Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents - a randomized controlled clinical pilot study

BACKGROUND Rubber dam is recommended for isolating the working field during adhesive dentistry procedures; however, dentists often omit rubber dam, particularly in paediatric dentistry, supposing that it would stress the patient. AIM The aim of this study was to evaluate stress parameters during a standardized dental treatment procedure performed with or without rubber dam. The treatment time was measured as a secondary outcome variable. DESIGN This study was designed as a randomized, controlled, clinical study with 72 patients (6-16 years; mean age, 11.1). During standardized fissure sealing procedures, objective parameters of stress (e.g., skin resistance, breath rate) were recorded. The operator's stress level was measured by pulse rate. Subjective pain (patients) and stress perception (operator) were evaluated by an interview. RESULTS The breath rate was significantly (P<0.05) lower and the skin resistance level was significantly higher during treatment with rubber dam compared to the control group. Subjective pain perception was significantly lower for the test group. The treatment time needed for the fissure sealing procedure was 12.4% less in the test group. CONCLUSION Isolation with rubber dam caused less stress in children and adolescents compared to relative isolation with cotton rolls if applied by an experienced dentist.

DEVELOPING A METHOD FOR IDENTIFYING AND REDUCING FUNCTIONAL DISCREPANCIES OF INFORMATION SYSTEMS

Currently more than half of Electronic Health Record (EHR) projects fail. Most of these failures are not due to flawed technology, but rather due to the lack of systematic considerations of human issues. Among the barriers for EHR adoption, function mismatching among users, activities, and systems is a major area that has not been systematically addressed from a human-centered perspective. A theoretical framework called Functional Framework was developed for identifying and reducing functional discrepancies among users, activities, and systems. The Functional Framework is composed of three models – the User Model, the Designer Model, and the Activity Model. The User Model was developed by conducting a survey (N = 32) that identified the functions needed and desired from the user’s perspective. The Designer Model was developed by conducting a systemic review of an Electronic Dental Record (EDR) and its functions. The Activity Model was developed using an ethnographic method called shadowing where EDR users (5 dentists, 5 dental assistants, 5 administrative personnel) were followed quietly and observed for their activities. These three models were combined to form a unified model. From the unified model the work domain ontology was developed by asking users to rate the functions (a total of 190 functions) in the unified model along the dimensions of frequency and criticality in a survey. The functional discrepancies, as indicated by the regions of the Venn diagrams formed by the three models, were consistent with the survey results, especially with user satisfaction. The survey for the Functional Framework indicated the preference of one system over the other (R=0.895). The results of this project showed that the Functional Framework provides a systematic method for identifying, evaluating, and reducing functional discrepancies among users, systems, and activities. Limitations and generalizability of the Functional Framework were discussed.

Differential inflammatory response of dental pulp explants and fibroblasts to saliva

Abstract AIM: To investigate the inflammatory response of dental pulp fibroblasts and the respective explants to whole saliva. METHODOLOGY: Explants from human and porcine dental pulp tissue and isolated dental pulp fibroblasts were used to investigate the inflammatory response to sterile saliva. Cytokine and chemokine expression was assessed by RT-PCR. Western blot analysis and pharmacologic inhibitors were used to determine the involvement of signalling pathways. RESULTS: Dental pulp explants of human and porcine origin exposed to human saliva exhibited no major changes of IL-6 and IL-8 mRNA expression (P > 0.05). In contrast, isolated porcine and human dental pulp fibroblasts, when stimulated with human saliva, exhibited a vastly increased expression of IL-6 and IL-8 mRNA (P < 0.05). In pulp fibroblasts, saliva also increased the expression of other cytokines and chemokines via activation of NFkappaB, ERK and p38 signalling. Notably, a significantly reduced inflammatory response was elicited when pulp fibroblasts were transiently exposed to saliva. CONCLUSIONS: Saliva has a potential impact on inflammation of dental pulp fibroblasts in vitro but not when cells are embedded in the intrinsic extracellular matrix of the explant tissue.

