Esthetic Anterior Resin Restorations: To Bevel Enamel or Not? / Restauraciones estéticas de resina en dientes anteriores: Biselar el esmalte o no?

Abstract Restoration of fractured anterior teeth presents a challenge to dental clinicians owing to its esthetic requirements and, more importantly, because of the young age of the patients. Thus, it is important to follow the most conservative protocol. Many professionals face the dilemma of whether or not to perform enamel beveling. This article briefly discusses the clinical perspective and evidence regarding this type of operative restoration procedure.

Resumen: La restauración de dientes anteriores fracturados representa un desafío para los odontólogos debido a sus requisitos estéticos y, lo que es más importante, debido a la corta edad de los pacientes que generalmente necesitan del tratamiento. Por lo tanto, es importante seguir el protocolo más conservador. Muchos profesionales enfrentan el dilema de si realizar o no el biselado del esmalte. Este artículo discute brevemente la perspectiva clínica y la evidencia con respecto a este tipo de procedimiento de restauración quirúrgica.

Stress distribution of composite resin filling in Class I cavity of molars with different cavosurface angle / 口腔疾病防治

Objective @#To analyze the effect of different cavosurface angles on the stress distribution of ClassⅠ cavity composite resin filling of molars through the three-dimensional finite element method and to provide references for the preparation of ClassⅠ cavities.@*Methods@#Three-dimensional finite element models of ClassⅠ composite resin filling of mandibular first molars with three different cavosurface angles (group A: 90°, group B: 120°, group C: 135°) were established. Polymerization shrinkage of composites was simulated with a thermal expansion approach. The mechanical behavior of the restored models in terms of stress and displacement distributions under the combined effects of polymerization shrinkage and occlusal load (600 N) was analyzed.@*Results@# For ClassⅠ cavities with the same cavity size, the total stress of the restoration model and the maximum stress of the enamel in group A were less than those in groups B and C after cavity composite resin restoration with three cavity cavosurface angles (in which the width of the enamel bevel was 1 mm in groups B and C). The maximum stress of the dentin and adhesive was similar in the three groups, the maximum stress of the composite in group C was the largest, and the maximum stress of the composite in group B was the smallest. In terms of stress distribution, the maximum stress in each restoration model was mainly concentrated in the enamel at the cavosurface, near the enamel-dentin interface and at the edge of the restoration material.@*Conclusion@#From the point of reducing the stress of residual tooth tissue, the preparation of 90° angle without enamel bevel is an ideal method for cavity preparation when composite resin is used to fill ClassⅠ cavities of molars.

Application of different phacoemulsification and chopping techniques in hard nuclear cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the efficacy of bevel-up phaco chop versus bevel-down phaco drill in the treatment of hard nuclear cataract and the influence on corneal endothelium.<p>METHODS: Between August 2018 and April 2020, 94 patients(104 eyes)with hard(grade Ⅳ-Ⅴ)nuclear cataract treated with phacoemulsification were enrolled in this retrospective study. Among them, 50 eyes treated by bevel-up phaco chop were included in the control group, while 54 eyes treated by phaco drill technique were included in the observation group. The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter in the two groups were recorded. The best corrected visual acuity(BCVA)in 7d, corneal endothelial cell count in 2mo, the proportions of normal hexagonal cells and the degree of corneal edema in 7d were compared between the two groups.<p>RESULTS: The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter of the observation group were shorter and lower than those of the control group(<i>P</i><0.05). The BCVA of both groups increased after operation, and the observation group had higher BCVA than the control group at the same time(<i>P</i><0.05). In 1 and 2mo, the corneal endothelial cell counts and the proportions of normal hexagonal cells in both groups were lower than those before operation. Meanwhile, the corneal endothelial cell count and the proportions of normal hexagonal cells in the observation group were higher than those in the control group(<i>P</i><0.05). Besides, corneal edema was milder in the observation group than in the control group at 24h and 7d after operation(<i>P</i><0.05).<p>CONCLUSION: Compared with bevel-up phaco chop, phaco drill can significantly shorten the time of using ultrasound, reduce ultrasound energy, promote visual recovery, and reduce corneal endothelial cell damage.

