showed 10 to 15% larger volumetric shrinkage in firing than the control because the porcelain powders could be less incorporated in the mixture with the viscous monomers. The shrinkage not only compensated for the lowered density of the porcelain but also markedly reduced the size of porosities except for the monomer M_<1-0> that produced significantly larger size and number of porosities in the fired porcelain. It was reflected in the compressive strength not smaller than that of the control. When the porcelains formed with the monomers were fired at a temperature lower than 850℃, the shade turned blackish due to the incomplete combustion of the polymers. However, distinguishable color differences could no more be found after firing at 900℃ among the control and the porcelains formed with M_<1-0>, M_<1-1> and M_<1-1.5>. The monomers were applied to form the shoulder porcelain at the margin of the collarless ceramo-metal crown on the plaster die to correct its margin contour. When distilled water was routinely used, a considerable amount of porcelain powders remained on the die shoulder in lifting the crown. With the use of M_<1-0> and M_<1-1>, however, almost all the powders could be withdrawn as a bulk from the die together with the crown, although no improvements were found on the separation from the die with M_<1-1.5> and M_<1-2>. As a result, the margins showed excellent fit to the die shoulder after firing when M_<1-0> and M_<1-1> were used for formation, while larger marginal gaps were observed in the cases of the control and the other two monomers. From the foregoing findings, it was suggested that the light-curing forming of the shoulder porcelain with the experimental monomer M_<1-1> would be an extremely useful technique for improving the workability and marginal fit without adversely affecting the physical and mechanical properties.

The clinical wear of three posterior composites

The wear of three posterior composites and two amalgams was assessed clinically and measured on replica models. For the composite restorations abrasion was measured as the depth of enamel exposed at the cavity margin. Attrition was measured for all materials as the depth of surface wear determined by laser interfereometry. For the posterior composites the mean abrasion was: Clearfil 79.2 microns, Occlusin 175.9 microns and P-30 96.1 microns. The corresponding values for attrition were: 153.4 microns, 205.9 microns and 255.5 microns, respectively. The attrition of the two amalgams was: New True Dentalloy 120.8 microns, Solila Nova 115.3 microns. Therefore, attrition was greater than abrasion and the attrition of the three composites was greater than that of the two amalgams. Abrasion was affected by local factors, including the marginal contour of the restoration, whereas attrition was largely a function of the properties of the material itself. These findings indicate that composites should not be considered as a direct alternative to amalgam, especially in patients with high occlusal stress.

Topographic criteria in the diagnosis of tumor emboli in intramammary lymphatics

Topographic relationships to adjacent structures were used as criteria to identify intramammary lymphatics with tumor emboli in breast cancer patients, in addition to conventional morphologic criteria. Patterns of relationship to blood vessels, non-neoplastic lobules and ducts, and empty lymphatics were defined. Ninety-five cases were independently reviewed by two observers. Interobserver reproducibility of the diagnosis of lymphatic vessel invasion (LVI) was 82% (kappa 0.60). The observers agreed on the presence of LVI in 23 patients (24%), of whom 21 (91%) had positive lymph nodes. Only among patients in whom more than ten emboli were identified was the frequency of positive lymph nodes markedly higher than in the total material. The location of tumor emboli relative to the invasive tumor was of little significance. LVI was a more powerful predictor of lymph node status than tumor size, margin contour, histologic grade and histologic type, and was highly significant also when controlled for these features.

Use of Mucogingival Surgical Procedures to Enhance Esthetics

The procedures outlined herein deal primarily with improving esthetics. The importance of esthetics in periodontics is most apparent in patients with a high lip line. Current mucogingival procedures provide the surgeon with the capability to have a major role in the total treatment of complex restorative cases. Periodontal considerations must be included as an integral part of esthetic dentistry. A complete examination of the patient must include a thorough periodontal evaluation. In addition to the usual detection of periodontal pockets and inflammation indicative of periodontal disease, the examination should include a thorough mucogingival evaluation for detection of the following: (1) inadequate keratinized gingiva; (2) gingival recession; (3) excessive gingival display; (4) insufficient clinical crown length; (5) asymmetric gingival margins; (6) flat marginal contour; (7) improper gingival margin relationships; (8) lack of harmony of gingival margins with the lip line; and (9) alveolar ridge deficiencies. Mucogingival surgical procedures should be performed after control of all etiologic factors and in concert with the restorative therapy so that the surgery can produce the most desirable esthetic result. It must be understood that the location and contour of the gingival margin and its relationship to adjacent margins are as important to the final esthetic result as the location, form, and relationship of the incisal margins of the anterior teeth. Attention to the total dental display as framed by the smile, with appropriate mucogingival analysis and treatment, is necessary to achieve the most satisfying esthetic results.