A comparison of the anterior adhesive system in the oncomiracidium and adult of the monogenean parasite Merizocotyle icopae (Monocotylidae)

The anterior adhesive system of the oncomiracidium and adult of Merizocotyle icopae (Monogenea: Monocotylidae) were compared. The oncomiracidium has one ventrally placed aperture on either side of the head near the anterior extremity. In the adult, there are three ventrally placed apertures on either side of the head region. Both systems have three types of electron-dense secretory bodies opening into each aperture. A rod-shaped secretion (S1) and a small electron dense ovoid secretion (S2) are common to larvae and adults. The third secretion type differs: in adults, it is a large, spherical (S3) type but in larvae, it is an ovoid (S4) body. S4 bodies do occur in adults, but appear to be secreted as a general body secretion. An additional anteromedian secretion (S5) is also present in the oncomiracidium, but is not secreted into the anterior apertures. Homology and function of secretions are discussed.

Pole tip recession in linear tape systems

The tribology of linear tape storage system including Linear Tape Open (LTO) and Travan5 was investigated by combining X-ray Photoelectron Spectroscopy (XPS), Auger Electron Spectroscopy (AES), Optical Microscopy and Atomic Force Microscopy (AFM) technologies. The purpose of this study was to understand the tribology mechanism of linear tape systems then projected recording densities may be achieved in future systems. Water vapour pressure or Normalized Water Content (NWC) rather than the Relative Humidity (RH) values (as are used almost universally in this field) determined the extent of PTR and stain (if produced) in linear heads. Approximately linear dependencies were found for saturated PTR increasing with normalized water content increasing over the range studied using the same tape. Fe Stain (if produced) preferentially formed on the head surfaces at the lower water contents. The stain formation mechanism had been identified. Adhesive bond formation is a chemical process that is governed by temperature. Thus the higher the contact pressure, the higher the contact temperature in the interface of head and tape, was produced higher the probability of adhesive bond formation and the greater the amount of transferred material (stain). Water molecules at the interface saturate the surface bonds and makes adhesive junctions less likely. Tape polymeric binder formulation also has a significant role in stain formation, with the latest generation binders producing less transfer of material. This is almost certainly due to higher cohesive bonds within the body of the magnetic layer. TiC in the two-phase ceramic tape-bearing surface (AlTiC) was found to oxidise to form TiO2.The oxidation rate of TiC increased with water content increasing. The oxide was less dense than the underlying carbide; hence the interface between TiO2 oxide and TiC was stressed. Removals of the oxide phase results in the formation of three-body abrasive particles that were swept across the tape head, and gave rise to three-body abrasive wear, particularly in the pole regions. Hence, PTR and subsequent which signal loss and error growth. The lower contact pressure of the LTO system comparing with the Travan5 system ensures that fewer and smaller three-body abrasive particles were swept across the poles and insulator regions. Hence, lower contact pressure, as well as reducing stain in the same time significantly reduces PTR in the LTO system.

The tribology of linear tape recording systems

This thesis is devoted to the tribology at the head~to~tape interface of linear tape recording systems, OnStream ADRTM system being used as an experimental platform, Combining experimental characterisation with computer modelling, a comprehensive picture of the mechanisms involved in a tape recording system is drawn. The work is designed to isolate the mechanisms responsible for the physical spacing between head and tape with the aim of minimising spacing losses and errors and optimising signal output. Standard heads-used in ADR current products-and prototype heads- DLC and SPL coated and dummy heads built from a AI203-TiC and alternative single-phase ceramics intended to constitute the head tape-bearing surface-are tested in controlled environment for up to 500 hours (exceptionally 1000 hours), Evidences of wear on the standard head are mainly observable as a preferential wear of the TiC phase of the AI203-TiC ceramic, The TiC grains are believed to delaminate due to a fatigue wear mechanism, a hypothesis further confirmed via modelling, locating the maximum von Mises equivalent stress at a depth equivalent to the TiC recession (20 to 30 nm). Debris of TiC delaminated residues is moreover found trapped within the pole-tip recession, assumed therefore to provide three~body abrasive particles, thus increasing the pole-tip recession. Iron rich stain is found over the cycled standard head surface (preferentially over the pole-tip and to a lesser extent over the TiC grains) at any environment condition except high temperature/humidity, where mainly organic stain was apparent, Temperature (locally or globally) affects staining rate and aspect; stain transfer is generally promoted at high temperature. Humidity affects transfer rate and quantity; low humidity produces, thinner stains at higher rate. Stain generally targets preferentially head materials with high electrical conductivity, i.e. Permalloy and TiC. Stains are found to decrease the friction at the head-to-tape interface, delay the TiC recession hollow-out and act as a protective soft coating reducing the pole-tip recession. This is obviously at the expense of an additional spacing at the head-to-tape interface of the order of 20 nm. Two kinds of wear resistant coating are tested: diamond like carbon (DLC) and superprotective layer (SPL), 10 nm and 20 to 40 nm thick, respectively. DLC coating disappears within 100 hours due possibly to abrasive and fatigue wear. SPL coatings are generally more resistant, particularly at high temperature and low humidity, possibly in relation with stain transfer. 20 nm coatings are found to rely on the substrate wear behaviour whereas 40 nm coatings are found to rely on the adhesive strength at the coating/substrate interface. These observations seem to locate the wear-driving forces 40 nm below the surface, hence indicate that for coatings in the 10 nm thickness range-· i,e. compatible with high-density recording-the substrate resistance must be taken into account. Single-phase ceramic as candidate for wear-resistant tape-bearing surface are tested in form of full-contour dummy-heads. The absence of a second phase eliminates the preferential wear observed at the AI203-TiC surface; very low wear rates and no evidence of brittle fracture are observed.