Influence of filling technique and bevel preparation on marginal sealing of conventional and low shrinkage composite restorations

AIM: The aim of this study was to evaluate two composite restorations (conventional methacrylate-based and low shrinkage-based silorane), associated or not to beveling and incremental technique, in relation to the microleakage and marginal gap formation tests. MATERIAL AND METHODS: 30 sound human molars had their mesial and distal surfaces prepared with and without bevel. The teeth were divided into six groups according to the type of resin (conventional nanofilled or silorane resin), and restorative filling technique (incremental technique or builk). Microleakage and marginal gap formation data were statistically analyzed by Kruskal-Wallis and Chi-Square tests, with a significance level set at 5%. RESULTS: Group 1 (Z350 XT, without bevel, incremental technique) presented highest rate of microleakage and marginal gap in most of the restorations, with statistically significant differences. Groups 4 and 6 (P90, beveled, builk and P90, beveled and incremental technique) had lower rates of microleakage and absence of marginal gaps in most of the restorations. CONCLUSION: It's concluded that the silorane showed lower rates of marginal gaps and microleakage, when compared to the conventional methacrylate-based resin. Bevel preparation was effective in reducing microleakage and marginal gaps for both resins used. Incremental technique was not necessary when associated with low shrinkage composite resin.

An Evaluation of the Effects of Marginal Design, Die Spacer, and Seating Force on the Marginal Fit of Cast Metal Crowns after Luting – An Invitro.

The marginal adaptation of cast metal crowns is essential for the success of cast restoration. The marginal design, die spacer and the seating force are considered as important factors effecting the marginal fit of cast metal crowns. Aims and Objectives; The aim and objectives of the present study is to evaluate the marginal fit of cast metal crowns 1.With three different marginal designs that are shoulder, shoulder with bevel and chamfer 2.With and without die spacer 3.Under seating forces 100N and 300N. METHODOLOGY: The study was done using 3 brass dies of 6mm height 10o taper with three different marginal designs shoulder, shoulder with 45o bevel and chamfer . 20 impressions of each metal die were made and casts were poured. 10 specimens of each group were coated with die spacer while the other 10 specimens were to serve as control group. Cementation done with GIC under two different seating forces (100N and 300N). The marginal discrepancy is determined by measuring the crown height before and after cementation. From this study it was concluded that specimen with combination of chamfer marginal design with die spacer under 300N seating force exhibited superior marginal adaptation.

Comparison of incidence of intravascular injections during transforaminal epidural steroid injection using different needle types / 대한마취과학회지

BACKGROUND: Infrequent but serious complications of transforaminal epidural steroid injection (TFESI) occur due to inadvertent intravascular injections. A few studies reported that the different needle types can influence on the occurrences of intravascular incidence in TFESI. This study prospectively evaluated whether short-bevel needle can reduce the incidences of intravascular injection of TFESI compared to long-bevel needles. METHODS: From March 2013 to December 2013, 239 consecutive patients were enrolled and received 249 fluoroscopically guided TFESI using the classic technique. Confirmation of intravascular spread was done initially with real time fluoroscopy and then with digital subtraction angiography method in a same patient. Injection technique for TFESI was the same for both short-bevel and long-bevel needle types. RESULTS: The incidences of intravascular injections with the long-bevel and short-bevel needles were 15.0% (21/140) and 9.2% (4/140), respectively. More than half of intravascular injections occurred simultaneously with epidural injections (8.0%, 20/249). There were no statistically significant differences between the long-bevel and the short-bevel needles in the rates of intravascular injections (P = 0.17). CONCLUSIONS: Short-bevel needles did not demonstrate any benefits in reducing the incidence of intravascular injection.

The Influence of Implanter Bevel Direction during Insertion on Transplanted Hair Survival Rate: Bevel-up or Bevel-down? / 대한피부과학회지

No abstract available.

A randomized double-blind clinical trial of posterior composite restorations with or without bevel: 1-year follow-up

OBJECTIVE: This randomized double-blind clinical trial compared the performance of posterior composite restorations with or without bevel, after 1-year follow-up. MATERIAL AND METHODS: Thirteen volunteers requiring at least two posterior composite restorations were selected. Twenty-nine cavities were performed, comprising 14 without bevel (butt joint) and 15 with bevel preparation of the enamel cavosurface angle. All cavities were restored with simplified adhesive system (Adper Single Bond) and composite resin (Filtek P60). A halogen light curing unit was used through the study. Restorations were polished immediately. Analysis was carried out at baseline, after 6 months and after 1 year by a calibrated evaluator (Kappa), according to the FDI criteria. Data were statistically analyzed by Mann-Whitney test (p <0.05). RESULTS: Beveled and non-beveled cavities performed similarly after 1 year follow-up, regarding to fractures and retention, marginal adaptation, postoperative hypersensitivity, recurrence of caries, surface luster and anatomic form. However, for surface and marginal staining, beveled cavities showed significantly better performance (p<0.05) than butt joint restorations. CONCLUSIONS: It was concluded that the restorations were acceptable after 1 year, but restorations placed in cavities with marginal beveling showed less marginal staining than those placed in non-beveled cavities.