Root resorption and submergence in retained deciduous second molars: A mixed-longitudinal study of 77 children with developmental absence of second premolars

The long term condition of retained deciduous second molars with no permanent successors, was studied. The children were examined once a year. Recordings included intraoral roentgenograms, dental casts and body height measurements. The rate of root resorption (mandibular molars only) and the occurrence of submergence were studied. Four stages of root resorption were defined and judged subjectively. The occurrence of submergence was diagnosed by the downward slope of the marginal bone contour toward the deciduous molar. Body height measurements were used to ascertain peak height velocity (PHV). On average, each resorption stage lasted about 4 years but the rate of root resorption varied considerably. No particular pattern of root resorption was found in relationship to sex, dental decay, submergence or age. The onset of submergence was not observed later than about one year after PHV. No relationship was found between the occurrence of submergence and sex, dental decay or the stage of root resorption. Submergence occurred more frequently in the mandible than in the maxilla.

Two Principles for Improving the Adaptation of Stainless Steel Crowns to Primary Molars

Two principles are discussed that address the length and marginal contours of stainless steel crowns. Application of morphologic findings of teeth and contours of marginal gingival tissues are presented to support these principles. Clinical applications of these principles are discussed. Use of them in your technique will enhance the efficient adaptation of stainless steel crowns. In fact, you will be more efficient with guesswork eliminated. Also, incorporation of the principles into your technique will ensure that the efforts you make will result in the adaptation of custom stainless steel crowns for your patients.

Intraalveolar transplantation: (I) The use of autologous bone transplants in the periapical region

Intraalveolar transplantation of teeth with unfavourable cervical root fractures were performed in 15 patients. The roots were surgically extruded on an average 4.5 mm, and autologous bone transplants were placed above the apical part to support the root. Temporary endodontic therapy was carried out before the transplantation in 10 patients and 3 weeks after transplantation in 2 patients. 3 of the teeth had old root fillings. Postoperative controls were made weekly during the first month, after 3 months, 6 months, 1 and 2 years. The roots had become stable in most cases after 3 weeks. The mobility grade was dependent on the extent of extrusion. Radiographic controls showed formation of a normal periodontal space around the roots after 3 months, but also minor root resorption in the most apical part in 10 of the cases. The resorption was, however, not progressive in nature and was limited to the apical part. Remodelling of the marginal bone contour around the transplanted roots was evident in 11 patients. Periapical destructions were found in 3 patients at the 2-year control. Crown therapy was carried out with due attention to the special prosthetic problems associated with preparation of small remaining root fragments with unfavourable crown/root ratio.

Standardized sequence for carving and finishing amalgam restorations

This method of amalgam carving and finishing, described in a step-by-step sequence, is fast and effective. The initial step of using the acorn burnisher eliminates the great bulk of excess amalgam and contours the restoration. A simple armamentarium is all that is required for carving, burnishing, and polishing. A general scheme for reestablishing original or ideal occlusal morphology has been discussed, emphasizing distinct triangular and marginal ridges and convex contour. Attention was focused on the prevention of ditching at the cavosurface margin, thus ensuring full benefit of the improved physical properties of silver amalgam.

Suprapubic prostatic sonography in the diagnosis of carcinomas and adenomas of the prostate (author's transl)

Prostatic adenomas and carcinomas were examined by suprapubic transvesical prostatic sonography. The value of the method is comparable with transrectal prostatic sonography. Adenomas and carcinomas can be differentiated on the basis of their echo patterns and marginal contours. In the presence of carcinomas, sonography is a valuable addition to clinical staging and staging by CT. Compared with CT, the ability to perform longitudinal sections permits good evaluation of the bladder base. Sonography is also valuable for serial observations after treatment and for diagnosing recurrences.

History of the American Board of Orthodontics

“Pink esthetics,” which are considered to be as important as “white esthetics,” have attracted increasing attention. To date, clinicians rarely have applied computer-aided design and computer-aided manufacturing (CAD/CAM) techniques in the rebuilding of the contour of the marginal gingiva in the esthetic zone.In this case report, the authors describe a female patient who had gingival inflammation and an asymmetrical contour of the marginal gingiva of the anterior maxillary teeth because previously placed ceramic crowns violated the biological width. The authors used a 3-dimensional–printing surgery template to guide precise crown-lengthening surgery to expose subgingival shoulders and to obtain an ideal marginal gingival contour. Then the authors used interim CAD/CAM crowns to induce the growth of the interdental papilla by 0.5 to 1.5 millimeters. Finally, the patient had a symmetrical and well-balanced contour of the marginal gingiva. In addition, the authors reduced the patient’s “black triangle” areas to the greatest possible extent.This case report illustrates that CAD/CAM products, including 3-dimensional–printing surgery templates and CAD/CAM interim crowns, are helpful in shaping and rebuilding the ideal contour of the marginal gingiva in the esthetic zone, such as the anterior maxillary teeth.

The copper-band splint

The copper-band splint may be made by any one of the four techniques described. Their use is a most gratifying adjunct to the procedures of crown and bridge and occlusal rehabilitation. When all or most of the mouth is involved (Fig. 8) these splints make it possible to correct irregularities in occlusion and support periodontally treated teeth. Gingival tissues may be maintained in maximum health. The durability and esthetics of the cold-cure acrylic resins, enhanced by proper marginal contour and fit, allow a comfortable interlude both for carrying on all procedures to insertion of the permanent appliances, and for provisional restorations over periods of many months, if necessary. This makes it possible to determine by both radiographic and clinical examination the advisability of retention or removal of questionable teeth.