Uptake of dental services

Previous research has indicated that the majority of the UK dentate population suffers from dental disease. This problem was examined in terms of the supply of, and demand for, dental treatment: how might the uptake of dental services be increased and dental health improved? The target population for the main survey was adolescents among whom demand for dental treatment has decreased. In 524 adolescents surveyed, fear of pain was the major deterrent to regular dental visits. The theoretical literature was explored for illuminating and practical approaches to the problem. The theory of reasoned action developed by Fishbein seemed the most promising. This theory was tested and validated on the adolescent sample identifying clear differences between regular and irregular dental attenders which could be usefully exploited by dental health education. A repertory grid analysis study further illuminated perceptions of dental treatment. A survey of a random sample of 716 dentists revealed that most dentists were in favour of delegating work to auxiliary help but few could do so. Auxiliary help would increase supply of services: data revealed an encouraging trend for younger dentists to be more in favour of delegation than older dentists. A survey was carried out of computer systems available for dentists suggesting that this might reduce the need for clerical assistance but would not ususally affect the supply of treatment. However in some dental practices computerisation might increase demand. For example a personalised reminder was developed and evaluated in a controlled study of 938 appointments demonstrating an uptake in dental services. Conclusions are that demand for treatment can be increased in various ways especially by teaching dentists' behavioural strategies to deal with fear and pain. Various recommendations on this are made. If demand were to outstrip supply increased delegation to auxiliary help could provide a viable way of increasing supply.

Adhesive bonding of aluminium

Adhesive bonding of aluminium is widely used in the aerospace industry. High initial bood strengths can be obtained, but bond failure occurs atter prolonged exposure to humid enviroments. The thesis contains details ot a test procedure which has been designed and developed for the assessment of different alloys, pretreatments, and adhesives, which will give adhesively bonded aluminium joints of high strength coupled with long term durability. The test involves assembly of lap shear specimens in a precision jig using 250 ballotini spacers in the adhesive to control the bond line thickness. The test is modified by drilling three accurately located holes through the bonded area after assembly of the joint and curing of the adhesive. Further important features at the test, such as fillet control, are detailed. The test was assessed, modified and developed to give a reliable and reproducible method which would discriminate amongst different bonding systems after exposure to humid test environments. This is the first test to have achieved the discrimination necessary for short term assessment of bond systems where long term durability is required. Even better discrimination has been obtained by applying stress in a stress humidity test. Having established accurate, reliable and discriminating test methods they were used to study the durability of structural epoxy adhesive bonds to aluminium as a function of alloy, pretreatment, adhesive and environment. It was established that the long term durability or adhesively bonded aluminium was directly related to the infulence of water migrating within the adhesive. Pretreatments differed in their ability to prevent hydration of the aluminium oxide by the water absorbed within the adhesive.