Effect of load cycling on nanoleakage of butt joint and beveled occlusal enamel margins in class V composite resin restorations / Efeito do ciclo de carga na nanoinfi ltração de margens de esmalte oclusal com e sem bisel em restaurações classe V

Objectives: This study evaluated the infl uence of mechanical and thermal cycling on the nanoleakageof Class V composite resin restorations with and without enamel beveling. Material and method:Using 60 Class V cavities prepared on the buccal surfaces of human molars, specimens were dividedinto two groups (n = 30) based on the confi gurations of the enamel cavosurface margins. (beveled andnon-beveled) After restoring the cavity preparations with a fl owable composite, half of the specimenswere mechanically load-cycled. The specimens were sealed leaving a 1 mm window around the cervicaland enamel margins. Specimens were placed in a 50% (W/V) silver nitrate solution then immersedin photodeveloping solution and exposed to fl uorescent light for 8h. The teeth were buccolinguallysectioned, gold sputter coated and examined with a SEM to evaluate the nanoleakage values. The datawere analyzed using two-way ANOVA (α = 0.05). Results: Enamel margin confi guration had no significant effect on nanoleakage (p > 0.05). However, the nanoleakage value was signifi cantly higher inthe load-cycled group than in the group not load-cycled (p < 0.05). Conclusion: Since enamel margin confi guration does not affect nanoleakage, there is no need to bevel enamel margins of Class V cavitypreparations for composite restorations.

Objetivos: O presente estudo avaliou a infl uência dos ciclos de carga mecânico e térmico na nanoinfi ltração derestaurações Classe V em resinas compostas, com e sem biselamento do esmalte. Material e método: Os espécimes(60 cavidades Classe V preparadas na superfície vestibular de molares humanos) foram divididos em dois grupos(n = 30) baseados nas confi gurações das margens cavosuperfi ciais do esmalte (biseladas e não biseladas). Após restauraçãodos preparos cavitários com um compósito tipo fl ow, metade dos espécimes foi carregada mecanicamente.Os espécimes foram selados mantendo janela de 1 mm em torno das margens cervical e de esmalte. Os espécimesforam colocados em solução de nitrato de prata (50%), imersos na sequência em solução processadora fotográfi cae expostos à luz fl uorescente por oito horas. Os dentes foram cortados em sentido vestíbulo-lingual, revestidos emouro e observados em microscopia eletrônica para avaliar os valores de nanoinfi ltração. Os dados foram analisadospelo ANOVA (α = 0,05). Resultados: A confi guração das margens do esmalte não teve efeito signifi cante nananoinfi ltração (p > 0,05). Entretanto, os valores da nanoinfi ltração foram signifi cativamente mais altos no grupode carga que no grupo sem carga (p > 0,05). Conclusão: Uma vez que a confi guração da margem do esmalte nãoafeta a nanoinfi ltração, não há necessidade de biselar as margens do esmalte nos preparos de cavidades Classe V emrestaurações de compósitos.

Influence of adhesive system and bevel preparation on fracture strength of teeth restored with composite resin

The aim of this study was to evaluate the fracture strength of teeth with different cavosurface margin cavity preparations and restored with composite resin and different adhesive systems. Eighty premolars were randomly divided in 8 groups, as follow: G1- sound teeth; G2- MOD preparation (no restoration); G3- Adper Single Bond without bevel preparation (butt joint); G4- Adper Single Bond with bevel preparation; G5- Adper Single Bond with chamfer preparation; G6- Clearfil SE Bond without bevel (butt joint); G7- Clearfil SE Bond with bevel preparation; G8- Clearfil SE Bond with chamfer preparation. The adhesive systems were applied according to manufacturers’ instructions. Composite resin (Filtek Z250) was incrementally placed in all cavities. After 24 h, the specimens were tested in a universal testing machine at a crosshead speed of 0.5 mm/min. Data were analyzed statistically by ANOVA and Tukey’s test (fracture strength) and Fisher’s exact test (fracture pattern). The confidence level was set at 95 percent for all tests. Prepared and non-restored teeth showed the worst performance and G4 exhibited the highest fracture strength among all groups (p<0.05). In conclusion, all restorative treatments were able to recover the fracture strength of non-restored teeth to levels similar to those of sound teeth. Using a total-etch adhesive system with bevel preparation significantly improved the resistance to fracture.