Study of porcelain-zirconia composites for dental applications

Materiais compósitos restauradores representam um dos mais bem sucedidos biomateriais na pesquisa moderna, na substituição do tecido biológico em aparência e função. Nesta linha, a porcelana feldspática tem sido largamente usada em odontologia devido suas interessantes qualidades como estabilidade de cor, propriedades estéticas, elevada durabilidade mecânica, biocompatibilidade, baixa condutividade térmica e elevada resistência ao desgaste. Entretanto, este material é frágil e pode falhar em ambiente oral devido ao micro-vazamento, baixa resistência à tração, descolagem ou fratura. Assim, para melhorar as propriedades mecânicas da porcelana, a zircônia parcialmente estabilizada com Ítria (Y-TZP) pode ser uma boa alternativa para fortalecer e produzir infraestruturas totalmente cerâmicas (coroas e próteses parciais fixas). Portanto, este estudo tem por objetivo avaliar as propriedades mecânicas e características microestruturais da porcelana reforçada com zircônia (3Y-TZP) em diferentes conteúdos e as variáveis que afetam as propriedades mecânicas destes materiais. O estudo de caracterização revelou que a zircônia comercial apresenta melhores resultados quando comparada com a zircônia sintetizada pelo CPM. Assim, os estudos seguintes utilizaram a zircônia comercial para todos os testes requeridos. As partículas de zircônia apresentam elevadas propriedades mecânicas quando comparadas a zircônia aglomerada. Os diferentes conteúdos revelam que as propriedades mecânicas dos compósitos aumentam com o aumento do conteúdo volumétrico até 30% vol.% (198,5Mpa), ou seja, maior resistência à flexão quando comparada com os outros compósitos. Do mesmo modo, a resistência ao desgaste para os compósitos com (30%, vol.% de zircônia) apresenta valores superiores quando comparado aos demais compósitos. Na adesão cerâmico-cerâmico a porcelana exibe elevada adesão para a superfície de zircônia porosa quando comparada a superfície rugosa. Os furos superficiais (PZ) e aplicação de compósitos com camada intermediária (RZI) na zircônia causam separadamente uma melhoria da resistência ao cisalhamento da zircônia-porcelana quando comparados as amostras convencionais de zircônia-porcelana (RZ), embora não sejam estatisticamente significativas (p>0.05). A presença de uma camada intermediaria produz um aumento significativo na força de ligação (~55%) em relação as amostras convencionais (RZ). Portanto, a correta a correta configuração e tratamento superficial podem produzir subestruturas com qualidade e força de ligação adequadas aos requisitos odontológicos.

Elucidating the interactions between the adhesive and transcriptioanl functions of beta-catenin in normal and cancerous cells

Wnt signalling is involved in a wide range of physiological and pathological processes. The presence of an extracellular Wnt stimulus induces cytoplasmic stabilisation and nuclear translocation of beta-catenin, a protein that also plays an essential role in cadherin-mediated adhesion. Two main hypotheses have been proposed concerning the balance between beta-catenin's adhesive and transcriptional functions: either beta-catenin's fate is determined by competition between its binding partners, or Wnt induces folding of beta-catenin into a conformation allocated preferentially to transcription. The experimental data supporting each hypotheses remain inconclusive. In this paper we present a new mathematical model of the Wnt pathway that incorporates beta-catenin's dual function. We use this model to carry out a series of in silico experiments and compare the behaviour of systems governed by each hypothesis. Our analytical results and model simulations provide further insight into the current understanding of Wnt signalling and, in particular, reveal differences in the response of the two modes of interaction between adhesion and signalling in certain in silico settings. We also exploit our model to investigate the impact of the mutations most commonly observed in human colorectal cancer. Simulations show that the amount of functional APC required to maintain a normal phenotype increases with increasing strength of the Wnt signal, a result which illustrates that the environment can substantially influence both tumour initiation and phenotype.