O objetivo deste estudo foi determinar, in vitro, a resistência à fratura de pré-molares superiores com diferentes preparos do ângulo cavossuperficial e restaurados com resina composta com distintos sistemas adesivos. Foram selecionados 80 dentes, divididos em 8 grupos: G1- hígidos; G2- preparos M.O.D.; G3- Single Bond sem bisel; G4- Single Bond com bisel reto; G5- Single Bond com bisel chanfrado; G6- Clearfil SE Bond sem bisel; G7- Clearfil SE Bond com bisel reto e G8- Clearfil SE Bond com bisel chanfrado. Os grupos 3-8 foram restaurados com resina composta Z250, pela técnica incremental. Os corpos-de-prova foram submetidos ao teste de resistência à fratura em máquina universal de ensaios, a uma velocidade de 0,5 mm/min. Os dados foram analisados estatisticamente pelos testes ANOVA, Tukey e exato de Fisher (α=0,05). O grupo 2 apresentou resistência inferior aos demais e o grupo 4 mostrou-se mais resistente à fratura do que os demais grupos (p<0,05). Concluiu-se que o bisel reto foi o preparo mais efetivo quando associado a adesivos dentinários com condicionamento ácido prévio. Ambos adesivos dentinários usados foram capazes de devolver a resistência perdida com o preparo cavitário.

The effect of implant system with reverse beveled platform design on marginal bone stress distribution / 대한치과보철학회지

PURPOSE: The purpose of this study was to investigate the effects of the surface morphology of the implant neck on marginal bone stress measured by using finite element analysis in six implant models. MATERIALS AND METHODS: The submerged type rescue implant system (Dentis co., Daegu, Korea) was selected as an experimental model. The implants were divided into six groups whose implant necks were differently designed in terms of height (h, 0.4 and 1.0 mm) and width (platform width, w = 3.34 + 2b [b, 0.2, 0.3 and 0.4 mm]). Finite element models of implant/bone complex were created using an axisymmetric scheme. A load of 100 N was applied to the central node on the top of crown in parallel with the implant axis. The maximum compression stress was calculated and compared. RESULTS: Stress concentration commonly observed around dental implants did not occur in the marginal bone around all six test implant models. Marginal bone stress varied according to the implant neck bevel which had different width and height. The stress was affected more markedly by the difference in height than in width. CONCLUSION: This result indicates that the implant neck bevel may play an important role in improving stress distribution in the marginal bone area.

Influencia del biselado de los márgenes cavo-superficiales en la desadaptación marginal mostrada por restauraciones posteriores de composite / Influence of beveling cavo-surface margins in maladjustment shown by marginal posterior restorations of composite

Las fallas marginales representan una de las causas más frecuentes de fracaso en las restauraciones de composite en el sector posterior. Los niveles de falla marginal presentados por estas restauraciones podrían verse afectados por el tipo de configuración dado a los márgenes cavo-superficiales; no obstante, la información disponible al respecto tiende a ser contradictoria. Determinar la influencia que tiene el diseño de tres tipos de márgenes cavo-superficiales (unión abrupta, bisel corto y bisel cóncavo) en los niveles de deterioro marginal presentados en restauraciones directas de composite realizadas en dientes posteriores sometidos a cargas compresivas. Sesenta dientes posteriores humanos sanos extraídos (30 premolares superiores y 30 terceros molares superiores) fueron distribuidos aleatoriamente en tres grupos, cada uno de los cuales estuvo conformado por 10 premolares y 10 molares. A cada uno de los dientes le fue realizada una cavidad clase I estándar con una configuración distinta de margen cavo-superficial para cada grupo (grupo 1= unión abrupta, grupo 2= bisel corto, grupo 3= bisel cóncavo), para posteriormente ser restaurados con un composite empacable mediante técnica directa. Todos los dientes fueron sometidos a 1500 ciclos térmicos entre 5 y 55ºC para posteriormente aplicarles 4000 ciclos de cargas compresivas cíclicas de 300 kN de fuerza máxima a una frecuencia de 5 Hz. El análisis en video lupa de las superficies oclusales de la muestra no reveló diferencias estadísticas significativas (p= 0,139) en los niveles de falla marginal mostrados por los tres tipos de margen cavo estudiados

Marginal deterioration is one the most frequent composite restoration failures at posterior teeth with chewing function. The type of configuration factor at cavosurface margins could affect marginal deterioration levels; however, available information is somewhat contradictory. To determine the influence of three cavosurface margin preparations (butt-joint, bevelled-edge, and concave bevel -chamfer style-) on marginal degradation found in direct composite restorations applied to posterior teeth under compressive strength. Sixty recently extracted human posterior teeth (30 upper bicuspid teeth and 30 upper third molars) were randomly distributed into three groups, having 10 bicuspid teeth and 10 molar teeth each group. Each tooth had standardized Class I slot cavities and was prepared according to the cavosurface margin preparations above mentioned (group 1=butt-joint, group2=bevelled-edge, group 3=concave bevel); then, it received direct packable composite restoration. All teeth were thermocycled 1500x at 5/55 degrees C, cycled 4000x of compressive loading at a maximum strength of 300kN and a frequency of 5Hz. Video loupe analyses of occlusal surfaces from the study sample did not show statistically significant differences (p=0.139) among the three cavosurface margin preparations studied

Avaliação da infiltração marginal em restaurações de classe II em resina composta com e sem biselamento dos ângulos cavo-superficiais / Evaluation of the marginal microleakage in composite resin restoration with and without bevel of cavosurface margins

O objetivo deste trabalho foi avaliar a adequada secção de esmalte na execução dos preparos cavitários a fim de se obter o melhor embricamento mecânico e a menor infiltração marginal.Foram utilizados vinte dentes terceiros molares humanos extraídos nos quais foram realizados dois preparos padronizados de Classe II, sendo um mesial e um distal. Os espécimes foram divididos em dois grupos. Nos preparos mesiais do Grupo I foram executados biséis nos ângulos cavosuperficiaisvestibular e lingual e, no Grupo II, os biséis foram realizados nos ângulos cavosuperficiais cervicais das faces mesiais. Desta maneira os preparos mesiais formaram os grupos tratados e os preparos distais os controle. Os biséis foram realizados com uma broca chama-de-vela diamantada em alta rotação. Os dentes foram restaurados com resina composta fotopolimerizávelZ250, e os espécimes foram termociclados. Os espécimes foram seccionados para a realização daavaliação da infiltração linear ao longo da interface dente-material restaurador. Os valores foram analisados segundo o Teste de Sinal de Postos de Wilcoxon ao nível de significância de 5%. Concluiu-se que houve diferença estatisticamente significante entre as restaurações mesiais e distais em ambos os grupos, isto é, nos preparos onde foram realizados biséis houve menor infiltração

The purpose of this study was to evaluate the best cavosurface margin design in the enamel in order to obtain the best mechanical adhesion and the smallest marginal microleakage. Twenty third molars human were used. They were submitted each one to two Class II cavities, being a mesial and a distal. The cavities were standardized and the specimens were divided in two groups. In the Group I, in the mesial cavities bevels were executed in the vestibular and linual cavossurface margins. In the Group II, the bevels were accomplished in the gengival margin. The bevels were accomplished with a diamond bur in high rotation. The teeth were restored with Z250 and the specimens were subjected to the termocicling. The specimens were sectioned. It was executed the evaluation of the linear microleakage along the tooth-restoring material interface. A standardization was adopted and the values were analyzed according to the Wilcoxon Sign of position test (5%). In both groups there was significant difference when compared the mesial and distal restorations. There were less microleakage in through the beveled walls