Influence of adhesive system on quartz fiber post dislocation resistance in endodontically treated teeth

Aim: To evaluate the dislocation resistance of the quartz fiber post/cement/dentin interface after different adhesion strategies. Methods: Forty bovine lower central incisors were selected and prepared with K-files using the step-back technique, and irrigated with 3 mL of distilled water preceding the use of each instrument. Prepared teeth were stored at 37ºC and 100% humidity for 7 days. The roots were prepared and randomized into 4 groups. The quartz fiber post was cemented with an adhesion strategy according to the following groups: GBisCem- BISCEM; GOneStep±C&B- One Step ± C&B; GAllBond±C&B- AllBond3 ± C&B; GAllBondSE±C&B- AllBondSE ±C&B with a quartz fiber post. Cross-sectional root slices of 0.7 mm were produced and stored for 24 h at 37° C before being submitted to push-out bond strength. Results: The mean and standard deviation values of dislocation resistance were GBisCem: 1.12 (± 0.23) MPa, GOneStep±C&B: 0.81 (± 0.31) MPa, GAllBond±C&B: 0.98 (± 0.14) MPa, and GAllBondSE±C&B: 1.57 (± 0.04) MPa. GAllBondSE±C&B showed significantly higher values of dislocation resistance than the other groups. Conclusions: Based on this study design, it may be concluded that adhesion strategies showed different results of quartz post dislocation resistance. Simplified adhesive system with sodium benzene sulphinate incorporation provided superior dislocation resistance.

Considerations on indirect adhesive restorations at the material and tooth interfaces

Objective: Lithium-silicate (LiSi) ceramic is nowadays widely used in dentistry. However, for the longevity of LiSi indirect restorations, it is important to pretreat the material and the dental substrate adequately. However, is not certain how the simplification of the manufacturing and conditioning procedures influences the bonding performances of LiSi ceramic restorations. Accordingly, the aims of this thesis were to investigate the effect of: 1) different LiSi ceramic surface decontamination procedures on the shear bond strength (SBS) to resin composite; 2) different types of lithium-disilicate (LiDi) (pressed vs CAD-CAM) on SBS to resin composite; 3) an experimental metal salt-based zirconium oxynitrate etchant [ZrO(NO3)2] on bonding performances to dentin. Materials and Methods: SBS test was used to investigate the influence of different cleaning protocols applied, or different processing techniques (CAD or PRESS) on the bond strength to composite resin. The third study tackled the interface between restorative materials and dentin, and investigated the microtensile bond strength test (µTBS), nanoleakage expression analysis (NL), gelatin zymography and in situ zymography of dentin conditioned with an experimental metal salt-based zirconium oxynitrate etchant [ZrO(NO3)2]. Results: MEP showed comparable bond strength to the double HP etching and higher compared to other groups. BS of press LiSi to composite was higher than that of CAD/CAM LiSi. ZON pretreatment increased bond strength to dentin when used with a universal adhesive, and inhibited dentinal endogenous enzymes. Conclusions: While simplification of the LiSi conditioning and cleaning procedures seems to yield bond strength comparable to the traditional procedures, it could be recommended in the clinical practice. However, pressed LiSi still seems to perform better in terms of bond strength compared to the CAD/CAM LiSi. Further, the novel ZON etchant seems to perform better compared to the traditional phosphoric dentin etching.

Does The Reciproc File Remove Root Canal Bacteria And Endotoxins As Effectively As Multifile Rotary Systems?

To evaluate the effectiveness of Reciproc for the removal of cultivable bacteria and endotoxins from root canals in comparison with multifile rotary systems. The root canals of forty human single-rooted mandibular pre-molars were contaminated with an Escherichia coli suspension for 21 days and randomly assigned to four groups according to the instrumentation system: GI - Reciproc (VDW); GII - Mtwo (VDW); GIII - ProTaper Universal (Dentsply Maillefer); and GIV -FKG Race(™) (FKG Dentaire) (n = 10 per group). Bacterial and endotoxin samples were taken with a sterile/apyrogenic paper point before (s1) and after instrumentation (s2). Culture techniques determined the colony-forming units (CFU) and the Limulus Amebocyte Lysate assay was used for endotoxin quantification. Results were submitted to paired t-test and anova. At s1, bacteria and endotoxins were recovered in 100% of the root canals investigated (40/40). After instrumentation, all systems were associated with a highly significant reduction of the bacterial load and endotoxin levels, respectively: GI - Reciproc (99.34% and 91.69%); GII - Mtwo (99.86% and 83.11%); GIII - ProTaper (99.93% and 78.56%) and GIV - FKG Race(™) (99.99% and 82.52%) (P < 0.001). No statistical difference were found amongst the instrumentation systems regarding bacteria and endotoxin removal (P > 0.01). The reciprocating single file, Reciproc, was as effective as the multifile rotary systems for the removal of bacteria and endotoxins from root canals.