Effect of Bevel Direction of 25G Spinal Needle and Addition of Epinephrine on Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Distribution of local anesthetics injected into subarachnoid space is determined by many intrinsic & extrinsic factors. The purpose of this study was to compare the spread of spinal anesthetic agent according to the direction of bevel and addition of epinephrine. METHOD: Eighty nine consenting patients, undergoing orthopedic surgery of lower extremities were divided into eight groups to direction of bevel and addition of epinephrine in each direction. In lateral decubitus position, 25-gauge spinal needle was introduced into the subarachnoid space and 1% tetracaine with the same volume of 10% dextrose was injected through the spinal needle. Patients were turned to the supine position and checked sensory block level by pin-prick test at anterior axillary line every 5 minutes. Degree of motor block was measured by Bromage scale and two-segment regression time was measured by pin-prick test every 15 minutes interval after maximal sensory block level was reached. RESULTS: No significant difference in maximum level of sensory block was found among groups. But two segment regression time was significantly prolonged in epinephrine added cephalad and down groups. CONCLUSION: Direction of bevel did not affect maximum level of sensory block and duration of spinal anesthesia but, epinephrine prolonged the duration of local anesthetics in special directions.

Effect of Direction of Bevel on the Spread of Spinal Anesthesia with Hyperbaric 0.5% Tetracaine / 대한마취과학회지

Many factors influence the distribution of local anesthetic solutions within the subarachnoid space. Among the factors which are under the control of the anesthesiologists, the effect of direction of bevel on spinal anesthetic spread was investigated in 40 young adult male patients undergoing orthopedic or urologic surgery, with ASA physical status 1. Patients were randomized into one of four groups, according to the direction of bevel(cephalad, caudad, up, down). With patient in the lateral decubitus position, dural puncture was performed in the midline at the L3-4 interspace with a 23-gauge needle, and the patients were immediately turned to supine position. Local anesthetic solution in all patients was composed of 1.6 ml of 1% tetracaine and 1.6 ml of 10% dextrose, resulting 3.2 ml(16 mg) of 0.5% tetracaine. Segmental spread of analgesia was determined by pin-prick in the anterior axillary line. Duration of block and degree of motor block were measured by two segment regression time and Bromage scale, respectively. No difference was observed among four groups in the onset time to maximal level of sensory block, two segment regression time, and degree of complete motor block of lower limbs. In caudal group, maximal level of sensory block was about 1.1-1.4 segments lower than other groups, but no statistical significance was found. There were wide variations in the maximal level of sensory block(T11-T3), and time to reach this(5 min-35 min). The present study indicates that the direction of bevel is unimportant in influencing anesthetic characteristics of spinal anesthesia and, it is difficult to predict accurately the onset time and the level which will be attained because there are wide individual variations in the spread of local anesthetics in subarachnoid spaee.

Effect of Position and Needle Bevel Direction on the Postdural Puncture Headache in Spinal Anesthesia / 대한마취과학회지

Postdural puncture headache is one of the well-known complications of spinal anesthesia. The sitting position is adequate for perineal and urologic operations, or when obesity makes difficult identification of midline anatomy in the lateral position. This study was done to see the effect of position (lateral or sitting position during spinal anesthesia), needle bevel direction (parallel or vertical to longitudinal dural fiber), and angle of approach (paramedian or midline) on the incidence, onset, location, severity of postdural puncture headache in the 160 patients underwent spinal anesthesia with 25-gauge Quincke needles. We observe the following results: 1) The total incidence of postdural puncture headache was 8.1%(13 cases). 2) The incidence of postdural puncture headache were 6%(lateral position), l0%(sitting position), 3%(parallel to longitudinal dural fiber), 11%(vertical to longitudinal dural fiber), 8%(paramedian approach) and 9%(midline approach). A significant increase in incidence was found with 25-gauge Quincke needles when the bevels were oriented so as to be vertical rather than parallel to the longitudinal dural fibers. 3) The onset of postdural puncture headache were within 3 days after spinal anesthesia in the almost cases (92.3%). 4) The location of postdural puncture headache were frontal(31%), occipital(15%), temporal(8%), and whole region(46%). 5) According to the duration of postdural puncture headache, two day headache was 31%, four day one was 15%, six day one was 15%, and over six day one was 38%. A significant increase in duration was found with sitting position when the bevels were oriented so as to bc vertical rather than parallel to the longitudinal dural fibers. 6) The treatments of postdural puncture headache were bed rest(20%), analgesics(54%), and epidural blood patch(31%). In conclusion, the significant increase in incidence and duration were found with 25-gauge Quincke needles when the bevels were oriented so as to be vertical rather than parallel to the longitudinal dural fibers.